Environmental & Global Health Issues
Barbara Salinas
Community Health Practice SZT1
Western Governors University
August 29, 2014

Environmental & Global Health Issues
SARS
The first pandemic of the 21st century began in February of 2003. The people of Asia were the first to be infected but the disease quickly spread world-wide. By the end of this pandemic over 8,000 people had become ill and 774 had died. The illness associated with this pandemic is known as Severe Acute Reparatory Syndrome, or SARS.
The infectious agent associated with SARS is a virus that appears to have crown-like spikes on its surface. This virus is known as the coronavirus. This virus has four sub-groups and was commonly known to infect animals. In the 1960’s there were six strains of the coronavirus that were discovered to have the ability to infect humans. The particular strain of this virus responsible for SARS was the SARS-CoV. This particular strain of the virus has the ability to infect humans and animals (CDC, 2012).
SARS is a contagious virus that is spread through droplets from person to person. This occurs as the infected person coughs or sneezes on or near a non-infected person. The droplets travel through the air as they land on the non-infected person the virus begins to invade their body. Shortly after the SARS-CoV virus has invaded and multiplied in the human body the individual may begin to experience upper respiratory symptoms such as high fever, headache, body aches, weakness or fatigue, loss of appetite, and a runny or stuffy nose. As the disease progresses, these individuals begin to experience a cough, shortness of breath, diarrhea, and often times progresses to pneumonia (CDC, 2012). As with many diseases, elderly persons, young children, and individuals whose immune systems are weak or have an underlying condition such as diabetes or heart disease are most susceptible to this virus. Falls and broken bones are an additional risk for the elderly because as the virus suppresses their appetite their strength deteriorates causing increased weakness and unsteadiness. As this disease progresses hospitalization may be necessary to treat those with severe symptoms such as respiratory distress requiring mechanical ventilation, multiple organ failure, or sepsis (Peiris, Yuen, Osterhause, & Stohr, 2003).
Individuals who were strong enough to survive this disease often times suffered from the long-term effects. Respiratory impairment, lung fibrosis, and muscle weakness were common symptoms that occurred in 6 to 20 percent of the individuals who had been discharged from the hospital. Some of these indiviuals also suffered from depression and post-traumatic stress disorder due to the severity of the illness and the hospitalization (Peiris, Yuen, Osterhause, & Stohr, 2003). Diagnosing SARS is a difficult task. The World Health Organization states that the diagnosis of SARS is an “acute febrile illness with respiratory symptoms not attributed to another cause and a history of exposeure to a suspect or probable case of SARS or their respiratory secretioins and other bodily fluids.” There are some laboratory tests that are being investigated to help to identify the SARS-CoV virus. Some of these tests include reverse transcription polymerase chain reacton (RT-PCR), anti-body tests, and cell cultures. While positive results identify the SARS-CoV virus as an infecting agent, a negative result can not be disqulaified because of several factors which may include a “false-negative” result or the specimen may have been collected when the genetic material of the SARS-CoV virus was not present. Depending on the sample collected the genetic material for the SARS-CoV virus is only present for a small period of time which makes it difficult to capture (SARS: Laboratory diagnostic tests, 2003).

International Pattern of Movement

As you can see from the above graph, SARS quickly spread from on place to another creating the first pandemic of the 21st century. The initial contamination began in Hong Kong and quickly spread through out the world.
(Outbreak of severe acute repiratory syndrome worldwide, 2003).

