One Health Toolkit for Health Officials Managing Animals with SARS-CoV-2

Summary of Recent Changes

Key Points

• Most animals with SARS-CoV-2, the virus that causes COVID-19, became infected after close contact with people with COVID-19. All animals infected to date are mammals.
• There is no evidence that animals play a significant role in spreading SARS-CoV-2 to people. Infected mammals spreading the virus to people during close contact is rare.
• This toolkit is for health officials managing cases of zoonotic SARS-CoV-2 infections within their jurisdiction, including state public health veterinarians, state animal health officials, zoonotic disease epidemiologists, and wildlife health specialists. State, tribal, local, and territorial (STLT) jurisdictions may have their own specific requirements for management.
• Public health officials, animal health officials, veterinarians, and wildlife health specialists should collaborate using a One Health approach when deciding to test an animal or conduct epidemiologic investigations for animals with confirmed SARS-CoV-2 infection. Early coordination with federal animal and public health partners is encouraged.
• STLT officials managing SARS-CoV-2 infections in animals should be informed of all animals that are being tested for SARS-CoV-2 within their jurisdiction. This is especially important if animals are positive for SARS-CoV-2 to ensure timely and coordinated response efforts when indicated.

Prepare for SARS-CoV-2 Test-Positive Animals

STLT public health and animal health officials may choose to apply this guidance to companion animals or other animals suspected to be infected with SARS-CoV-2, such as livestock or production animals, animals in zoos, rehabilitation centers, sanctuaries and aquariums, or free-ranging wildlife, as appropriate.

Clinical Signs in Animals

Like people, some animals with SARS-CoV-2 infection are asymptomatic, while others may present with a combination of respiratory, gastrointestinal, and non-specific illness. Based on naturally occurring infection in animals to date, clinical signs likely to be consistent with SARS-CoV-2 infection in mammals include:

• Fever
• Coughing
• Difficulty breathing or shortness of breath
• Sneezing
• Nasal discharge
• Ocular discharge
• Lethargy
• Vomiting
• Diarrhea

Veterinary facilities that are able to care for animals diagnosed with SARS-CoV-2 infection should have policies that align with the NASPHV Compendium of Veterinary Standard Precautions for Zoonotic Disease Prevention in Veterinary Personnel and should be familiar with the American Veterinary Medical Association (AVMA) recommendations for Delivering veterinary services, which include infection prevention and control best practices.

Establish Flow of Information

Developing relationships and close coordination between STLT health officials and local partners that may detect SARS-CoV-2 infection in animals, including veterinarians, researchers, diagnosticians, and animal caretakers, is important for early detection and response to an animal that is suspected or known to be infected with SARS-CoV-2. Ideally, STLT health officials can provide local partners with guidelines and key messages to discuss with the owner(s) or animal caretaker(s) (see example: What You Need to Know About COVID-19 and Pets).

STLT public health and animal health officials, including the state public health veterinarian and the state animal health official where applicable, should be informed of all animals that are being tested for or are diagnosed with SARS-CoV-2 infection within their jurisdiction.

STLT health officials are encouraged to make plans to conduct epidemiologic investigations when an animal with SARS-CoV-2 infection is first identified, even presumptively. STLT health officials should review local and state regulations regarding animal disease reporting and consider implementing SARS-CoV-2 reporting requirements where possible.

Testing Animals for SARS-CoV-2

Veterinarians or others testing for SARS-CoV-2 in animal populations, including those doing so for research or surveillance, should consider other common causes of illness when evaluating animals for SARS-CoV-2 infection.

The decision to test an animal, including companion animals, livestock or production animals, animals in zoos, rehabilitation centers, sanctuaries and aquariums, or free-ranging wildlife, should be made collaboratively using a One Health approach. Veterinarians  should contact their designated public health and animal health officials within their jurisdiction, such as state public health veterinarians and/or state animal health officials, who will include federal public health and animal health officials, as well as wildlife health officials where free-living wildlife are concerned.

Veterinarians should report any animal that tests positive for SARS-CoV-2 to these same health officials.

Animal testing for SARS-CoV-2 is available at veterinary diagnostic laboratories, including members of USDA’s National Animal Health Laboratory Network.

CDC and USDA should always be notified of presumptive positive test results. Early communication and collaboration across all relevant One Health partners is encouraged.

