SARS Disease, Based on Information

SARS

Disease, based on information of rubric and

Analyze the selected communicable disease outbreak: SARS

Severe acute respiratory syndrome or SARS is a new form of infectious disease which was first recognized in February, 2003. This disease is characterized by the following symptoms: initial flu -- like symptoms which may be accompanied by "… fever, myalgia, lethargy, gastrointestinal symptoms, cough, sore throat and other non-specific symptoms"( Meng). The one specific symptom that was common to all those infected was a fever above 38 "C (100.4 "F) ( Meng).

The SARS pandemic is known to have affected 8098 patients in 26 countries, between November 16th, 2002, and July 5th, 2003 ( Meng). The cause of this disease has been identified as the recently discovered coronavirus. However, it has also been suggested that"…. other infectious agents might have a role in some cases of SARS" (What Causes SARS?).

The first signs of SARS were observed with the emergence of an atypical form of pneumonia which began appearing in hospitals in Hanoi. Within a few weeks this outbreak was followed by other cases in hospitals in Hong Kong, Singapore and Toronto (Kamps and Hoffmann). In March of 2003 the World Health Organization perceived SARS as a worldwide threat and issued travel warnings and recommendations.

From an epidemiological perspective the SARS outbreak and transmission can be traced to the Guangdong Province in China, with the earliest cases being identified in late 2002. This disease was subsequently reported in seventeen countries. This included the rapid movement of the disease to Hanoi, Hong Kong, Singapore and Toronto (SARS epidemiology to date, 2003).

A central characteristic of the epidemiology of this disease was the occurrence of secondary transmissions outside hospitals and healthcare setting (Kamps and Hoffmann). However, the travel recommendations issues by the WHO were effective in that;

…After the recommendations had been issued, all countries with imported cases, with the exception of provinces in China, were able, through prompt detection of cases and isolation of patients, either to prevent further transmission or to keep the number of additional cases very low.

(Kamps and Hoffmann)

In an extensive epidemiology study of SARS it was found that the incubation period of SARS was estimated to be 6.4 days and the average time from the onset of clinical symptoms to hospital admission varied from 3 to 5 days (Yang, 2009). Furthermore, the mortality rate in those admitted to hospital was "… 55.0% in patients 60 years of age and older and 6.8% in those below 60"(Yang, 2009).

The last reported cases of SARS occurred in April 2004. The occurrence of this disease has, according to reports, been fully contained. "As of today, the spread of SARS has been fully contained," with the last infected human case seen in June 2003 and a laboratory induced infection case in 2004 ( Markey ).

Nevertheless, containment does not necessarily mean eradication of the disease and it still may be present in hosts such as animal populations. As one study notes; "However, SARS is not claimed to have been eradicated (unlike smallpox), as it may still be present in its natural host reservoirs (animal populations) and may potentially return into the human population in the future"( Severe acute respiratory syndrome).

The above has serious implications for the medical and nursing profession. As SARS has not been eradicated this could potentially mean that every community is still open to the possibility of a new SARS outbreak. This potential threat is increased considerably by the ease and frequency of international travel and by contemporary phenomena such as globalization. This in turn necessitates constant vigilance on the part of the nursing and healthcare community.

Figure 1. The spread of SARS

( Source: http://www.vadscorner.com/sars.html)

B. Explain the appropriate protocol for reporting the possible outbreak

All protocols intended to prevent and deals with an outbreak of this disease must take into account the fact that, "The primary way that SARS appears to spread is by close person-to-person contact. SARS-CoV is thought to be transmitted most readily by respiratory droplets produced when an infected person coughs or sneezes" ( Meng) . This means that the disease is highly contagious and communicable and this therefore places a practical and ethical emphasis on the way that the disease is reported.

This in turn means that the reportage of this disease must take into account the debate relating to individual confidentiality as well as public protection and awareness of the disease. As one study of this aspect notes:" Considering the relationship between SARS and public health, conflicts may arise between respect for persons (and their privacy) and autonomy or beneficence (the promotion of human welfare)" (National Ethics Teleconference: Health Care Ethics Issues Raised by SARS, 2003).

It is therefore incumbent on the medical and healthcare authorities to report the occurrence of this disease in a way that ensures public safety but which is also as sensitive as possible to private confidentiality. The primary role of the health professional is to educate the public about the necessity for isolation and secure management of the SARS patient and any of the people who may have come into contact with him or her ( Surveillance Protocol for SARS -- Draft).

Consequentially, the protocols surrounding the reporting of SARS revolve around the central themes of communication and education. " Rapid and frequent communication of crucial information about SARS -- such as the level of the outbreak worldwide and recommended control measures -- are vital components of efforts to contain the spread of SARS-CoV" (Key Measures for SARS Preparedness and Response).

Therefore, a central protocol would be to ascertain the correct level of the outbreak and danger to the community and convey this information clearly and unequivocally; as well as the recommended control measures. In this regard it is important to note that, "…the preparation and dissemination of messages and materials are designed to maintain vigilance in the healthcare community and general awareness among all parties about the possibility of a SARS outbreak" (Key Measures for SARS Preparedness and Response)

It is essential that the dissemination of information about the SARS outbreak should be designed to maintain public order and minimize public panic. This would include the rectification of any false rumors or inaccuracies that might abound and cause public confusion. Another more practical aspects is that provision should be made for state, local, and federal communication and emergency response personnel to meet and work together in dealing with sensitive issues and media inquiries ( Key Measures for SARS Preparedness and Response).

The medical and healthcare team should also be prepared to respond to any media queries. This can be facilitated by the perpetration of fact sheets and key messages, as well as question-and-answer documents ( Key Measures for SARS Preparedness and Response). Another aspect of the protocol that should be adhered to is the coordination of reports by spokespersons and experts on the subject.

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

Indoor air quality (IAQ) refers to the air quality within a certain area and the way that this index of quality relates to the health of the patients within that area or building. The quality of air can be adversely affected by a number of factors. These can include microbial contaminants such as (mould, bacteria) and gases such as carbon monoxide or radon.

Monitoring the quality of air is obviously extremely important to the healthcare professional as poor air quality could negatively affect patients with respiratory diseases and asthma. The care of patients therefore needs to be modified in the event of poor air quality.