Hello everyone, Antony Chadwick from the webinar vet. I've been conscious that obviously the coronavirus problem is, and I felt it was useful for somebody just to take a look at all the research out there, all the, all the news. There is a danger that, you know, there's so much news.

In fact, they were saying in South Korea people are getting, you know, so scared by all the news out there that I felt it was a, a useful time for us to look at the situation. What we need to know specifically in veterinary practise and then take things from there. So, just if we look at the agenda, we're gonna talk first of all about the coronavirus history in clinical sciences.

Then talk about the situation abroad, which is ahead of us in the curve. What's happening in the UK at the moment? There seems to be a bit of controversy, can pets be involved in this, so I'm gonna talk a little bit around that as well.

Where I maybe see the future going within the UK. And then Spending some time on what happens to veterinary practise if there's a big outbreak and how that can be dealt with. In, in typical, American fashion, I think you have to put a disclaimer on this because this is a very fast moving situation.

I, I put this information together by consulting trust, trusted sources, including some medical friends, but this information is really given as a guide, you know, when the government is struggling with it, then obviously there isn't, there isn't complete certainty in this. But I hope that this webinar will be useful for you. So, COVID-19.

Probably don't remember New Year's Eve, China alerted to, several unusual cases of pneumonia in Wuhan. A port city, 11 million people in China, I mean these places are incredibly large. The biggest city, you know, in the UK is, is 89 million in, in London, so this is a, a city that we've probably never heard of before, but has 11 million people in it.

And Very, very quickly, and this is the benefit, I think, of technology now. We, we took 2 years to really work out what AIDS was and yet within a week, 2 weeks of, of really being aware of this, I think obviously there were things happening in China before the 31st of December, but very quickly, it was recognised as being a coronavirus, a new variant, . 2019 and COVID as it was called then, obviously COVID-19 now.

And then on the 9th of January there was the first death, and this person they thought had caught it from a fish market where there was also sales of live animals as well. And I think there is some controversy about where it actually crossed over from, but there is a feeling it's probably been bats, possibly pangolins, possibly pigs, but it has come crossed over, from those species. And we can see a little bit of a coronavirus timeline there.

I will be putting these slides up on, on SlideShare on LinkedIn. So, you know, you will obviously have the recording, but if you find that the PowerPoint is useful, do just go to SlideShare on, on LinkedIn on my profile and you'll be able to find it. On the 23rd of January, the city of Wuhan was placed under quarantine because they were getting so worried about this particular disease, and by the 9th of February, it had already surpassed the death toll from the SARS epidemic in 2002, and you know, we've now got well over 100,000.

People who've been infected with approximately around about 3.5, 4000 people who unfortunately have died. And you may have seen, obviously, just the other day that Italy has now been placed in lockdown because obviously the disease.

Has spread from China first of all, you know, to places like the Philippines, South Korea. South Korea was the 2nd most populous place with coronavirus, but Italy has just taken over and is now in 2nd place behind China. So COVID-19 is a, is a coronavirus, which is an RNA virus, and many of you will know that the coronavirus, is, is implicated in the common cold.

A mild infection usually takes about a week to get over and er you know, really there's no mortality from that from that virus. But also there was the Middle Eastern acute respiratory syndrome virus and obviously also the South Asian respiratory syndrome virus, which happened at the beginning of this century, causing deaths but were fairly quickly snuffed out, so they didn't seem to be quite as infectious as, as COVID-19 is. And obviously, you know, I know you're aware that the feline infectious peritonitis.

Virus is a coronavirus and the. Researchers at Liverpool University always felt that canine coronavirus was an important virus, potentially causing gastroenteritis type signs. Maybe even exacerbating parvovirus and was in fact put in some vaccines, dog vaccines as part of the, cocktail of viruses that we protect our dogs against.

So, you know, we, we all know and have heard of the coronavirus, and of course, called corona because when you look at it under the electron microscope, it looks like a crown. So that's where the, the terminology comes from. And you can see it's a pleomorphic enveloped, particles.

The envelope is studded with projecting glyco proteins and surrounds a core consisting of matrix protein enclosed within, which is a single strand of positive sense RNA. So an RNA, virus, and you can see that sort of, Studded glycoproteins that are on the outside of the envelope, and then if you want to look at it more schematically, and we'll have all seen photographs of this in our papers, in our, in our news reports as well. This is, COVID-19.

Can coronavirus mutate? You know, the worry is that, it can mutate. There's already been, two strains seen.

We obviously have no vaccine against this, but like the influenza, virus, which does mutate, coronavirus does seem as if it has that potential as well. And there are two strains, the L strain and the S strain. The S was the original strain, it was milder and less infectious, but quite quickly an L strain has emerged which spreads quickly and is now 70% of the cases.

So it's, it's a more infectious organism and has obviously had a zoonotic spread. So first of all, those first cases were coming from. Animal to human, but obviously we've now also developed into human to human spread.

Clinical signs, this is a respiratory disease. For many people it is quite a mild disease, but unfortunately, in the more severe cases, pneumonia develops, there is dyspnea, difficulty in breathing, and this is the difference between influenza and coronavirus, that you get this shortness of breath in the coronavirus that is not seen commonly with influenza. Severe cough, we also see liver and kidney failure as well, and we think it's spread via droplets in the cough, but also by touching infected surfaces.

So if people are coughing, they cough on the table, unless that's removed, people can obviously catch that from the droplets containing the virus, and they can remain on the surface for a while unless they're cleaned away. So, this disease has obviously spread very quickly across the world, seen in most places. Obviously some places are better at reporting than others, which may explain some of the places where the the map is, is blank.

But it is clearly spreading quickly around the world. Some key statistics, these were from the 3rd of March, who was, saying that the death rate from this disease was about 3.4%.

In South Korea it was about 0.6%, and in the USA it was 5%, and when I looked at these figures, what they showed was the fact that South Korea have been very, very good and the model that we should follow, they've been very, very good at testing people very early on, so they've tested many, many more people than the USA have. The USA up until recently, all of the testing had to be done at the CDC centre, the centre for Disease Control, and they had a shortage of tests, and in fact, there was a report of one person who they thought had coronavirus, and they took 4 days before they had a test to be able to test them.

