Download Running head: SEVERE ACUTE RESPIRATORY SYNDROME

Running head: SEVERE ACUTE RESPIRATORY SYNDROME
Severe Acute Respiratory Syndrome an Emerging Infectious Disease
Emily Gullena
Ferris State University
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Abstract
The transmission of SARS is examined. The isolation of the SARS-CoV virus and findings are
discussed. The clinical presentation, diagnosis, and treatments for patients with SARS are
identified. There is a brief category describing the biological, environmental, and situational
factors regarding emerging infectious diseases. Also, considerations and applications for nurses
and health care workers are explored.
Keywords: SARS, infectious disease, transmission, isolation, clinical presentation, diagnosis
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Severe Acute Respiratory Syndrome
Severe Acute Respiratory Syndrome or SARS is a newly emerging infection that
was first seen in China in late 2002 (Rhinehart, Jackson, & Chiarello, 2007). The viral
respiratory illness quickly spread to more than two dozen countries including North America,
South America, Europe, and throughout Asia before being contained (Veenema, 2007, p. 443).
The mortality rate is less than 10% (Veenema, 2007, p. 444). Initially, 8,098 people
became sick and 774 died from SARS complications (Veenema, 2007, p. 443). The virus was
most fatal to the young, elderly, and people with chronic health issues (Veenema, 2007, p. 443).
The SARS pandemic received a great deal of media exposure and caused fear in people
who may have been exposed. Since the emergence of the SARS infection epidemiologists and
health care workers have been able to state a mode of transmission of the virus, have isolated of
the virus, identified signs and symptoms and a clinical presentation of the disease, found criteria
for diagnosing SARS, initiated therapy for treatment, explored some of the environmental and
situational factors that precipitate the disease, and have used evidenced based research to find the
best practices for nursing care of SARS patients in the hospital setting.
Transmission
The SARS virus was first seen in people who traveled to China, Hong Kong, and Taiwan
or those had close contact with someone that was in one of those countries (Veenema, 2007, p.
448). It was quickly identified as being spread by close contact and by droplet routes (Rhinehart
et al., 2007). It is suggested that airborne transmission is possible with in a room (Rhinehart et
al., 2007). It initially was been spread by large droplets on airplanes and from people who were
at the Amoy Gardens where the virus originated in Hong Kong (Veenema, 2007, p. 443).
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SARS is also found to be spread by small airborne droplets in hospitals (Veenema, 2007,
p. 443). SARS transmission has been associated with exposure when performing procedures such
as endotracheal intubation, when using noninvasive positive pressure ventilation, and during
cardiopulmonary resuscitation (Rhinehart et al., 2007). Also, it is important to note that
laboratories where SARS-CoV was being studied were the source of most cases reported after
the initial outbreaks in the winter and spring of 2003 (Rhinehart et al., 2007).
Preventing transmission in the public sector requires the use of a simple mask to protect
people in close contact from large droplet transmission (Veenema, 2007, p. 443). In the hospital
setting, it is recommended to wear N-95 masks, use hepa filters, and place the patient in a
negative pressure room (Veenema, 2007, p. 443).
Isolation
SARS is caused by SARS CoV, a new member of the coronavirus family (Rhinehart et
al., 2007). It was hard to diagnose initially because it presents similarly to many other respiratory
illnesses. The incubation period of the SARS CoV virus is generally 2 to 7 days (Rhinehart et al.,
2007). Some uncommon cases reported an incubation period of greater than 10 days (Rhinehart
et al., 2007).
The SARS-CoV virus can be grown in cell culture (Jiang, He, & Liu, 2005). It can live in
urine and feces for up to 2 days (Jiang et al., 2005). Because the virus is fatal it is considered a
Category C priority pathogen by the National Institute of Allergy and Infectious Diseases
Biodefense agency (Jiang et al., 2005). Scientists are currently working on 3 types of vaccine
development which includes using the inactivated SARS-CoV virus, a full-length S protein, and
a vaccine based on fragments with neutralizing isotopes (Jiang et al., 2005).
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Clinical Presentation
The prodromal or early symptoms of SARS include a fever greater than 38 degrees
Celsius, myalgia, headache, and diarrhea (Veenema, 2007, p. 444). Other early noted findings
are chills, rigors, a sore throat, and rhinorrhea. Severe presentation, in addition to the early
symptoms, would include a positive chest x-ray for pneumonia, Acute Respiratory Distress
Syndrome (ARDS), and an autopsy that shows findings of SARS (Veenema, 2007, p. 445). Of
course clinicians need to be aware of the patient’s recent activity or travel to areas with SARS
outbreaks
Diagnosis
There is no rapid and reliable test at this time to diagnose SARS. Instead, a diagnosis of
SARS is done by performing a chest radiograph, pulse oximetry, a complete blood count (CBC),
blood cultures, sputum cultures, testing for influenza A and B, testing for legionella and
pneumonia urinary antigens, and an RT-PCR test. Also, SARS can be identified by a serum
antibody to SARS-CoV, isolation in cells of SARS-CoV, or detection of SARS-CoV in
Ribonucleic acid (RNA) (Veenema, 2007, p. 444).
