Community Health Nursing
Karandeep Kalkat
WGU
ST Task 3

September 1, 2014

SARS, communicable disease outbreak
SARS (Severe acute respiratory syndrome) as described by the CDC is “is a viral respiratory illness caused by a coronavirus” (Centers for Disease Control and Prevention [CDC], 2013). It was first reported in February 2003 in Asia and has noted to spread through international travel to 29 countries worldwideto North America, South America, and Europe (CDC, 2013). According to the World Health Organization website, SARS was responsible for a large worldwide outbreak that affected 8,098 people and killed 774 between November 2002 and July 2003 worldwide and noted to be “the first severe infectious disease to emerge in the twenty-first century”( World Health Organization [WHO], 2014). The CDC lists the signs and symptoms if SARS are as follows: having a high fever (temperature greater than 100.4°F [>38.0°C]), headache, an overall feeling of discomfort, and body aches (CDC, 2013). It also states “some people also have mild respiratory symptoms at the outset. About 10 percent to 20 percent of patients have diarrhea. After 2 to 7 days, SARS patients may develop a dry cough. Most patients develop pneumonia“(CDC, 2013).
Epidemiological indicators/data of SARS
SARS first appeared and was detected in the Guangdong province in November 2002 as an atypical pneumonia. In late February 2003, similar cases began appearing among staff at a hospital in Hanoi and within two weeks, outbreaks occurred in various hospitals in Hong Kong, Singapore and Toronto where there was a rapid increase in the number of atypical pneumonia cases, especially amongst healthcare workers and members of their household. The incubation period of SARS is approximately four-five days with a maximum incubation period of ten days (Anderson et al., 2004). The duration between onset of symptoms and hospitalization was from 3 to 5 days with the second week of disease presenting the highest communicability. Primary mode of transmission of SARS is through direct contact of the mucous membrane such as eyes, nose, and mouth with respiratory droplets and through exposure to fomites. Contamination occurs primarily in persons with close contact with SARS patients such as in health care and household settings.
From November 2002 to July 203, a total of 8098 SARS cases were identified worldwide with 774 cases resulting in death worldwide (CDC, 2013). Risk factors for death included old age and comorbid illnesses, especially diabetes (Chan-Yenug & Xu, 2003). Prevention and control of SARS should be focused on early isolation of patients and quarantine for close contacts (Chan-Yenug & Xu, 2003) SARS route of transmission
SARS is spread primarily by close person-to-person contact, such as an infected person coughing, sneezing, or talking to an uninfected person. In the context of SARS, close contact means having cared for or lived with someone with SARS or having direct contact with respiratory secretions or body fluids of a patient with SARS (CDC, 2013). SARS is transmitted by the spread of respiratory droplets produced when an infected person coughs or sneezes and can spread when a person touches a surface or object contaminated with these infectious droplets and then touches his or her mouth, nose, or eyes (CDC, 2013).

How SARS can affect my community
With the dangerous potential to erupt into a catastrophic epidemic, the outbreak of SARS shocked the world. SARS victims were found in various countries, including Canada, China, France, Hong Kong, Taiwan, and USA. Such an outbreaks can have detrimental effects on a community. The daily activities of residents can be disrupted. People may avoid meeting in public places, and prefer to stay at home. Social relations can be affected when a community is under stress. There may be a breakdown in the social relations and organizational structures upon which the community relies. People may avoid meeting in public areas and taking public transportation. By no longer taking public transportation and choose to drive their own vehicles. Parents may reduce the frequency of taking their children outside, or reduce the frequency of visiting relatives and decrease the frequency of participating in gatherings with friends. Some daily routines, such as going to school or work, can seriously be affected. Many businesses will suffer because of this reduction in social contacts, such as reduced restaurant and department store visits. Public fear and anxiety will intensify. This fear and anxiety may lead to members of the community to not trust other individuals or health institutions. A lack of trust in government officials, medical experts, and healthcare workers may develop due to the lack of knowledge about SARS outbreak created early on in a community. Individuals may continue to help to people who coughed and or had a fever. There is a large possibility that healthcare workers and their family members, especially those who work in hospitals where SARS cases are reported, will be considered a high risk group and dangerous to the safety of the community. A SARS outbreak will shake the foundations of established institutional arrangements and routine social relations.
How to report SARS
Per the CDC website if a healthcare provider suspects any probable cases of SARS should be reported to the state or local health department immediately. It is necessary to explain the amount of SARS cases encountered in the community by describing the symptoms and physical finding and supporting laboratory examinations (Centers for Disease Control and Prevention [CDC], 2005). It is important to explain that SARS suspected in the family that traveled from overseas has spread to the general population. Information must be collected to describe the total population at risk. Collaboration with the local health department is vital to institute appropriate control measures through “strategies, including isolation, contact tracing and monitoring, and quarantine” (CDC, 2005).
Poor Air Quality Index and its risk
For those individuals who suffer from chronic respiratory issues, having poor air quality amidst a SARS outbreak can become a very serious issue. An article by Yan et al. explored the relationship between air pollution and SARS case fatality via an ecologic study design. Their data showed that “air pollution was associated with increased risk of dying from SAR” and that that “long-term or short-term exposure to certain air pollutants could compromise lung function, therefore increasing SARS fatality”. Later in the article, the study shows a “positive association between levels of air pollution and SARS case fatality in Chinese population by analysing SARS data and air pollution indices”. As a community health nurse, it is important to manage their care in a home setting away from school or work. By creating an isolation type setting in the home environment can limit the potential spread of the disease. It is advised by the CDC that “Patients should not leave the home for the duration of the isolation period, except as necessary for follow-up medical care” (CDC, 2005). By limiting the client’s activities outside in the polluted air, managing respiratory symptoms would be much easier. Ongoing education is key when addressing environmental triggers. Venerable clients should be taught to assess and manage their home environment to limit triggers that may exacerbate their respiratory condition. Teachings such as changing bedding covers weekly, vacuuming frequently, using asthma friendly cleaning supplies, avoiding wood fires, closing windows and doors, avoiding pet dander, venting fuel burning appliances to the outside, using an exhaust fan, and possibly installing an air cleaner with a HEPA (high efficiency particulate air) filter can be crucial in managing their care . By increasing knowledge of home environmental health threats, changing behaviors to reduce these threats can lower the risk of exposure to such threats. It I recommended by the CDC that if the client must leave the home, they would be required to wear a facemask and not use public transportation (CDC, 2005). It is important for an In-home outreach as the public health nurse to supporting in self-management, emphasize infection control measures, and maintain provider-patient communication.

References
Centers for Disease Control and Prevention. (2005). Key Measures for SARS Preparedness and Response. Retrieved from http://www.cdc.gov/sars/guidance/core/keymeasures.html#community Centers for Disease Control and Prevention. (2005). Reporting of Cases of SARS-CoV

Disease. Retrieved from

http://www.cdc.gov/sars/guidance/B-surveillance/reporting.html

Centers for Disease Control and Prevention. (2013). Severe Acute Respiratory Syndrome (SARS).
Retrieved from http://www.cdc.gov/sars/

Anderson, R. M., Fraser, C., Ghani, A. C., Donnelly, C. A., Riley, S., Ferguson, N. M., ... Hedley, A. J. (2004, June 15, 2004). Epidemiology, transmission dynamics and controlof SARS: the 2002–2003 epidemic. The Royal Society, 359, 1091-1105.
Chan-Yenug, M., & Xu, R. (2003, November 8, 2003). SARS: epidemiology. Respirology, 8, S9-S14.