In South Korea, they're actually having drive-throughs where you can drive through, take a test. Within half an hour you have the results. In America, up until recently, it would take 2 days to get the test results back.

If you can very quickly work out who is infectious and get them to go into quarantine, then they are much less likely to spread the disease to other people. So those figures have developed over time. And we're now seeing a situation that the, the sort of three top countries are probably China, Iran.

And Italy. And China's death rate has been about 3.9%.

Iran's has been about 3.3%, and Italy at the moment is standing at about 5%, and I think part of the reason for that is in China they've been able to put some very draconian measures in very quickly. It's obviously, you know, a totalitarian state, the people do on the whole what they're asked to do, and so people have been put into isolation.

Obviously in Italy, I think there's been a lot of spread of people moving around when they were hearing that the quarantine was coming in, they were jumping on trains, and I think this has created an unfortunate problem where there are, you know, unfortunately quite a lot of deaths and now of course Italy is in lockdown. So South Korea is showing about a 0.60.7 death rate, and I think it's because they are testing many more people.

They're also seeing that those very mild cases that perhaps wouldn't be included in those numbers are then included in the number, but they're also allowing people to go and isolate themselves quickly. So, you know, 3.4% is quite a scary number.

I think that we'll find that the UK average will be much lower than that. At the moment, the figures are there have been 5 deaths from 500, from 319 confirmed cases, which is about 1.6% death rate.

Obviously, sadly, you know, the older you are, the more likely you are to, to die from this disease. Young people under 40, basically you're very, very unfortunate if you, if you do pass away with it. But if you're over 80 and you get the disease, at the moment, the percentage seems to be about 15%.

In China, they seem to think that there was a a sex imbalance, 4.7% for males, 2.8% for females, so quite a big difference.

But that was also put down to the fact that many, many more men in China smoke than women do, and they thought that this might cause it due to the damage to the lungs, due to smoking. But 80% of cases are mild, so this is for the most people, a mild disease. But unfortunately there, you know, for people who are older, it's more serious.

And you can see the, the situation in Iran taken from, a website that I found, you can see that this is becoming quite exponential there. Again, I think the key points are, being able to isolate having the medicines available, you know, the National Health Service that you have, we're very fortunate in the UK, you know, it's free at the point of use in America. It isn't, that will probably have some effects on how quickly people will go in and and have themselves checked.

Pre-existing conditions, you know, if you have cardiovascular disease, if you have diabetes, hypertension, chronic respiratory disease, so hence, you know, if you smoke a lot, you get COPD and of course, cancer, all of these make it much more likely, that you would potentially die from the disease. How infectious is it? We, we, we look in microbiology with viruses at a, a reproductive number, how likely is this disease to spread from person to person?

And flu is usually between 1 and 21 and 2, and that means that if a person has flu, they're most likely to pass it on to one or two other people. I, I think that the number I'm quoting you there at 2.28 is from a scientific paper which looked at the spread of the disease over the, Diamond Princess, which was the, which was the, cruise liner that was in Japan.

You know, if you wanted to have a really good place to experiment on this boat, sticking people on a cruise liner and keeping them on there for a long time is a great way of doing it. A lot of shared and air conditioning that is recycling air all over the boat, and I think it's made it much more likely that people would catch the disease on the boat than if they'd been taken off. And in fact, there's now another cruise liner that's in San Francisco, and I know those people are being taken off a lot quicker.

Because I think they've already learned the lessons from the Diamond Princess, which was that the people were left on the, the cruise liner for far too long, so. Again, I think that reproductive number will probably come down, and it will probably be a similar sort of infectious level that, that influenza has as well. The situation in Italy is really quite dire at the moment.

There were 6 infections on the 21st of February. By the 27th, there were 650 infections. And 17 deaths.

By March 3rd, there were 77 deaths, and about the 8th of March, Italy was placed into lockdown. There's now been the most up to-date figure, as of today is 463 deaths, and there's been 9000 people, 9,172 confirmed with the disease. So that is a death rate of 5%, which is really high, and I think the, the health service in Italy is not coping with this because the disease has come very quickly.

And listening to our Chief Medical Officer, Professor Witty, he's talked a lot about trying to make the curve flatter so that we spend longer before we really go into a full-blown, epidemic. It's interesting that the situation in China now with those very, very, strong draconian measures that they've put in, that the numbers of cases seem to be decreasing, so that's sort of 2.5.

Months in, which is the sort of numbers that again, Professor Whitty has been suggesting for an epidemic in that it probably takes about 50% of all cases will happen in 3 weeks and then 95% of cases will happen over the nine week period. So China look as if they're coming towards the end of that. I think if it can be spread out, it, it also allows people to, to have those strict measures to, Hopefully slow down and, and prevent, many more people getting the disease.

If we can kind of let the disease burn itself out, hopefully less people will be affected than the government has suggested. The worst case scenario is 80% of our population could be infected by the virus. I think reading around the situation, talking to, to medical colleagues, I think that is a really, really, Worst, worst case scenario, and we've got to be careful that we're not scaring people with those numbers.

So we're, we're fortunate we've got a really strong leader in the UK called Professor Witty, the man on the right, not on the left, and we've already tested about 25,000 people. So similarly to Korea, we're testing a lot of people already. And so far we've had those 319 positives with unfortunately 5 deaths.

I think all of those deaths have happened in older people with pre-existing conditions, but, you know, clearly every death is, is, is a really sad case. So the, the NHS have set up really a, a four-pronged attack on this disease. They've talked about containment, delay, research, and mitigation, and I think we're moving out of the first stage of containment.