Confirmatory testing through USDA’s NVSL is required for all animals except domestic cats and dogs from STLT jurisdictions that have previously confirmed SARS-CoV-2 in cats and dogs. Confirmatory testing is conducted to monitor the virus and to fulfill international reporting requirements based upon the USDA case definition. Because virus monitoring efforts remain a priority, NVSL continues to support sequencing of all cat or dog samples that meet testing criteria.

USDA is responsible for confirming and reporting any new animal species that test positive for SARS-CoV-2 in the United States to the World Organisation for Animal Health. USDA also uploads sequence information to public databases, and posts all confirmed cases of SARS-CoV-2 infection on their public dashboard: Confirmed Cases of SARS-CoV-2 in Animals in the United States.

Guidance for SARS-CoV-2 Testing in Animals

Veterinarians should identify if an animal has been exposed to SARS-CoV-2 and has clinical signs consistent with SARS-CoV-2 infection. Table 1 describes epidemiologic risk factors and clinical features that can help guide decisions regarding animal testing.

Table 1: When Animals Should be Tested for SARS-CoV-2

This table is not intended to be prescriptive but may help guide testing priorities. Animals that meet one or more of the following criteria (A-E) are recommended for testing. Animals must meet both the Epidemiological Risk AND Clinical Features in the criteria row to be recommended for testing. Some clinical features are applicable to multiple rows.

¹ The International Union for the Conservation of Nature (IUCN) governs an assessment of the status of species ranging from “critically endangered” to “least concern”: https://www.iucnredlist.org/ 

Biological Sample Collection and Testing

Preferred samples for virus nucleic acid testing and isolating live virus include nasal swabs, oropharyngeal swabs, and rectal swabs. Samples may also be taken from internal organs collected post-mortem, or a fecal sample may be used in situations where direct sampling is not possible or may compromise animal welfare. Serum can be collected for antibody testing where available, although consideration for positives in vaccinated animal species, including farmed mink and zoo animals, should be considered. Contact the laboratory accepting diagnostic samples in advance for instructions on proper sample collection, storage, and transport. Always use appropriate personal protective equipment [PDF – 2 pages] when collecting samples.

Laboratories testing for SARS-CoV-2 should have established protocols and conduct testing under appropriate biosafety conditions. There are currently several molecular and serologic assays in use at veterinary diagnostic laboratories that are useful across multiple susceptible animal species.

Refer to USDA’s Testing and Reporting page for sample collection, transport, storage, and test result reporting for confirmatory testing.

Repeat Testing of a SARS-CoV-2 Test-Positive Animal

Repeat testing of animals for SARS-CoV-2 may be appropriate in some circumstances, such as determining duration of virus shedding in an animal for scientific or biosecurity purposes, but is not typically necessary. As with initial testing, follow-up testing should be conducted in coordination with One Health partners.

Additional Considerations for Testing Free-Ranging North American Wildlife

Some species of wildlife can be infected with SARS-CoV-2, and there is evidence that some free-ranging wildlife have been infected in the United States. Testing may be useful for improving understanding of the epidemiology of the virus in wildlife populations and in applying necessary management actions. These recommendations may also be applied to wildlife in human care for research or rehabilitation as relevant.

Wildlife health specialists or others conducting surveillance and research in wildlife consider other causes of morbidity and mortality when deciding whether to test animals for SARS-CoV-2.

Note: Testing of wildlife for research purposes is beyond the scope of this document.  Please refer to the WOAH Considerations on monitoring SARS-CoV-2 in animals for additional information.

When to Consider Testing Wildlife

Guidance provided in Table 1 is applicable to testing free-ranging wildlife. Additional scenarios to consider testing wildlife include when:

1. Conducting epidemiologic case investigations where wildlife are known or suspected to be associated with spread of SARS-CoV-2 to or from people or other species.
2. Opportunistic specimens are available to detect the presence of SARS-CoV-2 in wildlife populations, such as in hunted and/or trapped animals sampled for other purposes, or animals that are found dead or are euthanized.
3. Investigating threatened and endangered species or species of special concern to prevent SARS-CoV-2 infection spreading in endangered and vulnerable populations

Managing SARS-CoV-2 Test-Positive Animals

When an animal tests positive for SARS-CoV-2, a discussion regarding care should occur between the STLT health official(s) and the treating veterinarian. In most instances, animals with SARS-CoV-2 infection are asymptomatic or have mild, self-limiting illness. If the animal is healthy or has mild illness, it can undergo isolation at home or in its respective housing facility.

