Communicable disease outbreak (SARS) by doing the following: Describe the communicable disease outbreak.

A community wide outbreak of severe acute respiratory syndrome (SARS) within the greater metropolitan area of Los Angeles County would represent one of the most dangerous and damaging health incidents in America's recent history. An extremely virulent manifestation of the human coronavirus SARS-CoV, SARS is known to cause severe fever in exposed patients which is typically accompanied by aches, chills, myalgia and other bodily symptoms. This extreme fever is soon worsened when "a lower respiratory phase begins with the onset of a dry, nonproductive cough or dyspnea, which might be accompanied by or progress to hypoxemia" (Los Angeles County Department of Public Health, 2011). Because the disease is so easily transmitted from patient to patient through physical contact, outbreaks of SARS are relatively common when proper precautions are not taken during the initial stages of exposure.

2. Describe the epidemiological indicators associated with the identified disease.

During the initial stages of a SARS outbreak, it is critical that a community health nurse examine the epidemiological indicators associated with the disease and apply them to their patient population. One of the most reliable epidemiological indicators in the case of SARS has been observed to be "travel, including transit in an airport, (or close contact with an ill person with a history of travel), within 10 days of onset of symptoms to an area with current or recently documented or suspected community transmission of SARS (Mainland China, Hong Kong, or Taiwan in particular)" (Los Angeles County Department of Public Health, 2011). Because of the close association between travel to these areas and exposure to SARS, screening patients by their recent travel history and quarantining those who may be at risk is an important step towards containing a potential outbreak. Another prime epidemiological indicator for SARS is employment status as a health care worker, which means that I may have an increased risk of exposure to SARS in my capacity as a community health nurse. Considering the primary route of transmission for SARS, which is spread through direct contact with infectious respiratory excretions, the most common epidemiological indicator would obviously be close exposure to a person who is already infected with the disease.

3. Analyze the epidemiological data on the outbreak (see attached document).

Following the devastating global SARS outbreak in 2003, the World Health Organization (WHO) undertook the enormous effort of compiling epidemiological data on the disease. The population cohorts most likely to contract the disease, mortality rates for those infected, and the identification of transmission chains are among the many factors that the WHO considered when compiling their research. Ultimately, the WHO concluded that "a cumulative total of 8422 probable cases, with 916 deaths, were reported from 29 countries during the outbreak" while observing that "the last chain of human transmission was broken on 5 July" (2003). It has also been reported that "of this total, 5327 cases and 349 deaths are reported from mainland China" while "a global case-fatality ratio of 11% was recorded at the end of the outbreak" (World Health Organization, 2003). The most likely precipitating factor prior to the contraction of SARS was found to be airline travel, because literally thousands of infected individuals travelled on cross-country and international flights prior to the disease's identification. Due to the close confines of commercial airline travel, infected individuals unwittingly spread SARS to those they sat near, flight attendants, and airline workers.

4. Discuss the route of transmission of the disease causing the outbreak.

According to the Communicable Disease Manual, published by the Los Angeles County Department of Public Health, "the main route of transmission is direct contact, via the eyes, nose, and mouth, with infectious respiratory droplets" (2011) during a suspected SARS outbreak. Subsequent studies of SARS outbreaks have demonstrated that objects like clothing can also be contaminated by "infectious respiratory secretions or other body fluids" (Los Angeles County Department of Public Health, 2011), which means exposure to an infected individual through close physical contact is the most likely precipitating event for spreading the disease. While SARS was initially believed to be transferrable through airborne transmission or fecal-oral contact, nearly a decade of dedicated research has disproven this theoretical route of transmission. Patients infected with SARS are considered to be communicable almost immediately upon diagnosis, and because of this fact many nurses and health care workers become exposed to SARS during an outbreak.

5. Create a graphic representation of the outbreak's international pattern of movement...

The relatively rapid spread of the disease through air travel, from China and neighboring Asian nations to Europe and the United States, is clearly demonstrated by the data collected by Banos and Lacasa:
Part 2: Imagine that you are a community health nurse. You suspect that a family that has just returned from travel overseas has contracted SARS. Soon, several other community members present the same symptoms. Testing occurs in your health clinic and the presence of SARS is confirmed.

Explain the appropriate protocol for reporting the possible outbreak.

The role of a community health nurse is multifaceted and demanding, ranging from the personalized care delivered to individual families to maintaining the overall health of a large urban area. The ability to recognize the range of conditions which can precipitate an outbreak of communicable disease, such as the return of a person or family from a trip abroad, is an essential skill for a capable community health nurse. If I suspected that a family returning from overseas has unwittingly transmitted a potentially lethal disease like sudden acute respiratory syndrome (SARS) within my community, the first step would obviously involve comprehensive testing throughout the area. When the presence of SARS was conclusively confirmed, adherence to the established protocol for reporting potential outbreaks of communicable disease would be my paramount concern, because failure to properly manage a situation such as this could result in a health disaster of terrible proportion. The Los Angeles County Department of Public Health advises nurses and other health care workers to report suspected cases of SARS immediately by telephone, before completing the SARS Screening Form and other associated documentation.

The first step in managing a potential SARS crisis would be the efficient identification and quarantine-based isolation of infected patients, because "the rapid spread of SARS, its unique capacity to infect health care workers, and its many unknown features in the early days of the outbreak" (Murphy, 2006) combine to make the disease especially prone to outbreak. The expedient establishment of neighborhood triage centers would also be necessary, in order to quickly screen patients for the symptoms of SARS and administer appropriate treatment. Owing to the lessons learned by Chinese doctors and nurses during the initial SARS outbreak of 2003, I would be mindful of providing ample room within these triage centers to give patients distance from one another, thus reducing the rate of transmission from infected patients to those who have not yet been exposed.

Part 3: The news has just announced that the air quality index is poor. As the community health nurse, you are concerned about your clients who have asthma and other respiratory diseases.

Discuss how you would modify their care to address the increased risk due to poor air quality.

A competent and qualified community care nurse is capable of monitoring the overall health of the town or neighborhood they serve, while also paying special attention to the pressing needs of individual patients when atypical circumstances arise. For health care professionals practicing in the metropolitan heart of Los Angeles County, one of the most severe risks to the overall health of patients both young and old is the omnipresent layers of smog and other air pollutants which ring the city. Patients suffering from preexisting respiratory ailments such as asthma are known to experience higher rates of poor health episodes, and according to the Los Angeles County Department of Health Services "Among children 14 years and younger in Los Angeles County, asthma accounted for nearly 40,000 hospitalizations during the period

1995 -- 1997" (2001). As a community health nurse, I would be responsible for monitoring the news for updates on the Air Quality Index, which measures the air for particulate matter, ozone, and other pollutants, and reacting appropriately when the air may harmful to my patients.

In order to effectively reduce the risk of poor air quality affecting my asthmatic patients, it would be advisable to construct a simple email chain with myself at the center, so that reductions in the Air Quality Index automatically generate notices which are sent to asthmatic patients, or any patient suffering from respiratory disease. Patients would be encouraged to forward these messages to friends and family with the same symptoms, so a maximum number of potential health hazards are avoided. I would include advisements from the South Coast Air Quality Management District, a government agency which assists in overseeing the Air Quality…