Into delay, and delay, I think there are a number of strategies that The NHS is using to flatten the curve to make sure that it doesn't happen very, very quickly, it doesn't happen exponentially, where if there was a large, large number of cases, Of course there would be a large number of cases that were more critical, and there may not be the beds and the respirators to actually support those people and that's why we're perhaps seeing higher death rates in, in places like Iran where perhaps the, you know, the equipment isn't quite at our, at our level. So what is the NHS advice? Again, speaking to one of my doctor friends, it was interesting that what they're asking at this point, and of course I think this will change quite quickly, but if you have a cough or cold, you're feeling fluey, you're perhaps having difficulty breathing, my wife had somebody in, in the school yesterday, who, one of the cleaners who was coughing and spluttering.

And she'd rung the doctors and the doctors hadn't really given her the right advice. The right advice is that you want, shouldn't immediately go into your place of work. You should ring 111, which is the NHS telephone advice service, and they will almost certainly with those sort of, symptoms that I've just described, would be recommending that you got tested, and that would then be organised so that a test kit was provided for you to test yourself.

Or I think people are actually being tested. So it's, I presume that the test is then left outside and somebody then goes on and, and tests it. .

If the person comes back as positive, they will then be given advice on, on medical treatment. I think the standard treatment for people who don't get particularly unwell is going to be, you know, paracetamol, plenty of fluids, Buren if you need it as well. But the self-isolation is important, and they're talking about, you know, 2 weeks isolating yourself from others if you, you know, are tested positive for the coronavirus.

I think why they're not immediately giving out medical advice, if you look on the websites, that's not present, is because they want people to be tested. At some point, testing will stop as they see that the disease is, is going more mainstream, but I think it's really important that if people are tested, they know that they're positive and they isolate, that will make it much less likely that the disease will be spread. You know, to other people.

The NHS advice, how can you prevent the spread, and regular hand washing is, is the big one that they're talking about. Soap is better than sanitizer, so, you know, you should be using soap. Obviously, sanitizer is the thing that's actually run out in the shops, but the best thing to do is just to wash your hands regularly.

Obviously after having washed your hands, you know, don't be placing your hands over your face a lot. We touch, we all of us touch, you know, as we look at this, I was watching one of the football managers on the television. We all touch our faces quite a lot, and it's something that we, we should try and, reduce certainly at this time.

And certainly reducing physical contact with other people. So, in my church, we're not giving out a sign of peace at the moment. We're not shaking each other's hands.

So there's certain things like that. And then obviously, I think particularly for veterinary practise, we should be really upping the ante on regular cleaning of communal spaces. What will the future hold?

Inevitably there is going to be more and more pressure on the NHS, and I think it was great to hear from the Professor Witty that, you know, the NHS is able to flex in these situations, but clearly if we can flatten that curve, then it's a more manageable situation. People are becoming ill over the next 2 months and if it's over the next 2 weeks. So this self-isolation, I think is really important.

You know, we are hearing of cases going into a GPs that GPS is then closed. It's deep cleaned before it's opened again, so there have been cases of that. You know, some schools, I know a few schools had gone to Italy for skiing.

They're coming back again. They need to probably be isolated and wait and see if they develop the disease. Disease, I think people are saying it is somewhere between 7 and 14 days before it comes out, but I think 7 is, is the more accurate number.

So if you catch the disease, it's likely within 7 days that you will be showing symptoms. Clearly, if we're inside in a pub, in a restaurant, in a cinema, people are coughing around us, that air is shared, you know, in one space. It's much better at this point to be out and about, and this is one of the controversies again that Professor Whitty has has broached about stopping sporting events or or playing them behind closed doors.

If, you know, Liverpool's match goes on, and the fans are not allowed in, they probably will congregate in pubs around the city. A pub is probably a less safe place than being in an open plan stadium. And I think of course we have to worry about food and supply shortages.

There has been some panic buying on things like sanitizers, but, having gone into the supermarket, you know, they, they still seem to be well stocked and one of the benefits or advantages of Brexit is that we obviously as a country have stockpiled somewhat worrying about, you know, a no deal Brexit. Can pets catch coronavirus? There has been a case in Hong Kong of a Pomeranian that tested weekly positive for this disease.

It, it has stayed as positive, but I think this has probably been caught. From the owner, so it's a reverse zoonosis. There's no evidence, even with previous outbreaks of SARS and Mars, that the disease really would spread to other animals or back to people.

So I think it's something that we shouldn't be worried. The people will As goes sounding some of this is Anthony, you're just breaking up a little bit, so I'm not sure whether you want to dial in. Yeah, I'll go on, just give me.

Yeah, just bear with us please while Antony dials in just to make sure the S sound quality remains good. Is that better, Rich? Perfect, yeah.

OK, that's super. So. My understanding is that if people have the coronavirus infection and they've got pets in the house, there is some information that's suggesting that these, the pets that we should tell people that we have pets in the house, and they may get tested.

But my own feeling is that this probably will not be a problem, but again, Watch this space. At the moment, just one case, weakly positive, the pet showed absolutely no clinical signs, so the pet was very much asymptomatic. But what could happen in veterinary practise, I think there is a danger that fewer pets being brought to the practise.

We're seeing it, you know, with people who are not flying, they're perhaps not going, you know, to the cinema as much, you know, people are changing their behaviour somewhat, and there is a worry, I think, with the economic effect that the virus will have that, you know, some businesses will really struggle and and may close down, . So I think that's certainly a worry that, you know, if there was an outbreak in a practise that obviously the practise can't really function then. And if there is a staff illness, of course that person should be encouraged to self-isolate.

They may not be very unwell, they may just have one or two days of being unwell or they may be asymptomatic, but they will need to be tested and perhaps to also test the other areas as well. Are you still hearing me OK, Rich? Yeah, we can hear you, but we've lost your presentation.

Do you want me to share the screen? Yeah, if you share the screen for me please. We're just on what could happen in veterinary practise.

Yeah, no problem. Of course, if, if clients come in and you know, are ill, they won't be able to come into the practise either. There may be a shortage of drugs.

I know I saw some information from MWI yesterday which suggested that there aren't any drug shortages at the moment, but deliveries could be curtailed. It may be worth just looking at the essentials vaccines that you are, you know, well stocked up. And of course if a practise does have an infection within it, it probably will need to be closed and then deep cleans and such like will have to happen.

