SARS Treatment Methods - Research Paper Example

SARS Treatment Methods Unexpectedly, the incident at the Fukushima Dai-ichi nuclear power plant awoke fear among the American citizens that radiation would linger on for years and affect them as well (Krupa). Likewise, the fear of severe acute respiratory syndrome (SARS) still lingers among the world population. According to Krupa, the 2003 SARS outbreak created commotion among people, mostly because the disease was unknown to the majority. The fear of the unknown, of something that never really goes away, produces a subconscious hysteria among the populations, thus making them susceptible to any minor outbreak of that disease (Krupa). Since SARS is almost impossible to extinguish from the face of the planet Earth, the fear of this disease has existed since it first appeared among the populations in 2003, making it a powerful weapon against the fearful populations that never truly goes away. The primary source comes from the American Medical Association (AMA). AMA collects data on disease outbreaks, as well as research and activism related to health (AMAa). Its mission and guiding principles focus on the belief that a corporate association can promote ethical approaches to patients, further innovations in the field, and set standards for other physicians and medical students, among other things (AMAb). It also acts as support to physicians on legal issues by providing information on antitrust laws and physician payment filing (AMAc). The AMA website contains 64 different sources on the word “SARS” (AMAd). Resources range from definitions of the disease, to clinician infections and health system preparedness (AMAd). Information through articles is provided on international SARS outbreaks as well (AMAd). AMA provides links to other organizations, such as the World Health Organization (WHO). AMA also focuses on other infectious diseases. Besides SARS, AMA also provides information on “tuberculosis, influenza, viral hepatitis, HIV/AIDS, bloodborne and foodborne pathogens … allergies, meningitis and many others” (AMAe). Information provided comes in form of “extensive reports, fact sheets, toolkits and links to then latest research” (AMAe). AMA also includes information on how to prevent these diseases and approach patients who might or did contract any of the above listed diseases (AMAe). 2003 Detection and Responses to SARS In November 2002, SARS contagions began in Foshan City (Kaufman 53 - 54). This city is located in the South of China, where large numbers of pigs and chickens live in close proximity to humans (Kaufman 54). Thus, this area is known for virus mutations and disease outbreaks among humans (Kaufman 54). Symptoms of SARS are similar to flu. According to the Center for Disease Control and Prevention (CDC), symptoms start with an increased bodily temperature above 38 Celsius degrees (1). Other symptoms might follow: bone ache, headache, and feeling of discomfort, diarrhea, dry cough and finally, pneumonia (CDC 1). However, China, unlike other countries, attempted to hide SARS outbreaks. As the outbreaks set in, the Chinese government covered them up, thus allowing the infected to travel abroad and infect more persons (Kaufman 54). As a result, the contagion became global, instead of being only isolated to a few areas in China. By January 2003, when authorities were secretly notified, disease had spread across the entire region. However, the public was still kept unaware (Kaufman 54). According to Kaufman, the justification for secrecy lies in the fact that pneumonia was not required to be reported to the public (54). WHO acted a few months later. According to Bloom, one of the top WHO infectious disease specialists was infected by SARS in March of 2003 in Hanoi (701). The specialist died. Rumors spread about additional contagions in China (Bloom 701). Once WHO was alerted by a health computer logarithm, on February 11 the Chinese authorities reported the epidemic (Kaufman 55). It was in April that WHO was allowed to access the area (Kaufman 55). In April there were officially only 12 infected persons, but unofficially there were 301 (Kaufman 56). Finally, the responsible for the cover up were fired and a two billion Yuan emergency fund was created (Kaufman 56, 67). Subsequently, WHO declared a Global Alert (Bloom). This was the first time in its history that WHO declared such an alert (Bloom 701). WHO responded promptly. Together with CDC, WHO established a network of 13 laboratories in 10 countries which worked on SARS. CDC identified the virus within two weeks, and sequenced its genome in additional two weeks (Bloom 701). Labs shared knowledge and findings with each other. Thanks to such