Considerations in this determination of care should include:

• Severity and complexity of illness in the animal
• Animal welfare
• Risk of severe illness in the owner or caretaker, such as animals owned by or cared for by older adults or those with serious underlying medical conditions
• COVID-19 vaccination status of the owner or caretaker, veterinarian, and staff
• Availability and ability of the veterinarian and their staff to safely provide in-patient care and treatment for the animal
• In companion animals:
  • Whether the veterinarian can provide telemedicine consultation so the animal can be examined and treated remotely;
  • Where telemedicine and in-patient care are not possible, whether it is safe for the veterinarian to provide in-home care services; and
  • Emotional wellbeing and mental health of the companion animal’s owners.

Epidemiologic Investigation of SARS-CoV-2 Test-Positive Animals

The risk of animals spreading SARS-CoV-2 to people is low. However, understanding the epidemiologic context of a positive animal, including human-animal interactions, is important to furthering our understanding of how this virus may circulate and spread under natural conditions. This understanding is necessary to inform public health and animal health measures.

When an animal tests positive for SARS-CoV-2, an epidemiologic investigation should be conducted. Ideally, epidemiologic investigations should be jointly conducted by all relevant STLT and federal One Health partners. Investigation should begin when the case is identified (e.g., an animal is suspected of SARS-CoV-2 infection or tests positive for SARS-CoV-2) – do not wait for presumptive or confirmatory test results.

The investigation should include:

• Description of the diagnostic and clinical factors used to make the case determination;
• Assessment of risk factors in the test-positive animal, including potential source of infection;
• Evaluation of potentially exposed people; and
• Evaluation of potentially exposed animals.

CDC’s One Health Case Investigation Form for Animals with SARS-CoV-2 is a standardized data collection tool for animal investigations that can be completed through HHSProtect. Please contact CDC’s One Health Office for additional guidance and resources on conducting an epidemiologic investigation.

There are no additional precautions recommended for people or animals with potential contact with test-positive animals, aside from animal caretakers. Identifying potential contacts (human or animal) and documenting their health status could help inform the public health risk of these zoonotic SARS-CoV-2 events. Should the risk associated with test-positive animal contacts change, additional precautions may be indicated.

When a SARS-CoV-2 Test-Positive Animal Requires Hospitalization or Veterinary Care

Animals that test positive for SARS-CoV-2 and require veterinary treatment or hospitalization may fall into one of several categories:

1. Receiving routine medical care (e.g., vaccinations or boosters)
2. Receiving medical care due to pre-existing conditions (e.g., ongoing chemotherapy treatment, monitoring for control of diabetes, worsening of an existing condition)
3. Obtaining care for physical injuries and other health conditions unrelated to SARS-CoV-2 (e.g., abscesses, lacerations, fractures)
4. Receiving medical care believed to be associated with SARS-CoV-2 infection.

For each category, an evaluation of risk to the veterinary staff should be balanced with medical necessity to make determinations for treatment plans. When safe to do so, non-urgent care should be postponed until the animal is cleared to return to normal activity. Because the risk of animals spreading SARS-CoV-2 to people is low, necessary veterinary care for animals that test positive for SARS-CoV-2 should not be withheld. Rather, biosecurity measures should be enforced, and appropriate PPE [PDF – 2 pages] should be used when administering care.

In the event a sick, SARS-CoV-2 test-positive animal requires transport to a veterinary facility for medical care, follow best practices as outlined below.

For companion animal transport:

• Under ideal conditions, the animal’s owner or caretaker should transport the animal in a private vehicle to the veterinary facility.
• Owners or caretakers with suspected or confirmed COVID-19 should not transport the animal to a veterinary facility. If an owner or caretaker has COVID-19 or is otherwise unable to transport the animal to the veterinary facility in a private vehicle, they should:
  • Arrange for a friend or family member from outside the animal’s household to bring the animal to the veterinary facility.
  • Transport the animal for curbside pickup if available, while wearing a mask. The caretaker should not enter the premises. A healthy family member can also transport the animal while wearing a mask.