So just let me get my slides up properly because I just can't spot the bottom of the slides. Just give me one second. So suggested actions, I would advise that it's well worth holding a meeting as soon as possible to inform teams of the steps you are taking.

It's really important that people understand this. Some will understand it more than others. Some will have been reading lots.

There is misinformation out there, so it's important that you're reading the right sources. Sppis have actually done and BVA have done some really good information sheets on this, and they've even done Sppis has even done a PowerPoint to give, you know, out to your, to your team, and I've left those as a resource on the end slide, which we can put up at the end, and obviously we can share this with you later. So I would very much advise that you hold a meeting now.

We've already held a meeting and we decided as a digital business, and I think every, you know, I remember, the ex CEO of the Royal College saying every business needs to be a digital business, and this was 3 or 4 years ago, even more so now, you know, you need to be able to have a digital offering and so. Our business is obviously very digital. We've decided to leave the office at the moment to work from home to make sure that we can run things efficiently, albeit with a slightly dodgy internet today, but this is the way to test things out before perhaps the disease, you know, hits more fully.

I think this is the time to really be cleaning the practise. Obviously, most veterinary practises are impeccably clean anyway, but it probably is a time when we should even up the ante on the cleaning as well. And if you've got that ability to arrange delivery services, people may not want to come into your practise, so you can offer them the fact that you can send the drugs out to them.

You know, you can have a delivery service. They're they're all going to be in your local area, so you could have one of your nurses perhaps going out or, or, you know, another member of staff to deliver drugs so that people, especially older people, don't need to come into, you know, a, a building where there are more people and they're worried about catching infection. And I think also there is that option of using telemedicine, .

I've been talking to a telemedicine provider in Canada that's unusual in that it develops it for the practises. I think there's a lot of controversy around telemedicine in the UK and part of that is because it's seen as being, you know, an external company coming in, providing this service without providing the more difficult, you know, day to day service as well. And quite rightly, you know, I had my own practise, many of you will be listening, you know, work in a practise.

I, I think it's something that practises should have the ability to do as well. This is where I talk about, you know, practises being digital businesses, you know, communicating these messages to their clients on Facebook, on Twitter. On Instagram, but also being able to perhaps potentially have consults with sick clients, older clients who don't want to come out, perhaps using a vet who has had the virus, but has to isolate himself or herself for two weeks, they can then be used in the telemedicine service.

So, I hope this has helped. My own sort of final feelings on this is that of course it's a serious disease. I think we are probably dealing with it in an appropriate way in the UK.

I think we've got a fantastic chief medical officer who seems to be really on the ball about it. Having said that, I think there is always a worry with all this information that we become very afraid. We get very worried.

Some bright spark told me that the Bible has 365 times. It says, do not be afraid, do not worry. You know, worry doesn't get us anywhere.

If we're going to get the virus, we're going to get it. We can obviously put measures in place to try and make that less likely, but the likelihood is that for most people this is a mild disease. They may be even asymptomatic, you know, or they'll, they'll be unwell for 2 or 3 days and then better again, so.

In as much as it's a serious disease, I don't want you to worry, I certainly don't want you to panic. I don't panic. Carry a towel and maybe a little bit of soap as well, and I'm hoping that that will keep us all safe and well, .

There's the further advice. There's some of the the documents that I was looking at to prepare this talk as well as talking to medical colleagues. And I wanted to, I've I've I've invited Sharon Quinn and and Sharon Quinn from the, the smart vet business over in Canada.

She actually has her own practise, the Nelson Animal Hospital quite close to Toronto in Burlington. She's a a vet veterinary surgeon qualified from G Guelph. And she really had this idea that telemedicine shouldn't just be for the big companies but should be something that all veterinary practises should offer.

I've been talking to Sharon and Jason from the company for a few months now, and we were wanting to give that as an offering to practicers, but particularly now that coronavirus has struck, I felt it was a really opportune time to give people the opportunity. To be able to speak to their clients in a really professional way, in a way that they can also charge for using a telemedicine platform that can be white labelled to your practise. So Sharon, I hope you can hear me OK and perhaps if you want to swap over to your slides and we can enjoy the your presentation.

Yes, of course. Thank you so much, Anthony. Thank you for that presentation as well.

It was really informative. So my name is Sharon Quinn as Anthony said, I'm here with my partner Jason Warnock. And we're, we're here today and thank you again, Anthony, for the invitation to speak to you about the future of telehealth as it pertains to veterinary medicine.

The reason that we're here is that we, along with our, our other partners, co-founded Canada's only accredited telemedicine service. We're very proud of that, and, I'll tell you a little bit about ourselves. Jason, if you want to send to the next slide.

Again, I'm a practising veterinarian in Canada. I've been practising for 16 years. I've purchased my practise 2 years out of school, which was a little bit challenging, as you can imagine, but, I've enjoyed every minute of it.

I also have 4 children, busy, busy kids, and so another aspect that we'll touch on a little bit later is just handling work-life balance and a, and a, and a busy practise at the same time and how telemedicine can play into that a little bit as well. Jason Warnock, this is Jason here. I'll let him introduce himself in a minute, but that adorable fuzzy thing, licking his face is not his beard, that's his dog, cowboy.

Jason, go ahead and introduce yourself. Yeah, thank you, Sharon. Yup, guys, I'm Jason Warnock.

I have a sure love for two things in my life, animals and technology. Smart but has certainly allowed me to bring both of those together and we're thrilled to be here today. Thanks, Jason.

OK, so, so Smart vet, the original idea actually was Jason's idea, not my own. Jason and I have been friends for a number of years, and he came to me with it nearly 3 years ago, suggesting telemedicine for pets. And I think like a lot of veterinarians, I was quite resistant at first.

I think the idea of change can be a little bit scary for some of us, and I think when you look at it in a narrow-minded way, as I was doing. We tend to think the worst and imagine, you know, doctors prescribing medication over the internet to pets they've never seen and never will see, and when we think of all the potential disasters that can come about because of that. And so I was resistant and then more and more we were hearing at conferences and, and different CE things that we were attending.

