In today’s society healthcare personnel need to be aware of the various chemical, environmental, food borne, water borne and airborne illnesses that abound. Being well versed in this area means understanding the epidemiology, being aware of the signs and symptoms, knowing what treatments or cures and knowing the notification process for outbreaks, should they arise. Severe acute respiratory syndrome also known as SARS is a type of viral Pneumonia that is very serious for those affected. It causes acute respiratory distress for the patient which can cause death. SARS is transmitted by contact. According to the U.S National Library of Medicine the coronavirus can live up to 6 hours on hands, tissues and some other surfaces and can stay active for up to three hours after the droplets have dried (A.D.A.M, 2013). The virus can live in feces for nearly four days and it is unknown exactly how long it can live in freezing temperatures but it is believed to live for months or maybe even years. The Coronavirus family is the same group that births the common cold, just as you can catch the cold over and over again, you can also become re-infected with SARS. Since this is a newer illness only manifesting in 2003 there are still unknowns regarding the illness. One of these things is how long before and after someone is contagious with the infection. It is clear that they are actively contagious while showing symptoms. Usually people who are infected will begin showing symptoms within a few days to two weeks after being initially exposed. This can vary depending on age, immune system compromise and other factors. Symptoms to look for are dyspnea, fever, muscle aches, headache, and a cough that begins 2-3days after the initial onset of other symptoms (A.D.A.M, 2013). If you have these symptoms you need to be seen and treated by licensed medical staff. They will begin by running tests to determine if you have SARS. These tests may include a thorough health check, chest X-Ray, blood tests including a CBC, antibody tests, and possibly a chest CT. If you are suspected of having SARS you will need to be isolated from others due to the highly contagious nature. The medical staff will then begin treating you with breathing treatments, antibiotics to kill the bacteria that cause Pneumonia, steroids to reduce the inflammation in the lungs, and antiviral’s although this is a controversial part of the therapy because it is not clear how well they work. As you battle this illness you will be in isolation and have separate utensils, you will need to cover your mouth when you cough, health care providers will wear special attire to protect you, them and other patients, surfaces will be cleaned with potent disinfectants and good hand hygiene is vital. While the prognosis is good for many healthy adults who seek medical treatment promptly, there is a special risk for those over 65. According to the Center for Disease control around 50% of people greater than 65 years old die after contracting SARS (CDC, 2013). 10% of the general population affected, also expire from this illness. Prevention is possible by avoiding those with SARS, staying out of areas where SARS is not controlled and utilizing proper medical safety equipment when you must go into contact with someone who is infected . World Health Organization (WHO) states that this disease has been found in 17 countries and killed many people (Sophie M. Colleau, 1998). When the outbreak first began daily updates were released and many people were advised against traveling to certain areas to avoid being exposed. It is so deadly that not only did the first patient diagnosed die from it but also the first doctor to diagnose it also died shortly after contracting the illness. The diagram below shows the identified travel pattern of the illness. Since world travel is the norm nowadays this illness has really reached many places. When you look at the map it has touched all the corners of the countries that have been affected, from New York to Alaska to Texas. The key to SARS is quick response globally to any outbreaks and education (CDC, 2013). If SARS were to have a second outbreak the most likely starting point would be China since it originated there and we are still unsure of the cause. It would then spread quickly to areas that have frequent travel to and from China. The most common inbound and outbound travel to and from China is from South Korea, Japan and then Russia (Lin, 2012). Based on this information we would assume that these countries would be the most likely to experience the next wave of SARS.
If you look at the country relations and travel for those countries it would be assumed that the next locations to be affected would be those that they have frequent contact and travel with. South Korea has the most inbound and outbound contact with Hong Kong and Singapore. There is also a high risk of transmission to North Korea, not based on travel but based on the military interaction in what is known as the demilitarization zone that is about 2.5 miles wide and has hundreds of thousands of military personnel that come into contact. These areas then have travel to Iraq, Iran, Pakistan, and due to close proximity there is a lot of ground travel to the northern African countries.
Japans website houses statistics that show they have the most travel to and from the Philippines, Taiwan and the United States (JNTO, 2013). Due to commerce this is to be expected. Mexico would likely be affected due to the high amount of border traffic to and from the US. In fact Mexico and Canada account for over 50% of American travel. Once Mexico has become infected with SARS then it would be logical to assume it would spread to South America since there is a great deal of travel between Mexico and the Northern South American countries.
Since Russia is in close contact with Germany and France and has a vast amount of travel to Canada as well. These countries would likely be affected and then spread to other destinations as travel patterns permit. Australia, New Zealand and Iceland make up the largest sector that receives inbound travel from Canada, France and Germany.
