Western Governors University
Kyle Mawer
HAT1 Task 3

A1. Outbreak SARS stands for severe acute respiratory syndrome. This syndrome is a viral respiratory infection caused by a member of the coronavirus family (PubMed Health.gov, 2011). This virus belongs to the same family of viruses that cause the common cold. Linked to being a serious form of pneumonia, it presents symptoms like difficulty breathing, fevers, cough, chills and shaking, and muscle aches. The outbreak of SARS originated in the Guangdong Province, in southern China, in November 2002. It is suspected that SARS started in small mammals in China and spread to humans who handled these mammals (PubMed Health.gov, 2011). Another source states contaminated sewage was found to be responsible for the outbreak in a housing estate in Hong Kong affecting over 300 residents (Chan-Yeung, M., 2003). On February 21, Liu Jianlun, a 64-year-old Chinese physician from traveled to Hong Kong to attend a family wedding despite the fact that he had a fever. Epidemiologists determined that Mr. Jianlun passed on the SARS virus to other guests at the Metropole Hotel where he stayed—including an American businessman en route to Hanoi, Vietnam by the name of Jonny Chen (SARS, 2012). Mr. Chen grew ill in a Vietnam Hospital. Dr. Carlo Urbani, who was a member of the World Health Organization, contracted the SARS virus after caring for Mr. Chen. Dr. Urbani was the first to formally identify SARS as a unique disease. Unfortunately, both Mr. Chen and Dr. Urbani died from the disease. Hospital workers caring for Mr. Chen became infected with SARS. Simultaneously, the disease began spreading around the world along international air travel routes as guests at the hotel began to fly home (SARS Reference, 2003).
A2. Indicators SARS epidemiological indicators for this epidemic believe it originated from small mammals in China and was spread to the handlers of the mammals (PubMed Health.gov, 2011). As mentioned above, it’s also believed contaminated sewage is responsible for infecting 300 people in a housing estate (Chan-Yeung, M., 2003). Once a person is infected, they develop symptoms related to the common cold that quickly develops into a serious form of pneumonia. Symptoms include difficulty breathing, fever, body aches, chills and shaking, cough. Once people are infected, the virus has an average incubation period of 6 days and an average of 3-5 days duration between onset of symptoms and hospitalization. Because of the relatively long incubation period, this allowed the infected asymptomatic people to travel and spread SARS globally (Chan-Yeung. M, 2003). One case of SARS is estimated to infect 3 people.
A3. Data The SARS epidemic started in November of 2002 and was considered contained in June of 2003. There were a total of 8,422 people infected with 916 people dying from the SARS virus (Chan-Yeung, 2003). This placed a case fatality rate of 11% to those who were infected. People of all ages were infected by the coronavirus but, predominately were female due to most being hospital personnel. A number of the infected also suffered from other comorbid diseases. Health care workers were at high risk because they would care for the infected patients that would be admitted to hospitals. Health care workers actually accounted for one-fifth of the infected (Chan-Yeung, 2003). The areas that were affected the greatest was China (5,327 infected, 349 deaths), Hong Kong (1,755 infected, 299 deaths), Canada (251 infected, 43 deaths), Taiwan (346 infected, 37 deaths), and Singapore (238 infected, 33 deaths) (Kamps, B. &Hoffman, C., 2003).
A4. Route of Transmission Evidence available suggests that SARS originated in the Guangdong Province in southern China in November of 2002. SARS spread from small animals in China to handlers who killed, sold or even prepared these animals which accounted for on-third of the early detectable cases. However, the SARS virus main mode of transmission is through airborne droplets or direct contact with the droplets through mucous membranes like the eyes, nose and mouth (Global Health Security, 2003). Also, “The SARS virus may live on hands, tissues, and other surfaces for up to 6 hours in these droplets and up to 3 hours after the droplets have dried” (PubMed Health, 2012). Cases of SARS occurred when one person was in direct contact with an ill person in either healthcare settings or the household of the infected. Basically, an infected person can pass the virus to an entire room of people just by coughing. If people with SARS are being cared for in the home setting, they should wear a mask when around other people, wash their hands often (especially after using the toilet or coughing), and make sure they do not share eating utensils (forks, spoons, glasses), towels and bedding with other people in the household (New York City Department of Health and Mental Hygiene, 2012).
A5. Graphic Representation It was researched that SARS was carried out of the Guangdong Province in February of 2003 by a medical doctor who was infected by SARS by patients he was treating. He flew to Hong Kong and stayed at a hotel on the 9th floor for one night to visit his family. He was admitted to the hospital the next day where he died 10 days later. It is suspected that the doctor infected 17 people who were staying on the 9th floor of that hotel. Before the end of February, those guests and visitors of the hotel’s 9th floor started becoming ill and was admitted to hospitals throughout Hong Kong, Vietnam, and Singapore. This is where the majority of cases started. Healthcare workers who were caring for these people were unaware of how contagious and the magnitude of this disease. These healthcare workers would be infected and then spread it among their household. Simultaneously, the disease began spreading around the world along international air travel routes as guests at the hotel flew home to cities around the world (SARS Reference, 2003). This was possible because the incubation period of SARS was on average 6 days and 3-5 days between the onset of symptoms and hospitalization. The SARS epidemic started in November of 2002 and was considered contained in June of 2003. There were a total of 8,422 people infected with 916 people dying from the SARS virus (Chan-Yeung, 2003).