That this is coming. Telemedicine is coming and we need to embrace it now or it'll just sort of happen around us. And, and in fact, we did see that start to happen.

So here in Canada, we started to see clients asking about it and, and certainly demand in our practises, clients using telemedicine for their own, for their own personal needs and wondering why we didn't have it for them as well. And we started to see telemedicine businesses coming about that were not designed by veterinarians, that in a lot of ways the positioning in the marketplace undermined. The industry of veterinary medicine undermined the veterinary professional.

And so we weren't happy with that. And so we, I went to Jason and we said, OK, it's, it's time to do this and position it more as a buy vets for vets, and enable veterinarians to provide this themselves out of their own practises rather than it be big external business. And, and it would be able to extend the scope of care, for the veterinarian as well as providing a lot of other benefits.

Sorry, I'm just getting over a cold myself, so I apologise. I might have to stop periodically and clear my throat. So we became accredited by the College of Veterinarians of Ontario in September 2019, and that was important to us, for credibility and to go through the process.

We really felt that that was necessary. We're currently in the, in the process of finalising contract with the Ontario SPCA as well, and that's something that we're really excited about doing. Particularly as we will be enabling care in, in remote areas that veterinarians can't always have access to, hoping that we can get veterinary technicians out into those areas and, and we can use telehealth to allow veterinarians access.

We offer 3 consultation methods, message, phone, and video as well. And we're Canada's leading pet telehealth platform currently with consumers and clinic owners. We just about 2.5, 3 weeks ago launched our White Label solution for clinics, which, which will allow clinics to actually have their own telehealth service branded through their own website.

So we're gonna talk a little bit about how pet owners have used telehealth in our space. Certainly many, many ways. This is not an exhaustive list by any stretch, but, but there are many applications.

We'll just talk about a few examples. We'll talk about the benefits for veterinary clinics using telehealth and also talk, Jason will speak to how your own clinic could become enabled. OK, so we'll just go through a couple of cases.

These are based on actual cases. Obviously didn't use the, the names and photos from the actual cases. One of the popular use cases for clinics is in post-op checkups.

So, obviously, these are your own patients, we can use it for several different scenarios. We can use it in dog neuter. Checkups, obviously, these are cases where we have subcuticular sutures, dissolving suture lines, where we can just, you know, save the pet and the owner the stress of coming into the clinic.

It works really, really well for cats, spays and neuters as well, particularly helping out with the free, fear-free movement, with cats in particular. And, and another thing that veterinarians are pretty excited about too is getting their registered veterinary technicians or vet nurses, I think, they're referred to in the UK, getting the vet nurses on board with doing these reevaluations themselves over telehealth and freeing up exam rooms for the veterinarians at the clinic. So this was, you know, obviously this was just a, a dog neuter and, and so you can upload photos into the message consult or you can do it as a video consult, even a video consult, you can upload photos, any imagery, videos, or documentation that you want to upload into the system.

So the next way that we often find people are using the service is for triage. So in this case, this was a, a dog that was at the dog park and was stung on the nose by a bee and, and the owner was worried. So, it's a good way to sort of help.

With peace of mind for the client, and give any sort of immediate first aid advice that should be given. A lot of these cases are going to need to be seen, not this one in particular, but when we can dealing with torn nails, for example, cuts and scrapes, things like that. Sometimes they do need to be seen, but just, you know, the client may need some reassurance, may need some assistance in that moment, and, and they don't want to wait to come into the clinic.

They want to know if they need to, if they need to come to the clinic. Also, so that's another way that we use it. It can be really helpful in toxicology cases and any sort of acute medical concern, so acute vomiting, diarrhoea, hematuria, those kinds of things as well, just, just to help advise the client and help to avoid taking a wait and see approach because, or, or just, just seeing, you know, ringing somebody ringing up and saying about a bee sting, it's hard because you can't see it, so you have to say, well you have to come in, whereas.

You know, with this video very clear there, you can say, well, look, it doesn't look too bad, you know, it's not an emergency emergency, so it's It's so helpful to have the video element to it as well, isn't it? Yeah, I mean, this dog was jumping around the car was clearly fine, but, you know, the clients are still worried and so they just need the reassurance. And it's really helpful to them, even just the face to face time, I find, with your own client gives them peace of mind.

They know you, they're comfortable with you. It's so much, it's a different relationship from just being on the phone or sending a A quick message, you know, so. Exactly, yeah, sorry to disturb, but you know it's, it looks really good and obviously it's a big help in those sort of cases.

Yeah, no, thank you. No, do interrupt, if there's anything you'd like to discuss. We, this particular one, didn't have to come into the clinic in this case, so just gave some advice.

On, on what should be done at home and, and sent her on her way and she's thrilled with that. It's certainly an option for practises, you know, with, with our platform, you set your own pricing. So, it's an option that you could elect if the patient you're consulting on does end up attending at your practise, that you could decide to discount the, The examination fee, you certainly wouldn't want to discount the entire amount of the telehealth consult because you've provided that service, but you'd have the option of, of giving a smaller discount just to again to encourage them to actually attend the practise and, and have them not feel like they're, you know, basically paying for a full consultation twice.

Yeah. OK. So another, and this, this has become, it's funny because originally when thinking about telemedicine, I thought, you know, I was thinking about all the ways we couldn't use it and thinking, OK, well, if we have a lump on a dog, or we have a skin condition or we have a real medical concern, we can't use telehealth in any of those scenarios.

But that's actually turned out to be very full. Just poor thinking on my part. A lot of the reason why clients reach out to us is because, and we sometimes forget this, they don't have a, a basic medical knowledge or grasp, you know, at all.

So they're reaching out to us for reassurance and a lot of times what seems like just a a simple little lump or problem that's easy to resolve. For us, can be very frightening to the owner. And so they're thinking kind of all or nothing, you know, I'm going to be told I have to put my pet down, or this is going to cost me $10,000 and I can't afford it.