Therapy
At this time there is no known treatment for SARS outside of the supportive treatments
that are available (Veenema, 2007, p. 444). A few patients that have the mildest symptoms
recover without any treatment or intervention (So, Lau, & Yam, 2006). SARS patients present
with symptoms similar to community acquired pneumonia and the initial course of treatment is
antibiotics (So et al., 2006). After the discovery of the virus SARS-CoV antiviral treatment was
used even though there is little evidence to determine its effectiveness (So et al., 2006). Antiviral
treatments include Ribavirin, Tamiflu, Kaletra, and human interferons and immunoglobulins (So
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et al., 2006). The Chinese have also used a component of the liquorice root that has been used to
effectively treat HIV and Hepatitis C in the past (So et al., 2006). With most infections
proinflammatory cytokines are releases and a corticosteroid is used for immunomodulatory
therapy (So et al., 2006). This can help to effectively reduce fever and improve oxygenation (So
et al., 2006).
Approximately 20 to 30% of SARS patients will end up in an Intensive Care Unit and 10
to 20% of patients require mechanical ventilation and intubation (So et al., 2006). Other options
to help with oxygenation are face masks, nasal masks, and continuous positive airway pressure
(CPAP). Treatment protocols have been developed have shown positive outcomes in Hong Kong
(So et al., 2006).
Biological, Environmental, Behavioral, and Situational Factors
Host susceptibility plays a major role in the emergence of new diseases (Veenema, 2007,
p. 438). Those that are most susceptible to a virus include people with Human immunodeficiency
virus (HIV), patients who have received an organ transplant, cancer patients, people who have
overused antibiotics and have less good bacteria, and people who are malnourished (Veenema,
2007, p. 438).
Climate can be a factor in disease transmission. For example, places that have prolonged
warm weather. Also, changes in the environment can affect the prevalence and emergence of a
disease. Studies show that 75% of emerging diseases are zoonotic or transmitted from an animal
Some scientists believe that the SARS-CoV virus originated in animals. It was identified
in palm civets and other animals in the live animal markets of Guangdong, China (Jiang et al.,
2005). The virus that was found in animals does not cause the disease. It is thought that the
animals are not a host transmitting the virus to humans (). The virus is instead thought to have
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evolved into the human form of SARS-CoV (Jiang et al., 2005). International travel is another
factor that contributes to the spread of the disease (Veenema, 2007, p. 438).
Application to Nursing Practice
Nurses are able to help evaluate the patient for alternative diagnosis. They can monitor
labs, vital signs including pulse oximetry, obtain blood cultures and sputum cultures, and
perform tests for influenza A and B (Veenema, 2007, p. 448). Nurses should have an awareness
and knowledge of recent health department findings and clusters of patients that have similar
presentation (Veenema, 2007, p. 448).
SARS has had a significant impact on health care workers. A large number of health care
personnel were infected with SARS due to infected patients being undiagnosed (Rhinehart et al.,
2007). Initially when a patient arrives with a suspected respiratory illness the nurse must
implement protective infection control and initiate droplet precautions to prevent the spread to
other patients and to health care workers. A study done in a Toronto hospital found that
“consistent use of an N95 respirator was slightly more protective than a mask” (Rhinehart et al.,
2007).
The Centers for Disease Control and Prevention offer many recommendations for health
care workers preparedness and response to the SARS infection. They recommend that the facility
has a written plan in place, a SARS coordinator for communication needs, and identifies the
appropriate state and local health department contacts (Center for Disease Control and
Prevention, 2004). The CDC recommends testing the facilities response with exercises. Also,
they advise in educating clinicians in early detection, signs and symptoms, how to report
incidences, modes of transmission, and isolation procedures and guidelines (CDC, 2004). They
suggest maintaining the air-handling capacity of designated rooms and planning for supplies
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(CDC, 2004). The CDC suggests identifying what personnel what care for SARS patients and
any additional staffing needs during an outbreak (CDC, 2004). And lastly, they recommend the
organization creating a policy regarding controlled access to the hospital and when to close the
facility (CDC, 2004).
Conclusion
It is noted that in dealing with emerging diseases “Nurses, the largest sector of the health
care profession, are poised to take the lead in the fight against these invisible enemies”
(Veenema, 2007, p. 453). Training and continued education regarding emerging infectious
diseases allows nurses to help in identifying and minimizing the negative impact of such
illnesses. The information that health care providers have learned from the outbreaks of SARS
can be of great value when responding to future pandemics or bioterrorism.
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References
Center for Disease Control and Prevention (2004). Severe acute respiratory syndrome:
Preparedness and response in health care facilities. Retrieved from
http://www.cdc.gov/ncidod/sars/guidance/C/pdf/app2.pdf
Jiang, S., He, Y., & Liu, S. (2005). SARS Vaccine Development: Origin and Evolution of
SARS-CoV. Medscape News. Retrieved from
http://www.medscape.com/viewarticle/507912_2
Siegel, J., Rhinehart, E., Jackson, M., & Chiarello, L. (2007). Guideline for Isolation
Precautions: Preventing Transmission of Infectious Agents in Health Care Settings.
Centers for disease control and prevention. Retrieved from
http://www.cdc.gov/hicpac/pdf/isolation/Isolation2007.pdf
Veenema, T. (2007). Disaster Nursing and Emergency Preparedness. New York: Springer
Publishing Company.
So, L., Lau, A., & Yam, L. (2006). SARS Treatment. SARS reference. Retrieved from
http://www.sarsreference.com/sarsref/treat.htm