Community Health Nursing Term Paper

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SARS

Severe Acute Respiratory Syndrome (SARS) is a form of respiratory disease that is caused by a virus (corona virus). It is a form of pneumonia whose cause was identified to be a virus sometime in 2003.The is a highly communicable illness which spread worldwide within a period of few months before the outbreak was contained.

The outbreak

The SARs epidemic was reported to have first started in Guangdong Province in south China in the month of November 2003.The first case was however reported to have originated from Shunde in Guangdong province of china in November 2002.The first patient was a farmer who was treated at Foshan in a hospital -The First Peoples' Hospital. (McKay).However, the patient passed away later on. No definite diagnosis was made regarding the patient's cause of death. Even though the Chinese government was taking measures to contain the spread and infection of the disease, they never reported the disease's presence to the rest of the world or to the WHO until the February of 2003.

The holding of information regarding the outbreak cased too much delay in devising efforts to curtail the spread of the epidemic. This eventually resulted to a worldwide cry and criticism of China by the entire global community. The Chinese government however made a public apology to the whole global community for acting slowly to the matters that pertain the control and reporting of the SARS illness.

The very first clue of the epidemic was on November,27th of 2002.This is when an electronic medical warning system which is an element of the World Health Organization's Global Outbreak and Alert Response network (GOARN) detected various reports of a certain flu outbreak in the People's Republic of China. This was through the analysis of various media content. The initial reports that were analyzed by the system were in Chinese. This presented a challenge since by the time of SARS outbreak; the system could only support English and French reports. The WHO then eventually requested for more information regarding the outbreak from the Chinese government on the 5th and 11th of December, 2002.The fact that the GOARN network could not identify the outbreak early enough proved that it was defective. It was after further information was received from the Chinese government that the WHO issued the details of the outbreak. The details included the name and the definition of the pandemic. The WHO also activated a systematic and coordinated worldwide outbreak network whose role was to bring sensitive attention together with the appropriate containment procedures that were to avert further spread of the pandemic (Heyman,2003).

A2: Indicators

Epidemiological indicators

The World Health Organization (WHO) came up with the key epidemiological indicators of SARS after it conducted .The WHO held its very first global meeting regarding the epidemiology of SARS in Geneva, Switzerland on 16th -17th of May, 2003.The key indicators were identified on the basis of a variety of factors. These factors were seven in number. The first one being the incubation period which is the amount of time that elapses between the moment of exposure to the exposure to a SARS s and when signs and symptoms are first noticed. The incubation period of SARS usually lies between two and seven days. In rare cases though, the incubation period can be extended to a period of ten days. This indicator was particularly important to the WHO in the process of facilitating the development of an elaborate research plan which was necessary to enable the evaluation of the relevant public health policies for use in the process of containing and controlling SARS (WHO, 2003).

The second parameter or indicator is the infectious period. This indicator was put in place in order to come up with an appropriate clinical data regarding the onset and the change in the major signs and symptoms of the SARS. These signs and symptoms comprise of high fever, coughs, and diarrhea and dyspnoea. The changes in X-ray outcome is also noted under this factor. The other important parameter on this parameter is the degree of viral shedding which must include both the retrospective and prospective analysis.

The third factor in the evaluation of the epidemiological indicators is the Case-fatality ratios. This indicator is evaluated from statistical techniques. This is as opposed to the consideration of the aggregate data that is never reliable in the estimation of the case-fatality ration in the course of the SARS epidemic. The statistical method that is employed in the evaluation this ration as its basis on the various case-based data that has laboratory backing. The statistical techniques employed are chosen in order to present both parametric and nonparametric survival analysis. The evaluation of this parameter aids in the establishment of the criteria used to distinguish the causes of death due to SARS with death that result with SARS being a co-morbidity factor.

The fourth factor is the route of transmission of SARS. This indicator is used in determining the possible routes through which SARS can be transmitted. While evaluating this epidemiological indicator, it is necessary to pay special attention to very confined spaces such as aircrafts, vehicles, offices, hospitals among others. This indicator takes into account the various routes of transmission, the necessary dose of exposure and the various risk factors that aid in the transmission. The fifth factor in the evaluation of the epidemiological indicators is the significance of the subclinical infections/incidences. This was devised by the WHO in order to be determined by way of serological testing of individuals who are suspected to be having SARS. It is carried out on patients who have either symptomatic or asymptomatic infection.

The sixths is the reproduction number of the SARS in the various transmission settings which is also taken into account. The final factors were the animal and the various environmental reservoirs.

A3: Data

Incubation Period.

The incubation period of SARS was reported to have a median of a 4-5 day period. The minimum incubation period is 1 day as reported from a Chinese case. An analysis of 1425 cases in Hong Kong by Donnelly etal (2002) indicated that the optimum likelihood estimation of the time needed for the virus to incubate was 6.37 days. The maximum reported incubation period was ten days. It was also observed that the transmission efficiency of the virus was highest from patients who were severely ill. This occurs during the second week of falling ill.

Case-fatality ratios (CFR)

An outbreak of SARS is marked with a great amount of both morbidity and mortality. The estimate of the case-fatality ratio is statistically evaluated to range from 0% to more than 50% .A WHO CFR estimate is a crude figure of 14% which were recorded at Singapore and another 15% reported from the Hong Kong case (WHO,2003).

Infectious period

The infections period was determined from a variety of test. The analysis and tests which included virus shedding and several serological analyses among the patient who had been quarantines in Hong Kong revealed the extent of infectivity. The test was conducted from th time of infection's onset up to the time of infectivity. The infectivity is estimated to be about 1.2% and 2.4% depending on the level of contact

A5: Graphical representation

Graphical representation of the SAR outbreak in selected International sites.

Source: WHO Consensus Report, 2003.

A6: Effect on Community.

The SARS outbreak has numerous effects on the general community. The initial effects would be felt on the economy of the community. The community's economic standards would be affected adversely due to the fact that no economic activities would go on due to the quarantine and fears that would grip the community. People would not freely participate in their daily activities such as shopping and working. This therefore would lead to loss of revenue and income for some members of the community (WHO,2003).

The other effects of SARS on the community is the decrease in the level of social activities since most social events are discontinued in order to avert further infections. This is due to the fact that SARS in highly contagious and therefore measures are taken in order to reduce the chances of its spread. This fact leads to the closure of all entertainment spots and even the shutting down of public transportation networks.

The community members are also subjected to various psychological stresses since they remain confined in their houses as recommended by the WHO. The lack freedom of movement and assembly is another cause of psychological stress. The general fear that grips the community too is a cause of major stress.

B1: Protocol

Appropriate protocol for reporting SARS outbreak

After confirming the outbreak of SARS in our community health clinic it is imperative to initiate a reporting procedure in order to avert the rapid communication of the disease to other community residents and also to the general global village. This is necessary since SARS is a major global concern that demand an unprecedented and yet multifaceted response. Since the management of SARS had been outlined due to…[continue]

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