And they're sort of thinking in that, in that way. So this was a case of a, a cat, you know, kind of our typical older cat that comes in with some weight loss, a little more vomiting than normal. Obviously needs some blood work, some laboratory testing to determine what's going on with this pet, but she's thinking kind of the worst.

And what sometimes happens to these clients, I think, is that they just decide or talk themselves into, I'm just, you know, there's nothing that can be done. I'm going to let my pet just, you know, let nature take its course. She's old, you know, all those kinds of things, and they may elect not to bring this patient into the practise.

This is a way that if, you know, if they can reach out to you and just get some reassurance, a little bit of hand holding, you may be able to pull this client in and help and really help this pet. And we've seen this happen on the global network that we have a number of times. So we do provide, I don't want to confuse the issue, but in addition to the white label that we can give to the clinic to provide care to their own clients, we do have a global network of veterinarians who can respond to general cases outside of this.

Overnights, for example, when clinics don't want to be attending their telehealth service. So, and we see this in the global network all the time where clients say, oh my gosh, this rash, you know, is this the end? Or something drastic?

Do I have to take my pet back to the, to where I got it from and, and I can't keep it. And so this again, just sort of giving them an idea of what will happen when you come into the practise, you know, we can do this step by step. This is, it doesn't have to be scary.

That's become a massive, massive use for telehealth. Some, some clients think. The vet is gonna tell them the dog, the dog, the cat needs to be euthanized and that puts them off, whereas they're not aware of some of the things that we can do, so it's, it helps to educate before they've committed to coming to practise, doesn't it?

It does and I think that there's more benefit in in this direct communication with the veterinarian. I mean we all have very capable staff in our clinics, but sometimes it's hard for clients to get across or they're afraid to get across on the phone how they're really feeling, so this is just a way around that that we've actually found really helpful for many clients. So, yeah, so medical concerns in general.

And our next, our next case, this is also a really, really common one, on the global network as well as White Label, is, is end of life, quality of life, euthanasia discussions, palliative care. A lot of times people are afraid to ask these questions in person, they become choked up and emotional. They can't quite get it out in person or on the phone.

And, and they really want to sort of talk through the process, talk about how do I know when it's time, what will happen at the euthanasia appointment, all of those kinds of things, and, and they just need that support. And so we've also found that's another case where clients will really reach out to us to kinda, to have that, again, a little more hand holding, but it, it's really valuable for them. And helps them to feel more comfortable with the, the whole process.

And I think sometimes just the just the feeling somebody's there for them too, can be, can be helpful. So those are sort of, those are some, I mean, certainly just the, the cases keep coming in and the uses keep growing. We've had nutritional consultations, behavioural consultations, puppy and kitten appointments when maybe, you know, puppy went to the veterinarian for their vaccine appointment, but owner came home and thought of a bunch of other questions that they didn't have time to ask.

Vet to vet also specialist consults, that's something that we're seeing in Canada, veterinarians who are specialists who are saying, you know what, I'm gonna offer this to my, my veterinarian colleagues to be able to do these consultations with me online and upload information, also rehabilitators, you know, so there, there's so, so many uses for it and more coming in all the time and we're excited to work with practises on finding new use cases and . And yeah, just just excited for what the future holds. That's excellent.

I think we're gonna have Jason speaking as well, aren't we? Yes, yeah. Jason, are you there?

Brilliant. Yeah, I'm here. Jason, as you said, did a degree in computer science, worked for a lot of the big companies.

Sharon's been a good mate. You're, you're a lover of animals, aren't you? So you wanted to see if you could pull those two skills together and produce something beautiful, which I think is what you've done.

So I love to hear your thoughts on it as well. Absolutely. I mean, If I could do it again, I would, would have rather studied animal science, now that I'm, you know, have more experience in my.

I started studying computer science, but animal science certainly still is my passion. And then that's one of the most intriguing things about SmartB is when consultations come in, I thoroughly review them with Sharon. And I don't review them from the business sense.

I review them from the pure perspective of intrigue and fascination. And with every consultation that comes in, I'm Myself learning more and more about animal care, which drives me to believe I probably will pursue some, some form of education in the animal space as this passion just continues growing. It's truly, it's truly inspirational.

There's a variety of benefits, you know, to implementing telehealth for specific practise, and we firmly believe at SmartB that Every practise should be able to offer the specific capability to their clients, you know, it, it introduces so many benefits and we'll send out this deck. Well, Anthony will send this out the recording afterwards you can thoroughly review it but in a new revenue streams, work-life balance, accessibility for pet owners in your remote areas. Efficiencies in the in the actual practise itself and there's so many different benefits this provides and in order to capitalise on these benefits and make them.

Can I just jump in quickly there? Sure, I just wanted to say just, just monetizing. I mean, I think so many of us are giving our, our, our education, we're giving our knowledge and our time away for free, and we're getting it, giving a good portion of every day.

Away to our clients for free and I mean I think there needs to be out there and this is a way to monetize and it needs to take some some transitioning of clients' mindsets but at least what I find is that it really becomes an expectation over time on the client's part and I think we need to change that, and that kind of plays into work-life balance a little bit, doesn't it where we end up, you know, giving so much of our free time, our family time, to our clients also if, if we make the mistake of giving out our number or email address and that kind of thing. So anyway, this has really helped, I think in a lot of ways with those two, those two factors in particular. So with my clients who travel with their pets, we've used it a lot just to assist with continuity of care for those clients and giving them again the peace of mind that we're still there for them even when they're travelling.

Go ahead, Jason. I think solicitors charge for their time, don't they on the phone, but with the telehealth, I think particularly with the video. You're offering something, you know, a lot more potent than just a telephone call, and I think people will, will understand that as clients.

You know, and appreciate it as you've said. Yeah, yeah, exactly, and you're right, they do charge for the time I mean they charge for every email and all of that as well and obviously I'm not suggesting that, you know, if a client comes into you today and pays for laboratory testing and an examination and all that that we shouldn't offer some form of consultation or further follow up for them but. You know, we don't have to monetize absolutely everything, but, but certainly we're, I think most of us are doing more than we probably should be doing for free.