SARS in My Community
I live in a small rural community with a population of 1,500. Our community is referred to as a “bedroom community” because we are within about an hour of several large cities. Our quiet small town has a low crime rate and cheap housing so many of the people who live here travel to work in the larger cities. There are not enough children here to have our own school so we have a combined school system where we have joined with two other small towns. The children are bused to the appropriate schools depending on the grade they are in. Elderly farmers also make up a large portion of our community as well. If SARS were to infect our small community it would be devastating not only for us for surrounding communities as well. The adults would spread it to the large cities and the children and farmers would spread it to surrounding communities as they attend school or through the planting and harvesting of crops.
An example of how SARS may be transmitted through our community might include the response of our local volunteer fire department. We do not have an ambulance in our small town so if someone calls for medical assistance due fever, weakness, cough, or diarrhea, as associated with SARS, our volunteer fire department would respond. If the individual they were responding to was suspected of having SARS, chances are they would not know it until they were transported to one of the surrounding hospitals. Each and every one of the firefighters that responded to the call of the ill person would have the possibility of unknowingly becoming infected and bring it home to their families. As the children go to school in the different towns and the adults go to work in the large cities, the disease would be spread. As the farmers become ill food production would decline thus affecting the availability of food not only for our community but for many around us. Much of the crops our farmers grow is shipped throughout the world. A decline in crop production would result in a decline of feed for animals as well as food for the people. A decline in food and feed results in an increase of not only the possibility of SARS but other illnesses as well. An outbreak of SARS in our community would be similar to that of a wild fire. It would be devastating and disastrous to our community as well as the surrounding communities while possibly having an effect on the entire United States!
Reporting a SARS Outbreak
When a community health nurse is working with a patient in the community who may have been infected with SARS it is very important to investigate and report it to the local health department. If a patient has respiratory symptoms such as the ones associated with pneumonia or SARS the community health nurse should ask the patient if they have been out of the country or around anyone who may have been diagnosed with SARS. It is also important to ask the patient if they had visited someone in the hospital setting who may have had a respiratory illness. If SARS is suspected it is required by the Minnesota Department of Health (MDH) to report these cases 24 hours a day, seven days a week.
If a sample of body fluid is collected it must be placed in an isolate which can be obtained from a laboratory. The sample then must be transported to the MDH, this can be done by highway, rail, vessel, air, mail, or a courier. All samples must go directly to the MDH for analysis (Infectious Disease Reporting, 2013).
Poor Air Quality Index
When client have conditions such as asthma, COPD, or any other respiratory condition it is very important for them to monitor the quality of the air to avoid respiratory emergencies. One tool that can be used for this purpose it the air quality index. This will give the patient a good indication how clean the air is before the venture outdoors. This index is very important in areas such as large cities or places where factories may pollute the air. The air quality index has a rating scale that goes from 0 to 500. The higher the number on the index the worse the amount of pollutants in the air and the greater risk for problems (Air Quality Index, 2014).
If a client has the need to go outdoors when the air quality index is high, there are several suggestions that should followed to avoid a breathing emergency. The first suggestion is if at all possible stay indoors on days where the air index is high. Reschedule appointments if possible or have family members or friends run errands for you and deliver them to your home if supplies are needed from the store. A second suggestion is to always make sure that the client with breathing problems has their medications such as rescue inhalers with them at all times. Rescue inhalers are designed for breathing emergencies and should only be used when necessary. If the client finds that they are using their rescue inhaler quite frequently then they should be advised to visit the physician the prescribed the medication so changes can be made offering the client better coverage when an emergency arises.
Encourage the client to stay hydrated. Dehydration is never good for the body. When the individual has breathing issues dehydration can increase the severity of the symptoms. It is also good practice for the client to breathe through their nose instead of through their mouth. This is an important tip simply because inside our nose we have tiny hairs that help to filter out pollutants that can irritate the lungs. When breathing through the mouth there is no protective filter to improve the quality of the air that enters our lungs.
If the client still must venture out doors, encourage them to wear a mask. This will act as an additional filter that will minimize the amount of pollutants that enter the lungs. Doing out door chores in the morning is another valuable tip. As the day progresses and more and more people travel the amount of pollutants in the air rises. The lowest levels are usually in the morning hours which may also be when it is the coolest outside (Payne, 2010).
One final valuable tip for those with lung issues is that if they are a smoker to seek a program to help them quit. Many people with breathing issues continue to smoke, even if the person has severe lung disease, smoking cessation can improve lung function making it easier to breathe. There are many other benefits that go hand-in-hand with smoking cessation in addition to improved lung function such as better air quality, additional monies that were spent on cigarettes can now be used for other purchases, reduced risk for blood clotting disorders, improved immune system, and reduced risk for developing other diseases including cancer. Once the person stops smoking the body begins to repair the damage that had been done, not all the damage may be repairable but it will improve giving the client a higher quality of life.

References
Air Quality Index (AQI) - A guide to air quality and your health. (2014, May 22). Retrieved September 2, 2014, from Air Now website: http://airnow.gov/index.cfm?action=aqibasics.aqi
Infectious Disease Reporting. (2013, September 27). Retrieved September 2, 2014, from Minnesota Department of Health website: http://www.health.state.mn.us/divs/idepc/dtopics/reportable/clinmat.html
Outbreak of severe acute respiratory syndrome worldwide, 2003. (2003, March 28). Retrieved September 2, 2014, from Centers for Disease Control and Prevention website: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5212a1.htm
Payne, J. W. (2010, June 11). Air pollution and asthma: 4 ways to stay safe on 'ozone-alert' days. Retrieved September 2, 2014, from US News and World Report website: http://health.usnews.com/health-news/family-health/respiratory-disorders/articles/2010/06/11/air-pollution-and-asthma-4-ways-to-stay-safe-on-ozone-alert-days Peiris, J. S.M., M.D., Yuen, K. Y., M.D., Osterhause, A. D., Ph.D., & Stohr, K., Ph.D. (2003, December 18). The severe acute respiratory syndrome. Retrieved September 2, 2014, from Mayo Clinic Library website: http://google3.mayo.edu/search?mayobanner=source&search=&client=tab_intranet&site=tab_arizona%7Ctab_jacksonville%7Ctab_rochester%7Ctab_mhs&proxystylesheet=tab_intranet&getfields=description&output=xml_no_dtd&q=sars&search_string=&searchRealm=on&bannerQuery=sars
SARS basics fact sheet. (2012, July 2). Retrieved September 2, 2014, from Centers for Disease Control and Prevention website: http://www.cdc.gov/sars/about/fs-SARS.html
Severe acute respiratory syndrome (SARS): Laboratory diagnostic tests. (2003, April 29). Retrieved September 2, 2014, from World Health Organization website: http://www.who.int/csr/sars/diagnostictests/en/