Vet Talk

My Least Favorite Room in the Hospital: Isolation

A tiny patient behind glass is hard to monitor, even with cameras and baby monitors

February 10, 2020 (published)
Photo courtesy of Depositphotos

What with all the news media losing its collective mind lately about the Wuhan coronavirus, we thought it might be good to shine a light on what happens to veterinary patients with infectious diseases when they need to be hospitalized.

But first, I must climb up on my soapbox – grrrunt…there we go! – and make a declaration: influenza is way worse than the coronavirus. The flu kills about 36,000 Americans a year, so go get your dang flu shot.

Also, “stomach flu” is not a thing. Influenza is a respiratory disease.

OK, here we go.

The most common ailment that will land a pet in isolation is parvovirus. Since veterinary folks love cool shorthand lingo, parvovirus becomes “parvo” and isolation becomes “iso.” (Now that you know the lingo, you can hang out with the cool kids. You’re welk.)

I hate both of those things.

I hate parvo because it’s deadly to puppies, and it’s easily preventable through vaccination. I hate iso because it usually houses the tiniest and sickest of patients in a place where they are prone to getting a bit less than the care and monitoring they need.

The parvo virus attacks the lining of the intestine, creating massive vomiting and diarrhea, and it also attacks the bone marrow, destroying the cells necessary to fight the virus. It’s a sneaky, vicious little bug. It’s also very, very contagious and can last for a long time in the environment. Since vet hospitals are busy places, you can see how a puppy with parvo can easily transmit the virus to, say, a puppy that was just in for a new puppy visit. Even if we do the best we can to clean up after the parvo puppy (mopping the lobby and spraying the exam room with bleach), there’s always the possibility that the healthy but soon-to-be not healthy puppy sniffed or licked just the wrong spot on the lawn outside the clinic where the parvo puppy was. It’s that infectious.

When a puppy with parvo is diagnosed, they’re usually dehydrated and very ill, often needing intensive care and monitoring. But, when faced with a desperately sick parvo puppy, we don’t want to expose other hospitalized patients to the virus. Enter the isolation room.

Isolation, in theory, is a mini hospital-within-a-hospital: a separate room with its own monitoring equipment and supplies of medicine, laundry and fluids. The reality can sometimes be a little more spartan. It doesn’t make economic sense to have a whole separate area stocked with supplies that may not be used before they expire and equipment gathering dust. Some hospitals see lots of parvo, while others may only treat a case every once in a great while. Also, a veterinary ICU is a place where I like to be able to touch and feel my patients. A tiny patient behind glass is hard to monitor, even with cameras and baby monitors.

Parvo puppies take lots of monitoring and cleanup. They often have profuse vomiting and diarrhea, and can need cleanup several times an hour. Cleanup that involves materials absolutely loaded with infectious agents. Because vet hospitals have to run efficiently, and often on a tight budget, it’s not feasible to take a staff member off the floor to stay in isolation; they have to come in, do what needs to be done, and go back and treat other patients. To prevent spreading parvo to other dogs (cats, luckily, can’t get canine parvo, nor can people) anyone going into isolation has to don protective outerwear, usually consisting of a paper gown, plastic booties and gloves. They often look like a version of the brave folks fighting the Ebola breakout a few years back.

Imagine getting all that getup on and off each and every time you have to go into isolation. And imagine a poor little puppy outputting what seems like several times its weight in bodily effluents every few minutes.

Another crisis comes up when you have another patient who needs to stay in the isolation room, but they don’t have parvo. Even if its cleaned and cleaned thoroughly after a parvo patient goes home, there’s always the possibility that some remnants of the virus are lingering. So, putting a non-parvo dog in isolation runs the risk that they’ll be exposed to parvo in addition to whatever put them there to begin with. This risk goes up exponentially if they both have to be in isolation at the same time (in separate cages, of course). I was lucky enough, while on faculty at the Purdue College of Veterinary Medicine, to have two separate isolation rooms: one for gastrointestinal diseases like parvo, and one for respiratory cases, like pneumonia.

Kennel cough is also very infectious, and sometimes evolves into pneumonia requiring hospitalization. I have had cases (very few, thankfully) of a dog being hospitalized with pneumonia that picks up parvo while hospitalized. It’s not a mark of a bad hospital, or laziness; it’s just one of the risks of being hospitalized. There’s even a medical term for picking up something in the hospital while you’re there; these are called nosocomial diseases or hospital-acquired infections. It happens in human hospitals too; C. diff is a common one there. No matter the level of hygiene or dedication to cleanliness, anytime sick patients congregate under one roof, there will always be the risk of someone catching something in the hospital.

Avoiding parvo is not only going to save a puppy from having to go into iso, but also from having it. Parvo is not something you'd ever want to see your puppy go through, plus its treatment costs real money. Get the dang vaccines at the right time but also don't put your puppy on the ground in any area where other dogs go who may not be vaccinated. The puppy can get parvo even if the feces containing it is no longer there because the virus is still on the grass, on the sidewalk, on the floor, etc. Carry puppies rather than put them on the floor when going into the veterinary hospital for the 8- and 12-week vaccines, and don't let them run around in the immediate parking area/dog walking area around the hospital.

The real trick here is that this non-vaccinated time is part of the critical period of the age 6-16 weeks for the puppy's socialization and learning. It's a Catch-22: you don't want the puppy to be exposed to stuff before the vaccinations are effective, and you don't want to put off socializing. What puppies see during this phase they will see as normal for the rest of their lives: bicycles, skateboards, children, crying babies, men with beards and baseball caps, umbrellas, headsets, etc. Anything new the puppy encounters past the age of 16 weeks may be seen as scary for the rest of his life. To satisfy both needs, arrange play dates and meet 'n greets with people and children whose dogs you know are vaccinated and good with other dogs. You can go to other people's houses, take rides in the car, take a bath, meet the neighbor's dogs, learn how to get their nails trimmed, and so on. They need to be 16 weeks and fully vaccinated before their first obedience class or puppy kindergarten.

So, how can you lessen the risks of your puppy contacting parvo, or some other infectious disease and have your poor pup end up sad and lonely in iso?

  1. As soon as you get a new puppy or kitten: See your veterinarian and listen. They hold the keys to isolation-avoidance and better health. These keys are knowledge and vaccination. Puppies should be vaccinated against parvo every 2-4 weeks starting about 6-8 weeks of age and continuing until 4-6 months old. Some breeds, like Rottweilers and pit bulls, are more susceptible to parvo, and might need earlier or more frequent vaccines.

  2. Don’t walk your less than 12-week-old puppy or take him out in public. This includes the dog park and basically anywhere where you can see the sky. Keep them safe at home (unless you’re at the vet, that is). The world is crawling with viruses and your new puppy isn’t ready to fight them off just yet.

Isolation isn’t a perfect system for sick pups and cats with infectious diseases, but it’s the best we can do. Prevention is a whole lot better than having them stay in a place that means it may be difficult for them to get the care they need when they need it most. Luckily, the vast majority of parvo puppies get better with appropriate care. I just tend to do a lot of hand-wringing and worrying while I’m caring for them in my least favorite room.


VIN News Service commentaries are opinion pieces presenting insights, personal experiences and/or perspectives on topical issues by members of the veterinary community. To submit a commentary for consideration, email news@vin.com.



Information and opinions expressed in letters to the editor are those of the author and are independent of the VIN News Service. Letters may be edited for style. We do not verify their content for accuracy.




 
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