technological interconnectedness and willingness to engage in global communication and cooperation, SARS spreading was fought off successfully and quickly. Bloom compares the 2003 SARS infection identification to the 1980’s, when it took two years to identify human immunodeficiency virus (HIV) as the cause of acquired immunodeficiency syndrome (AIDS), a disease still not eliminated (701). Countries were alerted to prepare for an epidemic, which created large costs to the taxpayers. Every country in the world was alerted and thus given time to prepare for the disease before it reached its borders (Bloom 701). However, the epidemic did not spread on such a global scale that every country needed to waste precious resources on SARS prevention (Bloom 701). As a result, taxpayer money was spent on healthcare, while other sectors were in a more dire need of those financial resources. Such mistakes lead to consequences for public officials, whose power and authority became threatened, as in case of the 1994 plague outbreak in China and 1976 swine flu outbreak in the United States (Bloom 701). Before the infections were contained, SARS had spread to over 24 countries in North and South America, Asia and Europe (CDC 1). According to WHO, a total of 8,098 infections were reported (CDC 1). Of the infected, 774 died (CDC 1). In the United States, however, only eight cases were reported (CDC 1). All of the infected individuals travelled abroad and so contracted the disease through either breeding in the infected person’s cough or sneeze droplets, or digesting the virus by having touched the surface on which the infected person sneezed (CDC 1). SARS Treatments According to Chan, Tang and Hu, SARS treatment depended on the stage of infection. The first stage involves active viral replication, and the second involves immunopathological injury (197 – 198). Antibiotics, unlike in previous epidemics such as the influenza epidemic, were useless in case of SARS (Chan et al. 198). Ribavirin was used as a replacement for antibiotics. However, though successful in fighting against viruses in vitro, the use of this medication failed to produce positive results (Chan et al. 198). Protease inhibitors such as ritonavir, nelfinavir and lopinavir, all used for HIV, were effective at treating the infected (Chan et al. 198). Human monoclonal antibodies managed to reduce replication of SARS in lungs and its shedding in pharyngeal secretions (Chan et al. 198). Several medicines exhibited a potential in fighting off SARS. Though vaccines are still tested, adenoviral – based vaccine produced strong immunological responses to SARS in 2003 (Chan et al. 199). Immune system produces antibodies as a response to viral infections. These antibodies will be produced in laboratories and used to fight off future SARS infections as well (Chan et al. 198). Different treatments worked in phase II of SARS development. At this phase, pneumonia has already developed (Chan et al. 199). Corticosteroids successfully reduced lung inflammations (Chan et al. 199). Rescue-pulsed methylprednisolone also proved itself to be useful, but mortality rates were much higher (Chan et al. 199). Convalescent plasma, i.e. plasma donated by SARS survivors, was still not fully researched at the time (Chan et al. 199). Traditional Chinese medicine, liquorice roots, had a positive impact on patients as well (Chan et al. 199). Intravenous ? – globulin, pentaglobulin, nitric oxide, and in case of a severe SARS progression, non – invasive positive pressure ventilation, were used as well (Chan et al. 199 – 200). In China, due to the fact that medical expenses are too high for many rural households, traditional medicines were used (Kaufman 58). The Guangdong Provincial Traditional Chinese Medicine Hospital reported it cured 105 out of 112 admitted SARS patients with herbal medicines (People's Daily Online). The hospitals in Beijing soon combined herbal medicines with modern therapies (People's Daily Online). Herbs lowered the temperature and helped the body recover from negative effects of antibiotics and hormones (People's Daily Online). Moreover, herbs are much cheaper than modern medicines (People's Daily Online). Despite multiple treatment methods, neither were fully functional. Some failed to prevent mortality. Others exhibited no effect on patients. Though some are potentially efficient, such as certain types of vaccines, they require further development. Moreover, according to Chan et al., 15.5 and 23.7 percent SARS survivors 6 and 12 months after survival developed diffusion problems (200). Survivors could not walk longer than six minutes, which indicated to physicians low lung capacity (Chan et al. 200). Thus, scientists are still