No veterinarians (yet) on the Italian covid-19 scientific committeeBMJ 2021; 374 doi: https://doi.org/10.1136/bmj.n1719 (Published 14 July 2021) Cite this as: BMJ 2021;374:n1719
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I would like to elaborate further on the Letter ‘No veterinarians (yet) on the Italian COVID-19 scientific committee’, and highlight the importance in a One Health perspective of the veterinary experience in effectively tackling large animal contagious diseases outbreaks. Notably, the author is concerned about the general attitude to downplay or neglect the contributions of public health veterinarians (e.g. epidemiologists, virologists) to the national COVID-19 multidisciplinary task-forces, which somehow reflects the dichotomy between the veterinary and human medical professions, as well as the existence of barriers to reach synergies and methodological convergence. Indeed, the management of COVID-19, which recognizes an animal source, and potential animal routes of infection transmission to humans, lies in complex interconnections among animal, human and environment, and as such bluntly requires the integration of the related disciplines and the full consideration to the One Health Berlin Principles of 2019. Taming COVID-19 pandemic, and predicting/preventing future pandemics are of paramount importance to strengthen the surveillance system. Despite the purpose of both human and veterinary public health is the reduction of pathogen circulation and transmission of infection, they have a different epidemiological approach: the former has traditionally focused on the treatment of individual patients, with measures rarely directed to the entire population, the latter, due to significant economic threats of major epizootic diseases, is based on a control strategy of the whole population’s health , albeit with limited public health risks. To understand the scale and dynamics of the infectious diseases , and to reduce disease prevalence, veterinarians carry out surveillance activities by collecting data in the field through tracing and random survey (e.g., serological tests) of samples representative of the population, including asymptomatic ones. Several software programs provide support to calculate appropriate sample sizes, to estimate the true prevalence, or to reach the level of ‘freedom’ from disease of a population.  Generally, at the outset of the epidemic the main purpose is to track all cases in an attempt at early eradication of the infectious agent from a given animal population. Afterward, when the pathogen largely spread and reaches a high prevalence, the main targets are the isolation of the infected areas from the free ones, so as to limit movements between the two populations, and the estimate of the true prevalence of the infection in the former. The repeated estimate of the prevalence within the infected areas, makes it possible to measure the reduction of the incidence and to forecast or model what will transpire in the future. The likely endemic status can be managed with minimal losses and possibly immune protection of the population through vaccination plans and adoption of biosecurity measures. These concepts can also be translated into human medicine vis a vis the understanding of the potential impact of COVID-19 pandemic or other pandemics. Generally, with a very low prevalence at the outset of a human epidemic, the syndromic and/or risk-based surveillances could be the main options to limit further spread. Once the infection is widely spread, the clinical surveillance is unable to effectively track, test and manage all infected individuals, including asymptomatic and mild cases that contribute to further transmission of the pathogen with the results of late alarms over high prevalence of infected people and related higher risk of hospitalization. With the aim of assessing COVID-19 outbreaks consistently and objectively and have a positive impact on the management of long-term epidemic, a basic veterinary protocol based on real-time active random surveillance has been proposed.  The protocol by ad hoc calculation of representative and statistically designed sample size, allows to ascertain the true prevalence of infected people corrected for the test’s error, or even antibody positive individuals. The protocol uses also the concept of “freedom” from disease, which is the confidence that a disease is absent in a population, if no cases are found, or if present, it is below a decided hypothetical cut-off prevalence. This concept has more recently been applied in public health . It goes without saying that the choice of testing type is central in the surveillance strategy for both human and animal infections. For instance, the molecular (PCR) for COVID-19 due to a sensitivity higher than the rapid antigen tests should be deployed early in the epidemic when the infection rates and prevalence are low, to support contact tracing, testing and isolation. As the viral circulation increases and it is no longer feasible to trace individual clusters, the repeated screening of large population groups with the rapid test (e.g. bi-weekly basis or twice on the same subject every 2-3 days) combines the advantages of getting timely results at low cost, identify the most contagious cases (due to high specificity) and allows to monitor the effectiveness of control measures . The low sensitivity of the rapid test is mitigated by the high number of subjects tested. However the recently developed rapid immunofluorescence tests with microfluidic reading (third generation) are at least one hundred times more sensitive and are able to qualitatively detect the SARS-CoV-2 core-capsid protein with results comparable to RT-PCR assays, especially if used within the first week of infection. For the above considerations, the proposed veterinary protocol based on repeated representative random samplings appears as a potential solution to allow reliable snapshots of COVID-19 epidemics, predict and monitor the epidemic curve, prevent straining of the healthcare system, and efficiently inform decisions on when control measures can be lifted. Its main limitations for the application to human health are the extensive participation of the population, and social, logistic, legal and economical impediments. However is fit-for-purpose and adaptable across different capacities and realities.
 Foddai, J. Lubroth, J. Ellis-Iversen, Base protocol for real time active random surveillance of coronavirus disease (COVID-19) - Adapting veterinary methodology to public health, One Health 9 (2020 Mar 28), 100129, https://doi. org/10.1016/j.onehlt.2020.100129.
 Martin PAJ, Cameron AR, Barfod K, Sergeant ESG, Greiner M, 2007. Demonstrating freedom from disease using multiple complex data sources 2: Case study Classical swine fever in Denmark. Prev. Vet. Med. 79; 98–115. https://doi.org/10.1016/j.prevetmed.2006.09.007
Competing interests: No competing interests
I support the comments of the author above. In light of the fact that the G7 and G20 now both recognize the need for Implementation of a One Health framework to prevent the occurrence of future pandemics (1), it is very surprising that veterinarians are not called upon to provide incisive input into policy formulations required for One Health implementation.
As is stated in the reference below (2), "Our most likely threat comes not from us, but 75% of it arises unintentionally from animals....... In sum, we need a One Health vision, policy, program, and resources for all. The G7 meeting provides a crucial step in doing so." Let us hope that reconsideration will be given to positioning the veterinarian with their expertise in One Health, on the platform for ensuring that we are serious about preventing the occurrence of the next global pandemic.
2.George Lueddeke - Rohini Roopnarine - Richard Seifman. G20 Summit: Make One Health a Reality. Impakter 2021 Jul 23
Competing interests: No competing interests