Severe Acute Respiratory Syndrome - Essay Example

SARS (Severe Acute Respiratory Syndrome) Introduction Severe acute respiratory syndrome commonly referred to as SARS is an infectious respiratory disease considered a variation of pneumonia. It is caused by a corona virus known as SARS-CoV (Kamps, Bernd, & Hoffmann 30). It was first identified in February 2003. Its origins are believed to be Guangdong province, Southern China. The immediate response to the new health threat by the scientific community was breath-taking. The establishment of the etiologic relationship between a coronavirus that was previously unknown and SARS one month after the World Health Organization issued a global health alert was commendable. The World Health Organization called upon 11 top laboratories in located in 9 countries to join a multicenter research was looking into the etiology of SARS so as to develop a diagnostic test. This was important in order to make the virus available for investigation to detect antiviral compounds and help develop vaccines for the illness.Infection with the virus causes in an acute respiratory problem. Chronic illness as a result of the virus leads to severe breathing difficulty and in extreme cases death. China and the surrounding countries incurred the highest number of deaths due to the virus. According to the World Health Organization, by July 2003, 8437 people worldwide were infected with the SARS virus (Kamps, Bernd, & Hoffmann 32). Eight hundred and thirteen died during the outbreak. The virus spread to more than 30 countries on 5 continents. In the United States, only 8 people were infected by the SARS virus all of whom had travelled outside the US. There were no fatalities recorded in the United States as a result of the virus (Kamps, Bernd, & Hoffmann 33). In the absence of a vaccine or effective drugs for SARS, rapid identification of symptoms associated with this disease remains the best way to combat its spread. Appropriate management of patients, including the isolation suspected and probable cases is also important. Close contacts of these patients need to be monitored to avert further infections. In a majority of countries, such measures have managed to prevent imported cases of the SARS virus from spread it to other people. Background Information In 2003, Dr. Carlo Urbani, a physician with World Health Organization (WHO) identified SARS as a new disease (Oehler n.p). He first diagnosed the disease in a 48-year-old businessman travelling from Guangdong China to Hanoi, Vietnam. The doctor who first diagnosed SARS and the businessman both died from the illness. In the meantime, the disease spread quickly and infected thousands of people all over the world from Asia, Europe, Australia, North and South America and Africa. Schools in Hong Kong and Singapore were closed so as to avoid the spread of the virus in schools. SARS was identified by the World Health Organization as a global health threat and travel advisories were issued. WHO closely monitored the spread of the virus and constant updates were made in order to prevent the disease from becoming a global pandemic. The fast response by global public health institutions helped to stem the virus spread. By June 2003, the rate of new infections decreased significantly that on June 7, the WHO halted its daily reports (Dugdale 1). Even though the number of new infections reduced significantly and travel advisories were lifted, a new case implied a potential of an outbreak. When an infected person coughs or sneezes, droplets with the virus are sprayed into the air. Breathing in of such droplets can facilitate the transmittance of the infection from one person to another. The virus can also live on hands, in tissues, and other surfaces for up to 6 hours before the droplets dry and up to 3 hours after the droplets have dried (Kamps, Bernd, & Hoffmann 40). The spread of infected droplets by means of close contact was responsible for most of the SARS cases reported in earlier stages of its spread. The viruses can also spread through hand contact and other objects touched by the droplets. In some cases, it is possible for airborne transmission to occur. Stool of people infected with SARS has been found to contain live virus which can live for up to 4 days (Oehler n.p). If the temperature is below freezing, the virus may live for several months or even years before dying. Re-infection is common with the other corona viruses; this may also be the case with the SARS virus. Symptoms Symptoms for the disease usually manifest between 2 to 10 days after infection. There are some cases where the illness started earlier or later than the approximated period after first contact. People that display active symptoms of the illness are contagious. The incubation period, the period between first exposures to the SARS