No, absolutely. Yeah, back to you, Jason. Thank you.

So with the, with the Smart platform, I mean, what we do for veterinary clinics is we enable them with their own online health centre and that online health centre will equip each practise with the full telehealth capability, including a landing page that integrates with your veterinary practises existing web page that provide information about your online consultation services. It also enables your clinic with online scheduling, custom intake forms, telehealth, e-commerce, and then, Client record management. So, I mean, let's take a quick look.

So if we look at what we did with with Nelson Animal Hospital, you can see on the left there, that's Nelson Animal Hospital's homepage. They simply have a link on their homepage to their online consultations, and that takes them to their online health centre link page, which has the same look, feel, and branding as their homepage. So users don't even know they're not on Nelson's page anymore.

So we need to keep the experience consistent for the pet owners. Now, when, the best way to showcase the platform, the online health centre rather, is to look at a real-life example. I mean, here's just one example that we see regularly.

So cowboys had a neuter surgery and the, and the Doctor Quinn would like to follow up with him 10 days after the appointment. So now we can do that follow-up, now via telehealth. So in this case, Cowboys owner John Smith has the greatest experience possible.

He simply arrives on Nelson's homepage, clicks online consultations. From there, he's unable to schedule a time with Doctor Quinn that works best for him. He then completed an intake form that Nelson set up in the platform to say, you know, this is Cowboy's current state and provide more information about it.

Then John would pay for the appointment for Cowboy and then attend the consultation, whether it's via video, phone, or message. I mean, and just a quick run-through of it and like the experience in more details. So here's a quick example of the homepage that John would arrive on for the online consultation that lives within Nelson's page.

And then John is actually able to then select Sharon's schedule. I was saying he can see all the availability that she set within the online health centre and select the time that works for him, and it's really easy for Nelson's staff in the system to say, I'm available from 9 to 5 today. And then from there, I mean, every veterinary practise can set their own intake form with their own questions that they would like to learn about their pet owners and the intake form answers are all available to that veterinarian, in the digital consultation room, which is the magical place in the platform.

So we wanted to say, well, how do we turn a a vet consultation room into something digital and we built the digital consultation room which provides a 360 degree view of your client's online telehealth interaction. And in there, you can see everything from the intake form questions, any additional videos, pictures, or documents that they've provided about their pet's condition, and then the client history as well, all in a single view. And when you're ready to meet with the client, the client will select the communication channel, whether it's video, phone, or message.

All three all three communication channels are housed within the system. And all you as the vet would do is just click start consultation. The system does the rest.

There's no dialling, nothing, everything is housed within the, within the system. And what's great about it too is you have the option to record your consultations. So why that's important is that you can watch them later, you have them for your records, and your pet owners actually have them as well, and they didn't follow all the instructions originally, they're certainly able to go back in and rewatch it again in case you gave them specific instructions.

Recording is optional. And with phone, We made it extremely easy, right? So with the phone itself, you just click start phone call on the system that would call your patients and then call your phone number and then bridge you together.

So you don't have to worry about dialling into a conference bridge and entering a passcode. And I mean, if a client doesn't want a video or phone consultation, it might be a less urgent concern as Sharon was showing, and we find that actually the majority of the consultations right now in 2019 to 2020 have been message consultations. So now, as opposed to people emailing your clinic and hoping for a response, you can actually have them send a paid message to you with all the specific detail in an organised format, and all of your staff can see a message came in, and then a specific staff member can choose the message as well and answer it.

And the great thing is e-commerce component. So every time you perform a consultation, the money is automatically deposited into your account and it's just directly charged from your client's credit card. But you don't have to charge for appointments as well in certain situations.

We don't charge for appointments depending on the nature of the visit. You have the option to actually click charge the client for consultation. I mean, and then all client record management is stored in the system too, so every time a new, someone, someone joins your online health centre, the complete record is stored and available for you as well, all in the single system.

And then employee management as well, whether it's a vet nurse or a vet practitioner, you can add and remove team members for your clinic with ease and you can control their permissions so that certain team members can see and do more, than others depending on the role and responsibility. And then marketing, and he has built-in social marketing as well to easily allow your clinic to push messaging of your online availability to social networks. And those are just a few, of the features that we have in the platform today.

Given time, I mean we can't go through it all today. It's, it's fairly extensive, but it's extremely easy to use. So, I mean, for set up and support of a clinic wants to enable themselves with telehealth, we can get you going in as as 48 hours, and have this completely set up and integrated in your existing website.

And the pricing is $249 per month to get it going. And, yeah, it's super easy and it, it's super fun. We're really excited about where this could go in the UK.

Now you're probably have a tonne of questions and your minds are probably spinning as to how you can Enable your clinic now with telehealth. So with that being said, I've left our contact information there. If you want to send us an email, it's [email protected] or you can visit our website at smart.bet to learn more in the four veterinarian section.

So with that being said, I'll pass it back to Anthony, to give us a time check and then see if there's any questions. That's great, that's spot on 3 o'clock as well, so I hope for everyone that's been helpful on the coronavirus, I did feel with this particular situation that this is an ideal time, you know, also for you to test out the the telemedicine, it's something to do for the next couple of months. If you're not using it, you know, now you possibly will never use it with the the situation, the very unique situation we find ourselves in.

And I wanted to offer something that isn't. You know, corporate and benefiting the The businesses more than it's benefiting us. So I do think we as businesses should have a digital presence.

And telemedicine obviously is a big area, it's quite contentious at the moment, but I think, you know, practises should want to start to, to embrace this. So I hope you've enjoyed that. Let's see if there's any questions, .

Jose says it's very interesting platform. We've also just been getting asked about the the various links that I promised. So if you know SlideShare and if you're on LinkedIn, if you go into my profile, I will very shortly be pushing up the presentation onto LinkedIn, but also the presentation itself will go onto our website very shortly.

