SARS in the Community
Spencer Larsen
WGU 725.8.7

SARS in the Community
There have been many communicable disease outbreaks in the history of the world. Some of these outbreaks have killed large percentages of the population, while others have caused large portions of the population to become very sick, and only killing a small number of those infected. One such communicable disease outbreak was the SARS outbreak from 2003.
Analysis of SARS
SARS is an acronym for severe acute respiratory syndrome. It was caused by the virus SARS-CoV and was first reported in Asia in February 2003. It then spread to over 20 countries in North America, South America, Europe, and Asia. It was successfully contained in 2004, and there have not been any other cases reported since then. In 2012 the National Select Agent Registry Program declared that the SARS virus is a select agent, which means that it has potential to become a serious threat to public health and safety (Severe Acute Respiratory Syndrome (SARS). 2013).
Epidemiological Indicators
There are many epidemiological indicators that are associated with SARS. It is important to understand the indicators so that the virus can be correctly identified in possible future outbreaks. The indicators that will be discussed are the incubation period, period of communicability, mode and risk factors for infectious agent transmission, and the significance of animal reservoirs.
The incubation period for SARS ranged anywhere between one day and 14 days. Most cases had an incubation period of between four and five days (Kutsar, K. 2004). Most patients started experiencing symptoms around 14 days. As a standard, the World Health organization, or the WHO, has recommended that the maximum incubation period is ten days (Kutsar, K. 2004).
There is also a broad time table for when people become contagious. In Singapore it was found that patients were most contagious during the second week of the disease, when they were the most sick. In most cases, if the patient was placed under quarantine during the first five days of the disease, the chances of a second person contracting the disease dropped significantly. According to Kutsar, laboratory studies showed that the virus started excreting in small amounts through the lungs on days 0-2 of the infection. The excretions increased during days 3-5 to a moderate amount, and days 6-14 the virus excretions increased to a very large amount. The laboratory studies further showed that on days 15-17 the virus excretions starting decreasing. They continued to decrease to a minimal level on days 21-23. What all of these laboratory studies mean is that a patient with SARS had a very small chance of passing the virus on to another person during the first two days, the person became more contagious during days 3-5, and days 6-14 the patient was the most contagious. It also showed that after day 14 the patient gradually started becoming less contagious, until days 21-23, when the patient is almost not contagious at all. Clinically, the patient started becoming contagious after the first two days of symptoms, and became most contagious during the second week of having symptoms.
It is important to understand the part the animals and other vectors have in the transmission of SARS. In Hong Kong it was found that domestic dogs and cats had the SARS virus. Rodents were found to be resistant to the virus, however, the virus was still found to be in rodent droppings. Cockroaches were also found to have the virus on the outside of their bodies. It is necessary to understand that the virus can be passed on between animal species, from human to animal and vice-versa so as to be able to avoid the virus.

Route of Transmission
The primary mode of transmission for the SARS virus was by direct contact of any mucous membrane with respiratory droplets from an infected person. In other words, when an infected patient would sneeze, cough, or even speak the respiratory droplets would enter a healthy person through either the eyes, nostrils, or mouth, causing the healthy person to the contract SARS. Another way that the virus was spread was through contact with fomites (Kutsar, K. 2004). Fomites are any object that is not living that has been touched by respiratory droplets from a patient with the virus. An example of a fomite is a doorknob after it has been touched by a patient with the virus. The risk factors for contracting SARS was found to be living in a house with somebody who already had contracted SARS, increasing age, men, and having other co-morbidities. People who worked in healthcare were also shown to have a higher percentage of contracting SARS. Another risk factor was traveling in airplanes, as the air in airplanes are recirculated, which causes viruses to be transmitted to multiple people. Remarkably, children were hardly effected by the virus. SARS was found to never have been transmitted in schools. There were only two cases of children passing the virus onto adults, and there were zero cases of children passing it onto each other (Kutsar, K. 2004).
Epidemiological Data
After investigating how the SARS virus started and spread into an epidemic, it was found that the most likely source of the outbreak was a physician from the Guangdong Province of China who was staying at a hotel in Hong Kong from February 21-22 of 2003. He had been caring for patients who had the symptoms of SARS, and he himself started displaying some of those same symptoms. Also staying on the same floor of this hotel were nine other individuals from different countries. Two of these individuals traveled to Canada, one traveled to Ireland, three traveled to the U.S., three traveled to Singapore, one traveled to Vietnam, and two others stayed in Hong Kong. The individuals from Canada came into contact with 11 close contacts, including 18 health care workers. The three from the U.S. came into contact with only one health care worker. The three from Singapore came into close contact with 37 individuals, not including 34 health care workers. The one from Vietnam came into close contact with 21 individuals, not including 37 health care workers. The ones who stayed in Hong Kong came into close contact with over 100 individuals, not including 95 health care workers. These nine individuals spread the virus throughout Hong Kong, and then throughout much of the world (Parashar, U. D., & Anderson, L. J. 2004).