virus to when the symptoms appear, is between 3 to 7 days but it may extend up to 10 days (Dugdale 1). Experts believe that an infected person can infect others only while he manifests the symptoms. As a precautionary measure, the United States Centers for Disease Control and Prevention (CDC) recommend that people infected with SARS should stay at home except when going for doctor visits for a minimum of 10 days after their symptoms go away (Oehler n.p). The major symptoms are for this illness includes coughing, difficulty in breathing, fever greater than 38 degrees Celsius or 100 degrees Fahrenheit and other breathing complications. The symptoms that are most common include shaking and chills, coughing usually 2-3 days after manifestation of other symptoms, high fever, aching of muscles, and headaches. The illness also has less common symptoms such as cough containing phlegm, occasional diarrhea, vomiting and nausea, sore throat, and a running nose. The lung symptoms for some cases may get worse in week two of the illness even though the fever may have ended. Causes of SARS The spread of the SARS virus occurs through close person-to-person contact. Transmission is through infected droplets produced when a person who is infected coughs or sneezes. The spread of droplets takes place when airborne droplets, produced through coughing or sneezing are deposited on the mucous membranes found in nose, mouth or eyes of a person. A sneeze or cough can infect a person who is up to 3 feet away. The virus also spreads through contact with a contaminated surface. Oral and fecal transmission of the virus is also possible. Heath care workers who do not wear protective equipment expose themselves to significant risk of exposure and acquisition of the infection when an outbreak occurs. The spread of SARS Just like other common respiratory illnesses, SARS spreads mainly through contact with infected cough droplets or saliva. Brief and casual exposure to an infected person is not enough to transmit the SARS virus from a person who is infected to a non infected person. For example passing an infected person on the street will not cause infection because close contact is necessary for an infection to occur. Generally, close contact is necessary for an infection to occur. The definition of close contact in this context includes breathing in air exhaled by an infected person and living with or caring for an infected person. Sometimes given certain conditions, SARS can spread to health care workers or within an apartment building. SARS infection can result from acts such as sharing food or drink with a person who is infected, hugs and kisses by an infected person, and close contact with a person who is infected. In addition touching contaminated objects or surfaces with your hands followed by touching your, nose, eyes or mouth may also cause infection. Another possible way of transmission is through feces. This may happen if an infected person fails to wash his hands after using the bathroom and he touches objects used by other people. The disease appears not to be transmittable from mother to child at birth (Kamps, Bernd, & Hoffmann 52). Exams and Tests Tests are done by listening to the chest by use of a stethoscope to check for abnormal sounds. A chest x-ray or CT-scan may show pneumonia when one is infected with SARS. This is a typical occurrence with SARS. Some of the tests in SARS diagnosis include: blood clotting tests, complete blood count, chest x-ray, and chest CT scan. Quick tests used to identify the SARS virus include: SARS antibody tests, SARS virus direct isolation, and Polymerase Chain Reaction (PCR) test. The limitation for current tests is that they may be unable to easily identify a SARS in the first week of infection. This is usually the most important stage of the illness. Diagnosis of SARS A doctor may suspect SARS if one has fever and he either traveled to an area affected by SARS was around a person infected with SARS in the past 10 days. Several tests such as X-ray may be done if the person has breathing problems and is coughing a lot. A blood sample, nasal swab or sputum sample may be done to detect viruses or bacteria. If tests rule out other probable causes of the symptoms being manifested, the doctor may suspect SARS especially one had contact with an infected person or traveled to an area with an outbreak of SARS. In such a case, a SARS antibody test may be done. At least two separate antibody tests conducted on different days are needed in order to confirm an infection. Treatment The method of treatment of the coronavirus associated with SARS is still evolving. So far there is no consensus has been reached on the optimal regimen to use. There are diverse treatments recommended by different medical experts to date. Medical experts are aiming to consolidate the