#acird

How a global pandemic affected awareness of canine respiratory disease

It's been about four years since the CDC confirmed the first case of COVID-19 in the U.S. on January 20, 2020. Less than two months after that, it was declared a global pandemic as the novel coronavirus SARS-CoV-2 had spread between 114 countries and lead to over 4,000 deaths.

Fortunately, vaccines became available in record time by the end of that same year, which then led to lower rates of hospitalization and fatalities. Yet, COVID-19 has not completely gone away and rather continues to mutate, with different variants now circulating in every country, affecting even those who are vaccinated.

Similarly, dogs who are up-to-date on all their vaccines may still sometimes develop "kennel cough". Although it is generally a self-limiting disease, there is a wide range of viruses and bacteria associated with Canine Infectious Respiratory Disease Complex (CIRDC), in which concurrent infection from multiple pathogens may be identified.

Symptoms of CIRDC may include:

Frequent, dry "honking" cough

Gagging or retching

Expectoration of mucus

Sneezing

Nasal and/or ocular discharge

Mild fever

Decreased energy and/or appetite

Disease may be transmitted through the inhalation of spores, or direct contact with infected dogs or contaminated surfaces. Dogs who are kept in close confinement, while under heightened stress, in poorly-ventilated areas with increased humidity (i.e. boarding/daycare facilities, grooming salons, shelters) are especially at risk for infection.

With an apparent rise in cases requiring hospitalization or more aggressive treatment, this type of severe kennel cough is now being referred to as atypical Canine Infectious Respiratory Disease (aCIRD), and is characterized by:

Mild-moderate inflammation of the trachea and bronchial airways for a prolonged duration (lasting 6 to 8 weeks or longer)

Chronic pneumonia or acute pneumonia that rapidly becomes severe leading to poor outcomes

Minimal or no response to antibiotic therapy

While aCIRD has been observed in multiple states within the U.S. in the last several months, the exact number of cases remains unknown as requirements for veterinarians to report aCIRD to their state animal health officials vary. Moreover, some veterinary clinics may actually have been treating cases like these perhaps over the last couple of years rather than just the past several months (mine included).

But, because there is no official health surveillance system available for pets the way there is for humans, it is hard to rule out whether or not these aCIRD cases are directly correlated to the same pathogen(s) - or even a new, unidentified one (or more).

Not to mention, without pet health insurance, many dog owners will often decline diagnostics due to cost - which removes the possibility for identifying infectious pathogens altogether. On the other hand, respiratory PCR tests that are performed may potentially be done too late, or use less diagnostic samples (i.e. nasal swab vs. transtracheal/bronchoalveolar wash). In other words, just because a dog comes back negative for all the pathogens listed on a canine respiratory PCR panel, does not necessarily mean they were NOT infected with by one of those bugs, nor indicate that a novel pathogen is involved.

According to Cornell University's Animal Health Diagnostic Center, PCR testing is recommended "during the acute phase of disease (ideally during the first week of clinical disease) and prior to initiating treatment.  Delaying diagnostics may result in negative test results, as detection of some viruses may be inhibited by a rapid immune response, and antibiotic treatment may impede bacterial growth and detection."

Yet, despite the lack of data, COVID-19 has left many people more vigilant over respiratory illness - both in humans and their pets. This has led to more widespread media coverage of aCIRD being portrayed as a "mystery dog illness", further inciting the idea of an unknown novel pathogen.

Many "pet experts" and social media influencers on TikTok and Instagram were quick to issue their own warnings of this mystery dog illness, while some even claimed their dog had the “rare” disease - possibly giving the appearance of a nationwide outbreak that didn't even exist.

Yet, what we don't know is...

how many aCIRD cases there truly have been

how many cases actually have gone through the appropriate (and timely) diagnostics to rule out any common and identifiable pathogens, and

whether or not all these reported aCIRD cases are even connected.

What we do know, however, is...

There has been an exponential rise in pet ownership since the pandemic. More pets = more pet illness reported. According to a 2019 ASPCA survey, about 1 out of every 5 American households acquired a new pet since the pandemic. "Looking back at the decade prior to the pandemic, there was a 4.7% growth in American pet ownership from 2009-2019. In comparison, that growth rate more than doubled to 9.77% growth in American pet ownership from 2020-2022."

Veterinary care has been disrupted in the last few years. Many businesses were forced to close or limit their hours, including non-emergency vet clinics. This caused many owners to have more difficulty with scheduling appointments with their primary vet, or rather some may have experienced financial constraints after being laid off. As a result, decreases in timely vaccination and wellness checks occurred, as well as a decline in owners’ willingness or capability to afford diagnostics/treatment for their sick pets. Additionally, many pet owners also previously expressed fear of getting COVID-19 from vet clinic staff themselves during the height of the pandemic. This may have influenced owners' decisions in bringing in their sick pets sooner than later, possibly allowing milder forms of kennel cough to develop into pneumonia.

