SARS is known as Severe Acute Respiratory Syndrome. SARS was identified in late February 2003 by Dr. Ubani World Health Organization epidemiologist, but the first case of SARS was seen in November 2002 in the Guangdong Province of Southern China. The SARS was particularly seen within the healthcare workers and in their family members. The most of cases were fatal. Due to the unknown respiratory disease and it was spreading fast among people. World Health Organization (WHO) was notified. By the time WHO was involved, there was already 305 cases and five deaths of an unknown disease were reported (Christian, 2003). A medical doctor who was caring infected personnel in Guangdong Province in February 2003 was the source of transmission of the infection. This doctor traveled to Hong Kong and stayed in the hotel at ninth floor for one night. During his stay at the hotel, the virus was spread among the other guests who were staying in the ninth floor of the hotel. From there, these guests and visitors implanted outbreaks of cases to the various hospitals of Hong Kong, Vietnam, and Singapore. Concurrently the SARS was spread worldwide by air as infected individuals travel back to their home to United States of America, Canada (Toronto), and other countries of the world. (Christian, 2003). From November 2002- July 2003, there were a total of 8,098 possible cases of SARS were reported to the WHO from 29 different countries. From 8,098 cases, 774 deaths were reported. The ratio’s of mortality was reported to be Singapore was 14%, Hong Kong 17%, France 14%, and Canada 17% (Sars basic fact, “2012). The SARS epidemic was contained in July 2003.
SARS is severe respiratory disease, and corona virus causes it. Corona viruses usually related to respiratory disease in some animal kind. Usually SARS has about 4-6 days of the incubation period. The most people started to feel sick within 2-10 days of exposure to the virus. The first primary symptom is high fever then it followed by headaches; generalized weakness and body ache, chills; rigors are common symptoms of the disease. Ten to twenty percent of patients did experience some diarrhea. The first 2-10 days, patient also experienced nonproductive cough, shortness of breath, and hypoxia as disease progressed. The initial phase of the disease, the chest x-ray, doesn’t show any changes and are negative. As the disease progressed, the chest x-ray shows some interstitial infiltrates this means development of pneumonia. Because of the development of pneumonia, about 15-25% of patients require mechanical ventilation, despite mechanical ventilation half of the patient’s still die. The risk of dying with SARS increases with advanced age and any other underlying medical condition for example diabetes. The death rate of 10% can increase to 50% in patient’s older than age of 60 (Parashar, 2004). Blood test shows decline in absolute lymphocyte count with normal to low white blood cell count. About 70-90% of patient showed a lymphopenia and 30-50% showed thrombocytopenia throughout peak stage (Parashar, 2004). Liver and renal functions need to monitor closely. The treatment of SARS usually supportive and also depends on the patient’s clinical picture. SARS treatment is usually similar to pneumonia antipyretics for fever, oxygen for hypoxemia, and ventilation in severe cases. There is no known supportive data on the effectiveness of the vaccine or antiviral agents (Trivedi, 2011 P. 1). The epidemiological data on SARS approximated mortality rate between 14-15%. During the epidemic, there were 8098 possible cases of SARS with 774 (9.6%) deaths reported in different 29 countries (Parashar, 2004). The highest rate of cases was reported in China and Hong Kong. There were also some cases in Taiwan, Singapore, and Canada. Most of patients who got the virus were between 25-70 years of age. There were only few cases under 15 years and younger. The most of people were infected before the global alert was issued. There were only 27 cases of SARS in United States with no deaths. SARS transmission among people was fast and it made difficult to control the outbreak. Early Recognition and initiation of isolation of infected people is necessary. It is also essential to provide information to the infected communities and initiation of a global alert was also helpful to contain the spread of SARS.
Route of Transmission
Corona virus causes SARS, and it is usually found in some animal kind. Thirty percent of SARS cases were found in people who were handling food. Corona
virus is usually spread by close contact with infected respiratory droplets of the sick person. The major mode of transmission is a close person to person contact. An infected person sneezes or coughs in the air and their droplets spread about 3 feet in distance. If a healthy person is standing nearby (about three feet) than the droplets enters into their mucus membranes of the nose, eyes, and mouth. The SARS can be spread by touching an infected object and then touches your nose, eyes, and mouth. The close contact also means sharing your eating or drinking utensils, kissing and hugging, and talking and standing by sick person. There is no evidence data on airborne transmission. The transmission can be prevented by identifying and isolating the infected object. The most important step to stop transmission of any disease is hand hygiene either using alcohol based hand sanitizer or simple hand wash with soap and water. Wearing proper mask is also important since droplets spread SARS.