current knowledge on the virus so as to prepare a standard treatment approach for persons with the illness. Treatments programs for SARS were initially developed based on theoretical formulations, clinical observations and inferences. This was due to the initial lack of prospective randomized controlled trial treatments during the first epidemic of the disease. Mainstream treatment interventions for the disease involve a wide spectrum from antibiotics, supportive care, and antiviral agents to the use of immune-modulatory therapy . Treatment for SARS may include: taking of antibiotics to treat pneumonia causing bacteria, antiviral drugs, prescription of a high dose of steroids to minimize swelling in the lungs, breathing support through mechanical ventilation and chest therapy. Sometimes, the liquid that composes blood obtained from persons who have recovered from SARS is administered as a treatment. This treatment has not yet been proven to as effective. Other evidence show that an antiviral medication, ribavirin, that is administered for the illness does not work (Kamps, Bernd, & Hoffmann 67). For severe cases of SARS, hospitalization is required more so if breathing complication develop. Isolation is also necessary to prevent spreading the disease to other people. There is no known medicine that can cure the illness. About 33% of persons infected with SARS become ill but recover. For 67% of those infected, their condition gets worse and hospitalization is necessary. The risk of death due to SARS depends on the age and health of an individual. People of age 65 and above bear the greatest risk especially those with chronic illnesses such as heart disease and diabetes. Recovery from SARS occurs for about 9 out of 10 infected people while about 1 out of 10 succumbs to the illness. Prognosis Of those people diagnosed with SARS, the death rate ranged between 9 to 12%. The death rate was higher than 50% for persons aged above 65 years (Oehler n.p). For younger patients, the illness was milder. Those people that became chronically ill required breathing assistance. Some people had to be put in intensive care for close monitoring. Policies on public health were effective in controlling outbreaks. Due to the ability of viruses in the corona family to mutate, countries are advised to keep vigilant so as to detect any new outbreaks on time. Possible complications due to the virus include liver, heart and respiratory failure. Prevention In contrast to other diseases like rubella or flu, SARS is moderately transmissible. An epidemiologic study found that SARS infections per index case ranged from 2.2 to 3.6. These values are considerably low compared to those estimated for other diseases that involve respiratory transmission (Kamps, Bernd, & Hoffmann 81). When a disease lacks a vaccine, the most effective approach to control the disease is to break the chain of transmission. Most documented cases show that SARS spreads through close contact with infected droplets that are released when a patient coughs or sneezes. The most basic rule is to reduce contact with people infected with SARS so as to lower the risk of contracting the disease. The WHO and CDC established several guidelines to help in curbing the spread of SARS. First and foremost, persons infected with SARS should not go to public places such as work, school until the expiry of 10 days after the fever ends and respiratory symptoms improve. They should stay indoors. Secondly, hands should be washed frequently using soap and hot water. Alcohol-based hand rub can also be used especially after coming into contact with bodily fluids such as urine or respiratory fluids. Another preventive measure is to wear disposable gloves when contacting bodily fluids from an infected person. The gloves should be safely disposed immediately after use and hands thoroughly washed. Surgical masks should also be worn to avoid air transmission. The WHO recommends covering the nose and mouth with a tissue when one sneezes or coughs. It is also advisable not to share eating utensils, bedding or towels. These items should be thoroughly washed using soap and hot water after use by an infected person. When tidying up, contaminated surfaces should be cleaned using household disinfectant. Other common surfaces that may be contaminated for instance doorknobs should also be cleaned. Disposable gloves should be worn while cleaning such surfaces. These guidelines should be strictly followed for at least 10 days after recovery of the patient. Works Cited Kamps, Bernd, and Hoffmann, Christian. SARS Reference. New York: Flying Publisher, 2003. Print. Oehler, Richard. Severe acute respiratory syndrome (SARS).emedicine health, Feb. 2004. Web. 15 Apr 2012. Dugdale, C. David. “Severe acute respiratory syndrome (SARS).” The New York Times 19 Feb 2011. Print. Read More