Many pet owners are also (ironically) hesitant to vaccinate their dogs. Common misperception and mistrust surrounding COVID-19 and other human vaccines have spilled over to pet vaccines. Out of 2,200 pet owners surveyed by Boston University School of Public Health, "nearly 40 percent of respondents believed that canine vaccines are unsafe, more than 20 percent believed these vaccines are ineffective, and 30 percent considered them to be medically unnecessary. About 37 percent of dog owners also believed that canine vaccination could cause their dogs to develop autism, even though there is no scientific data that validates this risk for animals or humans."

Changes in human activity since the pandemic have also changed the socialization of dogs. As quarantine restrictions, social distancing, and other pandemic precautions took place, more Americans limited their dogs' playtime with other dogs - both at parks and daycares. Even as "most companies are returning to the office, many workers will still benefit from increased time at home compared to the pre-pandemic norm - 'Workplace experts agree that most organizations will stick with the post-pandemic norm of spending two to three days per week in the office.'" With more people working from home, fewer dogs have required regular boarding at a daycare/kennel facility - which was a typical driving force for keeping dog vaccines up-to-date. This has led to larger populations of dogs with less immunity to respiratory infections.

Whether or not kennel cough/aCIRD may be due to one or more types of infection, some dogs may develop more severe symptoms that lead to pneumonia in as little as 24 hours - especially unvaccinated puppies and older adults with other underlying health issues. Dogs with pre-existing heart conditions, respiratory disease or anomalies like collapsing trachea, laryngeal paralysis, brachycephalic obstructive airway syndrome, as well as those who are obese, have limited ability to recover and thus higher chance of fatal outcomes from kennel cough.

This is why it is important to have your dog examined by a veterinarian at least once or twice a year. Dogs age faster than humans, and cannot verbally tell us when they feel unwell. They may instinctively hide their pain or not show any symptoms in the early stages of illness, preventing owners from realizing they are sick.

Wellness exams and screening tests allow veterinarians to detect diseases before they progress, and begin any treatments that will help your pet live healthier and longer.

How to Protect Against Respiratory Disease:

"Control the controllable." --- As of now, there are vaccines available in the U.S. which protect against the following respiratory infectious agents: - Canine adenovirus type 2 (CAV-2) - Canine distemper virus (CDV) - Canine parainfluenza virus (CPIV) - Canine influenza virus (CIV) subtypes H3N8 and H3N2 - Bordetella bronchiseptica

Talk to your vet about which vaccines are essential for your dog's health and lifestyle. Although there may still be possibilities for side effects from vaccines, they are often mild; dealing with a vaccine reaction may end up being a lot easier than dealing with your dog's chronic pneumonia.

Limit your dog's contact with other dogs. Try not to allow them to touch noses or play with dogs they do not know well, or have visible signs of respiratory illness (i.e. coughing, sneezing, nasal or even ocular discharge). Avoid dog parks and boarding kennels when there is a known outbreak in your area.

Invest in pet health insurance, or at least be prepared for unexpected medical expenses - aim to have at least $5000 in savings for emergencies. You may also consider looking into financial programs like CareCredit or ScratchPay, or inquire about any grants funded by your local animal shelter or hospital.

SOURCES/FURTHER READING:

Arbach, Lara. “Canine Infectious Respiratory Disease Complex.” Today’s Veterinary Nurse, 12 May 2021, https://todaysveterinarynurse.com/preventive-medicine/canine-infectious-respiratory-disease-complex/. 

“Canine Infectious Respiratory Disease Complex (CIRDC).” Merck Animal Health, Nobivac, 28 Nov. 2023, www.merck-animal-health-usa.com/nobivac/canine-infectious-respiratory-disease-complex-cirdc. 

“Canine Respiratory Disease Advisory.” Cornell University College of Veterinary Medicine, Animal Health Diagnostic Center, 1 Dec. 2023, www.vet.cornell.edu/animal-health-diagnostic-center/news/canine-respiratory-disease-advisory-0. 

Desmon, Stephanie, and Meghan Davis. “What We Know - And Don’t Know - About Atypical Canine Respiratory Disease.” Public Health On Call, 5 Dec. 2023. John Hopkins Bloomberg School of Public Health.  https://publichealth.jhu.edu/2023/understanding-atypical-canine-respiratory-disease

McKoy, Jillian. “Nearly Half of Dog Owners Are Hesitant to Vaccinate Their Pets.” The Brink, 7 Sept. 2023.  https://www.bu.edu/articles/2023/nearly-half-of-dog-owners-are-hesitant-to-vaccinate-their-pets/

“Post-COVID Rise in Pet Ownership Evident & Persistent.” Strategic Insights for the Pet Industry: Pet Owners 2023 & Beyond, American Pet Products Association, 7 Dec. 2023, https://www.americanpetproducts.org/news/blogpost/2023/12/07/post-covid-rise-in-pet-ownership-evident-persistent. 

Reagan, Krystle L., and Jane E. Sykes. “Canine Infectious Respiratory Disease.” Veterinary Clinics of North America: Small Animal Practice, vol. 50, no. 2, Mar. 2020, https://doi.org/10.1016/j.cvsm.2019.10.009.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7132485/

Smith, Sage M., et al. “Opportunities for Expanding Access to Veterinary Care: Lessons from Covid-19.” Frontiers in Veterinary Science, vol. 9, 11 Apr. 2022, https://doi.org/10.3389/fvets.2022.804794.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9036088/

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