And you will all be obviously registered for that, so you can go over it in more detail to look at that. I think there's also a survey which will allow you to leave your details and we can pass those on to Jason and to Sharon, so that you can hear more about the platform. Obviously that's just to give you a taste of it, but I think it's it's certainly well worth considering.

Let's see if we've got anything else coming up. Any other questions? It is a a a lunchtime, late lunchtime for some people, so I suppose you may be going back into practise.

I'll just give another couple of seconds, . As I said, there was a very good, some very good links from Spis and BBA as well on coronavirus, so do look at those, but I put all the links in the presentation and you can obviously just go onto the webinar and look at those and and click, you know, create those links yourself on your, on your browser if you want to look at them in more detail. How, how quickly, Could you get these set up, you know, actually to get a set of practise set up on the platform, Jason?

Yeah, 24 to 48 hours, completely up and running, and all the clinics need to do is just implement a link on the website that says online consultations, and we set up the landing page and the platform and then it's a Quick 30-minute training session. I mean, the platform is so easy to use, that's usually get it instantly. So, yeah, 24 to 48 hours, your clinic can be operational and you can providing telehealth service for your client from your clinic.

And you're doing it the way that you think is is right and ethical. I mean, it's telemedicine provided by veterinarians, to their own clients and completely controlled by, by them. So I think that's the piece of it that I really like.

It's completely customizable for, for how you see telehealth fitting into your own practise. That's brilliant. There's a question from Chloe, who said, are there any platforms existing specifically for vets who have to work from home due to, you know, different circumstances?

And, you know, obviously there are the different platforms that are that that will always need effects in those circumstances. So I presume, Sharon, I know you offer a global platform, you know, for things like out of hours as well. Presumably you use that, you know, from all over Canada for that.

Yes, but we're certainly open to looking at, veterinarians from other areas as well. So if that's something that, that anyone's interested in, they can reach out to us on their own, and, and we can, you know, look at getting them onto the, getting them onto the network. We certainly we'd be interested in doing that.

I suppose we just have to check up with with Royal College and so on that and with Canada that, you know, a vet whose degree is in the UK can actually give this advice. But these are all the issues I think with telemedicine that we're still trying to find our way through them. But certainly, you know, the, the big thing, Sharon, in the UK is the phrase that everybody uses is pet under your care.

And I think the danger with some telemedicine is that they say, well, they don't know this pet, whereas going direct to the practise, obviously the pet is known within the practise and it's, you know, it's a really great way of being able to solve that particular problem. Yeah, and the regulations will most certainly differ between for tele telehealth within your own practise, you're working under your own licence, under your own accreditation, your accredited facility. Your own insurance, all of that, and so, and you've already established the veterinary client-patient relationship, so you can prescribe medication even, and the global network, it is not that way at all.

I mean, we certainly wouldn't be prescribing medications, using that modality. So that's what we get into it all. It's really used more for triage, which is, I mean, very important though, a very important function, and certainly something that needs to be.

And I think the thing is that if the practise is not offering that, then other people will be, you know, the triage in some ways may actually create business for the local practises and that, you know, somebody has triage, you're then saying you need to go to a local practise, you know, where are you? I'm in Burlington, well, you could come to Nelson or there are other practises in that neighbourhood that you can You can use, so I presume it can also be a tool to help, you know, bring new business to the practise as well, can't it? It can definitely bring in new business.

I think also it helps control the flow for emergency clinics, for example, where they end up with, you know. Overflow of clients in the waiting room who waited till morning, but they're very anxious. We could have alleviated that anxiety somewhat, and then the opposite is true as well.

I mean, so I, so in that case that they avoid a visit to the emergency room and they can see their regular clinic in the morning, that helps the regular clinic, helps the emergency room, and it works the other way too, where clients would have waited too long and, and we can get those, those patients looked at appropriately. Yeah, yeah, and it's important to note too that if it's, if a clinic is using this for their own patients, they can certainly prescribe medication. You can upload just a picture of the prescription inside the digital consultation room as well.

In certain situations, Sharon would comment more on it, that's extremely useful. We're very cognizant. I think one of the advantages of having veterinarians involved in that, and it wasn't just myself, we had a big panel of veterinarians that was involved in the development of this.

Having veterinarians in on the discussion and, you know, really, really speaking to the ethical side of it and, and wanting to do no harm and, and making sure that you know, as this kind of evolves and this is something we haven't really dealt with before, sure that it happens in, in the best possible way for everybody and in particular the patient themselves. And so, that's something we've really been mindful of. We're speaking with the College of Veterinarians of Ontario next week to try and talk to them about some of the kind of regulatory issues that are surrounding currently.

And, for example, you touched on one already, you know, technically I'm licenced in the province of Ontario. I should not be treating patients in Alberta or British Columbia, for example. That becomes very difficult when you have people from those provinces, coming onto the network looking for assistance, and we have American companies coming in.

And offering that same service to Canadian pets, we say, OK, well, maybe we need to look at the regulations around this and certain ones being relaxed and then new regulations also being put in place to control the, the service itself. The new technology. No, absolutely.

I mean, and, and I think finally, just to go with coronavirus again, rearing its ugly head, I think we as a practicers, you know, have this responsibility to obviously our clients and our staff. You know, let's make sure we're cleaning everywhere, but also for some of those older clients, maybe at the moment a digital consultation may be better than a, than a physical one. So, a little food for thought to end there, Sharon, and Jason, I know it's very early.

I think we did potentially mix our hours up. Are you now 4 hours behind us rather than 5 of your hours as your clock gone forward? Yes, we, it's it's only 11 o'clock here.

Yeah, yours goes forward a little bit earlier than ours. Ours is at the end of the month and we'll be back 5 hours again. So thank you for for getting up early and .

Sharing that with us has been really fascinating. I hope everybody's enjoyed the webinar, and it will be up on the site in its entirety. Do feel free to pass that and the presentation on to others who you think it will benefit, but as I say, don't worry, don't panic, but perhaps do carry a towel.

Take care everyone, bye bye.