For animal groups other than companion animals that require transport:

• Animal handlers should be trained and prepared to implement biosafety procedures for infectious diseases when transporting animals. These should include infection prevention measures and use of appropriate PPE.
• As few animal handlers as is safe should come into direct contact with the animal.
• Animals should be placed in a secure carrier. Where possible, animals should be transported in species-appropriate, single-use cardboard carriers or hard-shelled animal carriers that can be cleaned and disinfected with an EPA-registered disinfectant after transport.
  • Ensure cleaning and disinfection guidelines are followed, and that workers performing these duties are protected from chemical hazards.

• Only the animal and necessary equipment should be transported.
• Animal transport should occur in a vehicle that has an area that can be covered and cleaned and disinfected and is closed off from driver when possible.

There is no evidence that SARS-CoV-2 can spread to people from the skin, fur, or hair of pets. Therefore, additional measures to disinfect the animal, such as bathing, are not necessary.

Treating a Sick, SARS-CoV-2 Test-Positive Animal

The infection prevention and control best practices involved in caring for a test-positive animal are likely to be regularly implemented at most veterinary facilities regardless of ongoing outbreaks of infectious disease. However, these are especially important when managing zoonotic infectious diseases such as COVID-19. Facilities should have:

• A separate, designated area where SARS-CoV-2 positive animals can be isolated from the rest of the patient population.
  • A planned route for moving the animal from the transport vehicle to an isolation space.
  • Where possible, only animals that test positive for SARS-CoV-2 and are being evaluated and treated should be housed in this isolation space.
  • Space for veterinary personnel to don and doff PPE prior to entering the room, and immediately upon exiting. Alcohol-based hand rub, or a sink with soap and water should be easily accessible.
• Availability of an adequate amount of appropriate PPE for the projected duration of hospitalization.
• Plans for limiting the number of veterinary personnel that have contact with the animal.
• Logs of all personnel that have had contact with the animal for occupational health monitoring.
  • Animal caretaker logs should include names of people interacting with the animal, date, and time the animal was attended, and the type of care provided (e.g., feeding, cleaning, medications, body temperature, pulse rate, respiration rate, procedure etc.).
• Ability to clean and disinfect the isolation area with EPA-registered disinfectants.
• Plans for safely exercising and enriching animals, as needed.
  • Dogs may be walked on leash in an area that is ideally separated from areas used by other people or animals.
• Plans for safe handling and disposal of animal waste until the animal is cleared to return to normal activity.
• Rules to limit or prohibit visitors and additional human traffic in the area(s) where sick, test-positive companion animals are being housed and treated.

PPE Guidelines

It is important that veterinary and animal care personnel be trained on the use of PPE, including how to properly don (put on) and doff (take off) PPE.

Veterinarians, their staff and other animal caretakers should review the concepts in NASPHV Compendium of Veterinary Standard Precautions for Zoonotic Disease Prevention in Veterinary Personnel. This document outlines routine infection prevention practices designed to minimize transmission of zoonotic pathogens from animals to veterinary personnel regardless of ongoing outbreaks of infectious diseases but are especially important for zoonotic diseases such as COVID-19.

¹ Reusable (i.e., washable) gowns are typically made of polyester or polyester-cotton fabrics. Gowns of these fabrics can be safely laundered according to routine procedures and reused.

²Respiratory protection that is at least as protective as a fit-tested NIOSH-certified disposable N95 filtering facepiece respirator is best practice. However, if an N95 or other respirator is not available, use a combination of a surgical mask and a full-face shield.

• Please see Proper N95 Respirator Use for Respiratory Protection Preparedness
• Respirator use should be in the context of a complete respiratory protection program in accordance with OSHA Respiratory Protection standard (29 CFR 1910.134), which includes medical evaluations, training, and fit testing.

³Aerosol-generating procedures, such as suction or bronchoscopy, should be avoided, if possible, on any animals that are test-positive for SARS-CoV-2.

When a SARS-CoV-2 Test-Positive Animal can be Isolated at Home

A protocol for isolation applies to all animals that are test-positive and do not require hospitalization. This protocol involves daily monitoring, isolation recommendations, and movement restrictions.