Graphic of International Movement of SARS
A represents the doctor, B-J represent the individuals on the Hotel floor who came into contact with the doctor. HCW represents Health Care Workers
(Parashar, U. D., & Anderson, L. J. 2004)
A represents the doctor, B-J represent the individuals on the Hotel floor who came into contact with the doctor. HCW represents Health Care Workers
(Parashar, U. D., & Anderson, L. J. 2004)

How the Outbreak would affect my community
If SARS came into my community, it could have potential to be disastrous. There are many elderly people who live in my community, and as was mentioned earlier, the older a patient is the more likely they are to contract SARS and to die from it. There are also many hospitals and health care facilities in my community, which would cause even more people to come into contact with SARS, which would cause it to spread even more. It was mentioned earlier that people with co-morbidities are also more prone to getting SARS, and there is a very large obesity population in my community. The people who are currently living with obesity would be even more likely to contract the disease and to die from it. There would most likely be many people who would be afraid to leave their houses, which could cause the economy of my community to suffer. It would be absolutely terrible if SARS were to be introduced into my community.
Appropriate protocol for reporting SARS
In the case of a suspected SARS case, the physician would have to notify the health department. The physician would have to question the patient about recent travel, employment history, and possible exposure to any other person who has been diagnosed with pneumonia. The doctor would have to report the case to the health department if a patient has pneumonia or ARDS with unknown etiology and requires hospitalization, and if the patient traveled within 10 days to China, Hong Kong, or Taiwan, or if the patient had close contact within the last 10 days with somebody who traveled to those countries, or if the person works in healthcare and had contact within the past 10 days with a person who has SAR (Reporting Potential SARS Cases. 2004).

How to care for respiratory compromised patients in poor air quality
On poor air quality days, people with asthma or other respiratory type diseases need to stay inside as much as possible. If they have to go outside, they should not perform strenuous activities while outside. If they absolutely have to do hard work outside, they should do it either in the early morning or late evening. There are many websites that project how the air quality will be for the next few days, and these patients need to follow these websites and plan their activities accordingly (Payne, J. W. 2010).
Patients should also keep their prescriptions with them at all times, especially their emergency meds. The patient would need to stay on top of their prescription to make sure that they don’t run out and that the medication isn’t expired. The patient would need to be aware of how often they are using their rescue inhaler, because if they are using it multiple times in a week they might need to talk to their doctor about increasing the dosage of their daily medication (Payne, J. W. 2010).
The last few things that a patient should do while the air quality is poor is to make sure that they stay hydrated, and that they breathe through their nose. The lungs not only require air to function, but they also require fluid in order to stay lubricated. If the patient allows himself to dehydrate, his lungs will not have the necessary lubrication to function properly, which would exacerbate any pulmonary issues they might be experiencing. It is also important for the patient to breathe through his nose, especially in poor air quality. The nose does a much better job of filtering the chemicals and particles that are in the air than the mouth does. If the patient only breathes through his nose, his lungs will not have as much irritants to do harm (Payne, J. W. 2010).

References
Kutsar, K. (2004, July). The global epidemiology of SARS. In EpiNorth. Retrieved May 13, 2014, from http://www.epinorth.org/eway/default.aspx?pid=230&trg=Area_5268&MainArea_5260=5263:0:15,2946:1:0:0:::0:0&Area_5263=5268:44984::1:5264:1:::0:0&Area_5268=5273:44424::1:5266:3:::0:0
Parashar, U. D., & Anderson, L. J. (2004, May). Severe acute respiratory syndrome: review and lessons of the 2003 outbreak. In IJE.OxfordJournals.org. Retrieved May 13, 2014, from http://ije.oxfordjournals.org/content/33/4/628.full#cited-by
Payne, J. W. (2010, June). Air Pollution and Asthma: 4 Ways to Stay Safe on 'Ozone-Alert' Days. In Health.USNews.com. Retrieved May 13, 2014, from 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
Reporting Potential SARS Cases. (2004, February). In Health.NY.Gov. Retrieved May 13, 2014, from http://www.health.ny.gov/diseases/communicable/sars/sars_reporting/attachment_3_reporting_sars_cases.htm
Severe Acute Respiratory Syndrome (SARS). (2013, February). In CDC.gov. Retrieved May 13, 2014, from http://www.cdc.gov/sars/