PVMA Keystone Veterinarian Fall 2020 - 16

Veterinarians as
'Keystone' Professionals
in Future Pandemic
Prevention

By Andrew M. Hoffman, DVM,
DVSc, Diplomate ACVIM (Large
Animals)
The Gilbert S. Kahn Dean of
Veterinary Medicine, School of
Veterinary Medicine, University of
Pennsylvania

Whiplash from the pandemic
The pandemic has forced us to make a staggering number of
consequential decisions in a short period of time, a true wake
up call. A short-list includes decisions about how to best control
virus transmission, overcome mask shortages, shift to on-line
education and meetings, perform contact tracing, interface
with public health departments, enact symptom checks, test
employees for COVID-19, provide emotional support for fearful
/ anxious essential employees, implement telemedicine,
communicate to the public about the origin of COVID-19 and
the risk to pets, facilitate working from home, hold or attend
virtual graduations, manage research lab shutdowns or pivot
to COVID-19 investigations, balance workload for caregivers
and their co-workers, reckon and repair gender and racial
disparities, address financial exigencies during lockdown and
the surge in demand that followed, and in farm animal practice
and state diagnostic labs, keep up momentum to prevent
domestic and foreign disease outbreaks. This has, unequivocally
been a massive 'stress-test' and public health re-education
for veterinarians. It has brought on many existential questions
about our role as professionals in society, and how we might
contribute to the prevention of the next pandemic.

What just happened?
First, it must be acknowledged that what got us into this
pandemic has not been resolved. Not by a long shot. Let's break
it down (bit.ly/NakedScientists). While the exact mammalian
reservoir of SARS-CoV-2 is unknown, based on a high degree of
16 | Keystone Veterinarian

genetic homology, SARS-CoV-2 very likely arose from horseshoe
bats. Direct bat-to-human transmission occurred somewhere
(exact location unknown), possibly Southwest China. This
'spillover' occurred well in advance of the Wuhan outbreak-in
other words, humans infected with the virus traveled to Wuhan.
Very low genetic diversity of SARS-CoV-2 was found in the first
human cases (as well as animals in the wet market) in Wuhan,
showing that the virus was already adapted to humans, and
spreading the dominant strain of the virus. In contrast, SARSCoV in 2003 thought to be transmitted indirectly from bats to
humans by an intermediate host (Civet), although the WHO
states that this is still unknown.
So why do bat coronaviruses infect humans? First, there are
myriad opportunities: humans hunt bats for wildlife trade and
collect bat guano in their caves for use as fertilizer, and these
ancient mammals flutter around in the skies above wildlife and
domestic animal farms. There are growing opportunities for
human-bat interactions as human populations expand, lands are
fragmented, bats are stressed, and humans contact bats. This is
a classical One Health nightmare. Once the spillover from bats
to humans occurred, the virus spread in humans and underwent
numerous mutations. Coronaviruses mutate many times, as
fast as fleas, about once every 2 weeks. They do not behave
like killer viruses in Hollywood films that depict one 'monster
mutation' triggering a pandemic. Mutations slowly increase
infectivity or pathogenicity of coronaviruses, but most are
inconsequential. While it is important to support programs that
track mutations related to human adaptation and virulence, it is
equally if not more important to address the human dimension
that enabled the outbreak to explode to pandemic proportions.

It's the human dimension, stupid
Beyond the biology of transmission, human dimensions (i.e.,
knowledge, behaviors, and attitudes) drive the public health
response to outbreaks. The effectiveness of containment
relates to the alignment of leadership with public health
infrastructure, efficiency and transparency of public health
communications, global governance, scientific rigor, and public
http://www.bit.ly/NakedScientists
PVMA Keystone Veterinarian Fall 2020

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