It is important to remember that some areas could avoid being infected. These would be in places like S. Africa where some tribes have little to no interaction with other tribes. Anyone on McMurdo base in Antarctica because they make few inbound and outbound trips or other desolate places. If you review the graph below you can see the travel representation of SARS. It is very dependent upon travel and interaction as to how quickly and where it will spread. If I were in a medical setting and a confirmed case of SARS were identified we would need to take the proper steps and notify certain agencies. First we would need to isolate this patient and wear proper protective gear. Secondly, we need to identify others who have been in close contact with this patient and notify them accordingly of their risk and to seek medical care immediately, informing the care provider of their recent exposure. Next we need to call the local health department so they are aware of what is occurring in the community. Some local health departments will opt to call the State Health Department, if they do not then the medical professional will need to contact the State Health Department and answer any questions they may ask regarding the outbreak.
The Center for Disease Control needs to be contacted and has a website and eight hundred number for medical personnel to call. They can also be consulted if there are questions regarding any potential disease or outbreak. The CDC currently reports that there have been no new cases of SARS reported anywhere in the world since 2004 (CDC 2013).
Air pollution must also be a concern to nurses taking care of people who experience difficulty breathing. This is very true for people who have severe chronic asthma. They need to be notified of when air quality places them in additional danger. When notifying my patients of dangerous air quality I can first education them about why the air quality is harmful to them. They need to understand that Ozone, particle matter, chemicals, dust, nitrogen oxide and sulfur oxide have all been known to trigger fatal asthma attacks in some patients.
The EPA released this air quality index table: EPA's Air Quality Index (Asthma and Air Pollution, 2005)
Air Quality Index (AQI) Values Levels of Health Concern Colors
When the AQI is in this range: ...air quality conditions are: ...as symbolized by this color:
0 to 50 Good Green
51 to 100 Moderate Yellow
151 to 200 Unhealthy for Sensitive Groups Orange
151 to 200 Unhealthy Red
201 to 300 Very Unhealthy Purple
301 to 500 Hazardous Maroon

It is advised for people with seriously debilitating asthma to avoid anything beyond 50 if it can be avoided. For people with moderate asthma they should attempt to avoid anything over 100 (Asthma and Air Pollution, 2005). Patients with asthma should be advised to stay hydrated because the lungs are sensitive and require a special balance of moisture and temperature. Rescue medications should be kept with them at all times and work, school, etc should be notified of their condition. Breathing through the nose and out through the mouth encourages the nose to do more filtering of pollens, dust and debris; this can also help prevent asthma attacks. Taking an allergen filtration mask with you on outings can be beneficial and make sure not to over exert yourself on high pollution days. Patients can be advised of what websites and eight hundred numbers to call to find out what the air quality index is and then they can plan their outings accordingly. If they do not need to go out then they can avoid it. The EPA also keeps air quality patterns so if you know that Wednesday is high pollutant day then patients can schedule their activities around that time. They should also be advised that pollution is higher at peak travel times than in the early morning and late evening. If at all possible during the worst days patients should stay inside with doors and windows closed. Patients with severe asthma who live alone should also have someone who knows of their conditions and checks on them regularly in case they experience a severe debilitating asthma attack.

Works Cited
A.D.A.M. (2013, January 28). SARS. Retrieved from US National Medicine Library: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004460/
Asthma and Air Pollution. (2005, August 6). Retrieved from Natural Resource Defense Counsel: http://www.nrdc.org/health/effects/fasthma.asp
Carolyn Middelton, B. (2003, September 16). Understanding the Physiological Effects of Unrelieved Pain. Retrieved from Nursing Times: http://www.nursingtimes.net/nursing-practice/clinical-zones/pain-management/understanding-the-physiological-effects-of-unrelieved-pain/205262.article
CDC. (2013, April 2). National Outbreak Reporting System. Retrieved from Center for Disease Control and Prevention: http://www.cdc.gov/NORS/about.html
McIntosh K, Perlman S. Coronaviruses including severe acute respiratory distress syndrome (SARS)-associated coronavirus. In: Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Disease. 7th ed. Philadelphia, Pa: Saunders Elsevier; 2009:chap 155.
Sophie M. Colleau, P. a. (1998, November). Retrieved from WHO Pain & Pallatative Care Communications Program : http://www.whocancerpain.wisc.edu/?q=node/244
WHO. (n.d.). SARS Epidemiology to Date. Retrieved from Global Alert and Response: http://www.who.int/csr/sars/epi2003_04_11/en/