developing proper solutions to SARS. Lederberg, Shope and Oaks too argue that early detection, isolation and prevention are best methods in dealing with SARS (200). Though Chinese traditional medicines have been acknowledged in the West, Chan et al. argue that more research is needed (199). International Cooperation on SARS In 2003, WHO organized an international conference on SARS. Over 900 participants from 44 different countries participated (WHO). SARS was contained because of alertness caused by WHO and world media, despite the fact that outbreaks were in geographically diverse areas with different levels of medical development (WHO). Moreover, severity and characteristics were different (WHO). There was lack of research on epidemiology and transmission, which hindered approaches to SARS (WHO). However, despite quick spreading of infections due to interconnectedness, that same factor contributed to quick global mobilization and response (WHO). In 2003, it was believed that SARS cannot be eradicated. The scientists at the conference were faced with a difficult task. The outbreak was new, and the solutions needed to be provided quickly. As a result, their assessment of the SARS eradication was based on assumptions and evidence gathered from the patients. Though they agreed that the spread of SARS from one person to another could be interrupted, they were equivocal about its planet – wide eradication (WHO). The problem with eradication at the time was situated in „the existence of an animal reservoir of the SARS coronavirus, as suggested by some studies, [which] would make eradication extremely difficult to achieve” (WHO). In any future outbreak, time will play an important role. In the 2003 outbreak, medical resources could not be maintained for a longer period of time (WHO). Luckily, the outbreak was not global, involving a pandemic. Thus, in the future, any response to SARS outbreaks will need to have the capacity to contain the infected for long periods of time and respond at different sites. A part of the ability building would be creation of an alert system so that early outbreaks could be detected (WHO). In turn, infrastructure could be built before an increase in further infections. Moreover, risk communication by the media and healthcare systems will contribute to capacity building, as the population will be made more aware and responsive to the prescribed behavior (WHO). Influenza and Measles According to Bloom, the SARS coronavirus is just like any other respiratory virus (701). Viruses spread through respiratory routes can quickly infect millions. In 1918, the influenza epidemic killed between 20 and 40 million persons around the world (Bloom 701). Moreover, measles more recently affected thousands of children on two continents. Influenza used to be a powerful killer. Symptoms are “fever, chills and headache, muscular ache, and cough” (Lederberg et al. 18). The 1918 pandemic is one of the worst disease outbreaks in human history (Lederberg et al. 18). First infections took place at the end of World War I in military camps in the United States (Lederberg et al. 18). The first wave took place quietly. It was the second wave in France later in 1918 that caused many deaths (Lederberg et al. 18). Most deaths were in Spain (Lederberg et al. 19). The last and third wave took place in 1919 (Lederberg et al. 19). Two more pandemics took place in 1957 and 1968, but neither was of such a devastating scale (Lederberg et al. 19). In 1976 a potential pandemic took place, but it never materialized, leading the authors to a conclusion that influenza epidemics can never be predicted (Lederberg et al. 19). In 1983, avian influenza in chickens took place, confirming the difficulty of forecasting the course of evolution of influenza (Lederberg et al. 19). Moreover, measles too spread rapidly among children in 2011. Between January and May of 2011, there were 7,000 measles infections among children in France (Roxby). The infection spread to the United Kingdom, affecting London and parts of Scotland (Roxby). In total, 38 European countries reported cases of measles (Szabo). Over 10,000 children were infected in Europe (Szabo). Travelers to Europe brought measles to the United States, a disease declared to be eliminated in 2000 (Szabo). Measles spread among unvaccinated children. Largest cause of the epidemic was lack of universal measles vaccinations among children (Roxbyb). According to Szabo, American parents feared measles would induce autism among their children. Thus, some parents refrained from its use due to concerns about possible side effects. Other parents believed the vaccine to be unnecessary, as measles were believed to be eradicated in the