A6. Effect on Community SARS could quickly affect a small community like Paulding, OH. It would take one infected person to cause a possible outbreak. That person would most likely spread it among their family members until hospitalization would be required. If SARS is not suspected, the infected members of the family could infect members of the health care team. The healthcare team would then take the disease home and spread it to members of their family. Before you know it, there would be a large outbreak of SARS. Hopefully, upon admission to the hospital and the admission of an entire family would throw up red flags. Hospital personnel could then protect themselves and the spread of SARS by placing the patient in isolation, hand hygiene, and the use of personal protective equipment like gloves, goggles, and masks. In doing so, SARS would be contained and eradicated from the community.
B1. Protocol As the community health nurse caring for family members who have contracted SARS, I would protect myself using contact and airborne precautions including eye protection. For the people who are confirmed in having SARS, they are to see their healthcare provider and in worse cases, be admitted to a hospital under strict isolation. The use of isolation is the principle tool to contain and control the spread of SARS. Effective control of nosocomial transmission includes early detection of disease, strict isolation of patients, practice of droplet and contact precautions and compliance with the use of personal protective equipment (Chan-Yeung, M. 2003). The state and local health departments are to be notified of the patients and their SARS diagnosis. The health department should identify, evaluate, and monitor relevant contacts of the patients and their health status. Health care providers are to also obtain a travel history of the people with SARS (Medical Society of District of Columbia, 2005).
C1. Modification of Care As a community health nurse, the air quality index is an important tool to pay attention to. The air quality index is a color coded scale used to measure the actual level of pollutants in the air (Wisconsin Department of Natural Resources, 2012). “Just like a stoplight, the air quality index reads as follows: green means good, yellow means proceed with caution, and red means stop and take warning” (Wisconsin Department of Natural Resources, 2012). Breathing air that is high in pollutants can cause respiratory distress, an increase in asthmatic episodes, and can cause or exacerbate heart and lung diseases. So, as the community health nurse, there are ways to modify their care in order to avoid exacerbation of diseases. The main modification would be to avoid activities outside when the air index for ozone rises to unhealthy levels. The chances of people being affected increase the longer a person is active outdoors or how strenuous the activity (U.S Environmental Protection Agency, 2012). Unhealthy levels of ozone usually occur during the afternoon. So, recommendations for people would be to plan their activities in the morning or evening hours during days of unhealthy levels. As mentioned above, the time of day is important but so is the type of activity. Modifying the type of activity is important because that determines how many times people are breathing and the depth of breaths. So, if people normally jog every day, the community health nurse would recommend taking a walk instead if the air quality index is higher than normal. In conclusion, the nurse would make modifications of limiting patient’s outdoor activity and the type of activity based on exertion during poor air quality levels.

Resources
Chan-Yeung, M., (2003). SARS Epidemiology. Respirology. Retrieved March 5, 2012, from http://www.ncbi.nlm.nih.gov/pubmed/15018127.
Global Health Security. (2003). Consensus document on the epidemiology of severe acute respiratory syndrome (SARS). Retrieved March 5, 2012, from http://www.who.int/csr/sars/WHOconsensus.pdf.
Kamps, B., & Hoffman, C., (2003). SARS Reference. Retrieved March 5, 2012, from http://www.sarsreference.com/sarsref/epidem.htm.
Medical Society of District of Columbia. (2005). DC Department of Health's SARS Reporting Protocol. Retrieved March 6, 2012, from http://www.msdc.org/msdcCommunity/latestNews.shtml.
New York City Department of Health and Mental Hygiene. (2012). Severe Acute Respiratory Syndrome. Retrieved March 6, 2012, from http://www.nyc.gov/html/doh/html/cd/cdsars.shtml.
PubMed Health.gov. (2011). Severe Acute Respiratory Syndrome (SARS). Retrieved March 4, 2012, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004460/.
Severe Acute Respiratory Syndrome. (2012). SARS. Retrieved March 6, 2012, from http://science.jrank.org/pages/6085/Severe-Acute-Respiratory-Syndrome-SARS.html.
United States Environmental Protection Agency. (2012). Ozone and Your Patients' Health Training for Health Care Providers. Retrieved March 7, 2012, from http://www.epa.gov/o3healthtraining/aqi.html.
Wisconsin Department of Natural Resources. (2012). Air quality information for health professionals. Retrieved March 6, 2012, from http://dnr.wi.gov/topic/AirQuality/Professionals.html.