Daily Monitoring

Animals confirmed positive for SARS-CoV-2 that can be isolated should be monitored daily by the caretaker for signs of illness.

If a SARS-CoV-2 test-positive animal develops new or worsening clinical signs, the treating veterinarian should be informed to develop a treatment plan (see: When a SARS-CoV-2 test-positive animal requires hospitalization or veterinary care). The treating veterinarian should also inform the responsible health officials in their jurisdiction, such as the state public health veterinarian and state animal health official of the animal’s status, whereabouts, and treatment/care plan.

Isolation Recommendations

For the duration of isolation, the animal should stay in a designated “sick room” or enclosure if possible, or otherwise be separated from people and other animals. This is the same way a COVID-19 positive person would separate from others in their household.

Regardless of whether the caretaker has had suspected or confirmed COVID-19, caretakers of an isolated animal should protect themselves and follow CDC’s recommendations for homes and other spaces the animal has encountered.

Where possible, people with an increased risk of severe illness should avoid caring for animals with SARS-CoV-2 infection.

Movement restrictions of SARS-CoV-2 infected animal

Below are activities that should be avoided until the animal is cleared to return to normal activities:

For companion animals:

• Walks in public or shared spaces (except when unavoidable for elimination);
• Visits to veterinary facilities, without prior consultation with the treating veterinarian;
• Visits to human healthcare facilities, long-term care facilities, schools, or daycares;
• Visits to parks (including dog parks), markets, or other gatherings such as festivals;
• Visits to the groomer, including mobile grooming salons;
• Visits to pet daycares or boarding facilities;
• Serving as a therapy animal; and
• Other outings such as playdates, hikes, or visiting other homes or stores.

For other animals under human care, the following activities should be avoided until the animal is cleared:

• Visits to other facilities, exhibits, or events;
• Interactive shows or performances;
• Activities that require close contact with people such as training;
• Movement between multiple enclosures or spaces;
• Interaction with other animals (to the extent possible).

Considerations for Service Animals

In the event that a service animal tests positive for SARS-CoV-2, the recommendations for monitoring, isolation, and movement restrictions should be handled based on the discretion of the attending veterinarian and the animal handler, in consultation with the responsible health official.

In accordance with the Americans with Disabilities Act, service animals must be permitted to remain with their handlers.

Considerations for Farmed Mink and Other Farmed Mustelids

In farmed mink and other mustelids that test positive for SARS-CoV-2, refer to Guidance to Prevent Respiratory Viruses like SARS-CoV-2 and Influenza on Mink Farms [PDF – 12 pages].

Ending Management of SARS-CoV-2 Test-Positive Animals

Test-positive animals may resume normal activities if these conditions are met:

• The animal has not shown clinical signs consistent with SARS-CoV-2 infection for at least 72 hours without medical management;

AND 

one of the following conditions:

• It has been at least 14 days since their last positive test from a lab that uses a validated SARS-CoV-2 RT-PCR diagnostic assay;

OR

• Oral and/or nasal samples collected at follow-up are negative by a validated SARS-CoV-2 RT PCR diagnostic assay.

Definitions

SARS-CoV-2: The scientific name for the virus that causes coronavirus disease 2019 (COVID-19) in people. Because we are addressing the virus itself in the context of animal health, we refer to it as SARS-CoV-2.

Companion animals: Refers to mammalian companion animals, such as dogs, cats, small mammal pets including ferrets and hamsters, and others that live in a home or on the premises of a home, including service animals.

Animals in zoos rehabilitations, sanctuaries and aquariums: Refers to exotic or native mammalian species under human care.

Free-ranging wildlife: Refers to non-captive wild animals present throughout the United States.

Test-positive animal: Refers to animals with a presumptive or confirmed diagnosis of SARS-CoV-2 [740 KB, 2 pages].

State public health veterinarian: Refers to the state public health veterinarian (SPHV) or designated public health official responsible for handling animal-related public health issues in their jurisdiction. Some jurisdictions do not have state public health veterinarians, or geographic, resource, or time limitations may prevent them from managing a situation involving an animal.

State animal health official: Refers to the state animal health official responsible for animal disease control and eradication programs in their jurisdiction. Where possible, coordination, information-sharing, and decision-making between relevant partners, including the state public health veterinarian and state animal health official, is recommended.