Western world (Szabo). In Southern America, where measles were common among the indigenous populations, governmental action resulted in 100 percent vaccination rates, and thus, complete elimination of measles infections (Roxbya). As a result, it was easy for measles to spread from France, across Europe and to the United States. Outbreaks throughout Early History Plague was first reported in ancient Greece. Plague is caused by bacterium Yersinia pesti (Lederberg et al. 16). In the Trojan War, around 1190 B.C., Homer reported plague – like symptoms to be present among the soldiers (Lederberg et al. 16). Carriers of the pathogen are rodents such as “rats, ground squirrels, rabbits, and, occasionally, even house cats can harbor infected fleas” (Lederberg et al. 16). Fleas from these animals infect humans (Lederberg et al. 16). In the medieval Europe, over 25 million persons died from it in the West (Lederberg et al. 17). The last known plague took place in the 20th century India (Lederberg et al. 16). Over 10 million people died from it (Lederberg et al. 16). There are two kinds of plague: bubonic and pneumonic (Lederberg et al. 17). The latter is transmitted through air (Lederberg et al. 17). Just like SARS, plague too was spread to Europe through transportation. In 1346, plague was transported to Europe through the so called Silk Road (Lederberg et al. 17). Marmots were hosts to the - plague - infested flees (Lederberg et al. 17). Mongols in turn, it is believed, killed marmots for their fur and on their conquests across Europe spread flees among other animals and humans (Lederberg et al. 17). The same type of transmission took place in 1896 San Francisco, when rats aboard a ship from Asia contained the pathogen (Lederberg et al. 17). Though a modern day epidemic of plague is unlikely, it is not impossible. Sanitation improvements have eliminated the spread and contagion of plague (Lederberg et al. 17). However, rodents remain infected in parts of the Western United States, South America, Africa and Asia (Lederberg et al. 17). As a result, there have been isolated cases of plague around the world (Lederberg et al. 17). A future outbreak could take place in crowded areas with poor sanitation (Lederberg et al. 17). Such are also areas where wars take place. Ancient Romans and Greeks fought against modern day malaria. Though they fought against fever, modern scientists believe that the cause of this fever was malaria (Lederberg et al. 20). In the sixth century B.C., Romans and Greeks undertook extensive engineering projects aiming to dry out swamps, which at the time, were believed to have caused outbreaks of severe fever (Lederberg et al. 20). Many different types of epidemics have been prevented successfully. Though measles are still present in Western Europe, only a few children died since the invention of vaccine against measles (Lederberg et al. 20). Penicillin was discovered in 1929 and ever since then has been used against many bacterial infections (Lederberg et al. 20). Future of SARS Epidemics and New Pathogens According to Lederberg et al., disease – causing microbes have threatened humans for centuries, and will continue to do so in the future (1). Just like any other living organisms, they mutate, and thus adapt to new hosts in order to survive (Lederberg et al. 1). Their susceptibility to treatment drugs and the host’s immune system decreases over time (Lederberg et al. 1). Modern lifestyle facilitates spreading of disease – causing microbes. Global transportation enables microbes to spread from one isolated and possibly less populated area of the world, to a much more connected and populated part (Lederberg et al. 1). Immunosuppressive medication makes humans more susceptible to infections (Lederberg et al. 1). Constant civil wars around the globe decrease sanitation levels and allow for pathogen dispersal (Lederberg et al. 2). Animals carrying pathogens have increased in numbers, thus increasing the probability of an infection by a human being (Lederberg et al. 2). Some pathogens have also become resistant to pesticides (Lederberg et al. 2). New pathogens might arise in the future. Due to the increasing world population, humans have been infringing upon the unexplored ecological systems, where new pathogens might reside (Lederberg et al. 1). As a result, according to Lederberg et al., disease – causing microbes will not be eliminated in the near future (2). Implications for Ethics Ethical standards are important if health workers want to contain SARS epidemics, and prevent any future outbreaks. When ethical rules are broken, patients and communities become dissatisfied. Moreover, when countries do not support ethical standards, the international