Effect on Community
SARS outbreak had a high effect on communities of all over the world. It did affected communities economically and psychosocially. According to the World Health Organization, airline industries lost business approximated from 30,000 to 140,000 million US dollars. Due to the outbreak people were canceling their flights to Asian countries. Effected communities also suffered psychosocially. Some ethnic groups experienced discrimination and quarantined. The affected communities suffered from fear and anxiety. People stop going out due to the spread of disease. Many schools and borders were closed for a course of time. To decrease stress and anxiety among people education about SARS was given. People were taught about signs and symptoms of the disease and how the disease was spread. Education was also given on how to control infection such as covering mouth or nose during coughing or sneezing, wearing mask at crowded places, using tissues to contain mucus, and the importance of hand washing with soap and water.
Every state has a protocol how to report a communicable disease. These protocols help health care provider to prevent the outbreak of a communicable disease. When health care provider finds a case of SARS, the initial step is to isolate the infected person. The second step is to notify state and county health department about the possible case of SARS. The Center for Disease Control should also be notified about the case. According to the Center for Disease Control, it is mandatory for healthcare worker to report ” All persons requiring hospitalization for radio-graphically confirmed pneumonia who report at least one of three risk factors for exposure to SARS-CoV, any clusters of unexplained pneumonia especially among health care workers, and any positive SARS-CoV test results” (“In the absence,” 2005). The main step for any heath care facility is to arrange for the SARS laboratory test. Once the SARS laboratory test is confirmed, and it is positive in the infected person. The next step is to do further testing of the sick person such as chest x-ray, blood cultures, pulse oximetry, the sputum sample for gram stain and culture, complete blood cell count, influenza A and B test to rule out viral illness, and urine test Legionella and pneumococcal antigen (“In the absence,” 2005). Sick person should admit as an inpatient and placed on droplet precautions. Family or Friends and any possibly exposed people to the sick person should be notified and assessed for signs and symptoms of the disease.
Modification of Care
Air quality index (AQI) is used for to monitor the air quality outdoors. The air quality index is used to notify public about the air pollution. It helps the patient who has respiratory illnesses such as asthma, emphysema, bronchitis either acute or chronic, flu or SARS and the old people and pediatric population. These people fall under a sensitive group. According to Environmental Protection Agency, the air quality index scale is 0-500, but in United States it never exceeds above 200 (“Patient exposure and,” 2014). This is the reason in most of the cases the index is usually shown between 0-300. Increase number of air quality index represents increased air pollution. Air quality index number is 100 or lower is usually decent. If the air quality index is higher than 100, it is not healthy for the sensitive group. Even air quality index of 51 can cause symptoms in people with respiratory problems. Air quality index number of 51 represents moderate air quality. It is essential to teach patients about air quality index website www.airnow.gov so they can continue to monitor air quality. The days of poor air quality index, the people who have respiratory problems should plan to stay home or indoors as much as possible. They should avoid exhausting activities or exercising outdoors. The people should also keep windows and doors closed and keep checking the air quality index and plan their activities accordingly. If the affected person cannot stay inside, he or she should wear a mask before going out. People should be educated about triggers what makes their disease exacerbation, about signs and symptoms of their disease such as Shortness of breath, cough, and wheezing. They should keep their rescue inhalers nearby in case of emergency. It is also necessary to teach them about when and where to get medical attention. Affected people can be benefited from antihistamines, nebulizers, and decongestant.
Christian, H. (2003). Sars reference 10/2003. (Third ed., Vol. October, p. 170). Flying publisher. Retrieved from http://www.sarsreference.com In the absence of sars-cov transmission worldwide: Guidance for surveillance, clinical and laboratory evaluation, and reporting version 2. (2005, May 03). Retrieved from http://www.cdc.gov/sars/Surveillance/absence.htm Parashar, U. (2004). Severe acute respiratory syndrome: review and lessons of the 2003 outbreak. International Epidemiological Association, 4(33), 628-634. Retrieved from http://ije.oxfordjournals.org/content/33/4/628.full Patient exposure and the air quality index. (2014, March 12). Retrieved from http://www.epa.gov/o3healthtraining/aqi.html (“Sars basic fact,” 2012)Sars basic fact sheet. (2012, July 02). Retrieved from http://www.cdc.gov/sars/about/fs-SARS.html Trivedi, M. N. (2011). Severe Acute Respiratory Syndrome (SARS). Retrieved from http://emedicine.medscape.com/article/237755-overview The World Health Organization. Retrieved on November 27.2012