community becomes dissatisfied with the international standards, and the unwilling country loses face. China in 2003 is such an example. An ethical framework is needed so that struggle against SARS can be effective (The University of Toronto Joint Centre for Bioethics [TUTJCB]). TUTJCB identified after the SARS epidemic ten key ethical issues that need to be preserved or dealt with in case of a future SARS epidemic. These are individual liberty, right to privacy, protection from public harm, proportionality, reciprocity, transparency of health workers’ actions, protection of communities from undue stigmatization, equity and solidarity. So far, some ethical standards have been violated in case of SARS. Five ethical rules were broken or became an issue in the 2003 SARS outbreak. The first broken rule is encroachment upon civil liberties (TUTJCB). In specific, quarantine hinders a person from moving around and fulfilling their other civil liberties, such as a right to prosperity or freedom of association. Second violation is violation of the right to privacy. Information on patient’s health must be disclosed so that health workers can better treat the patient for SARS. Third, health workers must care for the sick. However, in times of an epidemic, contagion among the health workers might be high. As a result, health workers choose their own health over that of their patients (TUTJCB). Fourth infringement affected patients at hospitals where quarantine was set up. Though some were healthy, they were cut off from the rest of the world. Lastly, solidarity among countries arose as a need out of the 2003 epidemic. Without global cooperation SARS cannot be contaminated. International cooperation on behalf of the United States is necessary. According to Bloom, international cooperation on behalf of the United States would prove to the world the former’s concern for human lives (701). Cooperation with other countries is necessary so that a global war on diseases such as SARS can be successful (Bloom 701). Such action would create an image of the United States which cares for other fellow human beings. Moreover, such cooperation might enhance protection of key ten ethical principles. Conclusion Epidemics have plagued humans since the time of ancient Greece. Because of its lethal potential, SARS is one of the new villains. However, until a potent treatment is developed, SARS will not become the new, almost harmless influenza, or malaria, which is secluded to few areas of the modern world. So far, best treatment methods are prevention, isolation and quarantine. Vaccines are still in the developmental phase. What will remain potent in our minds is the idea that will never go away, and that is the fear of the unknown. SARS is feared because it is still a largely unknown pathogen. In the future, fear of SARS will be replaced by fear of another pathogen. Thus as history has shown, fear of pathogens, epidemics, and consequences of infections will never disappear. Works cited AMAa. American Medical Association: Top News and Articles. AMA, 1995 – 2012. Web. 3 Dec. 2012. . AMAb. AMA Mission and Guiding Principles. AMA, 1995 – 2012. Web. 3 Dec. 2012. . AMAc. Business and Management Issues. AMA, 1995 – 2012. Web 3 Dec. 2012. . AMAd. Search Results. AMA, 1995 – 2012. Web. 3 Dec. 2012. . AMAe. Infectious Diseases. AMA. Web. 3 Dec. 2012. < http://www.amaassn.org/ama/pub/physician-resources/medical-science/infectious-diseases.page >. Bloom, Barry. “Lessons from SARS.” Science 300.2 (2003): 701. Web. 3 Dec. 2012. . Chan, Paul K.S., Tang, Julian W. and Hu, David S.C. “SARS: Clinical Presentation, Transmission, Pathogenesis and Treatment Options.” Clinical Science 110 (2006): 193 – 204. 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Web. 5 Dec. 2012. < http://english.peopledaily.com.cn/200306/07/eng20030607_117823.shtml >. Roxbya, Philippa. Measles Outbreak Warning as Cases Rise in Europe and UK. BBC, 13 May 2011. Web. 3 Dec. 2012. < http://www.bbc.co.uk/news/health-13561766 >. Roxby, Philippa. Measles Outbreak Prompts Plea to Vaccinate Children. BBC, 27 May 2011. Web. 3 Dec. 2012. < http://www.bbc.co.uk/news/health-13561766 >. Szabo, Liz. CDC: Measles Epidemic Poses Travel Risks. USA Today, 26 May 2011. Web. 3 Dec. 2012. . The University of Toronto Joint Centre for Bioethics. Ethics and SARS: Learning Lessons from the Toronto Experience. York University, n.d. Web. 4 Dec. 2012. < http://www.yorku.ca/igreene/sars.html >. World Health Organization (WHO). WHO Global Conference on Severe Acute Respiratory Syndrome (SARS). Where do we go from here? WHO, 17 – 18 Jun. 2003. Web. 3 Dec. 2012. < http://www.who.int/csr/sars/conference/june_2003/materials/report/en/index.html >. Read More