HAT1 COMMUNITY HEALTH NURSING TASK 3
Western Governors University

OUTBREAK
The issue of global health concerns is relevant and viable in today’s society. People travel easily from one country to another. Illnesses contracted in one country can easily be introduced to a new environment due to the freedom of movement of people from region to region.
In 2003, the World Health Organization became aware of a flu-like outbreak occurring in China, specifically the Guangdong Province. In March of 2003 the WHO issued a global alert and named this flu-like illness Severe Acute Respiratory Syndrome, aka SARS. SARS spread from China to another 37 countries around the world and is considered to be highly transmittable. The illness became publicly better known when an American businessman was traveling from China to Singapore. He became so severely ill on the flight that it landed in Hanoi, Viet Nam. The businessman succumbed to the disease, as did his treating physician. Several other staff from the hospital also became ill with the same symptoms despite delivering care to the businessman using standard protocol. This incident prompted the WHO alert. A physician from mainland China who had treated patients in Guangdong Province stayed in a hotel in Hong Kong. He had been infected with the SARS virus. Sixteen guests in the hotel were exposed to the virus and eventually became infected as well. As exposed patrons from the hotel returned to their respective home countries of Canada, Singapore, Taiwan, and Vietnam via international flights, the disease became global. (Severe Acute Respiratory Syndrome, 2013).
INDICATORS
There are two types of epidemiological indicators: qualitative and quantitative. Qualitative indicators include the quality of healthcare services obtained by victims of an outbreak. Quantitative indicators are factual and numerical. An illustration of this would be the actual number of identified people infected, the number of morbidities, and mortalities.
Severe Acute Respiratory Syndrome is part of the Corona virus family, specifically the SARS CorV. (Severe Acute Respiratory Syndrome, 2013). Identification of the causative virus allowed the virus to be identified in individuals and quantitative epidemiological indicators could be tracked and tallied. This virus presents as pneumonia, with a mild sore throat, fever, general malaise, aches, chills and cough. SARS incubation time period is 4-6 days, though most patients have become ill from days 2-10. The disease can quickly progress and be fatal. The disease quickly spread globally and the number of reported cases increased dramatically within a few months. As the WHO responded with appropriate protocols to improve hospital infection controls, the incidence decreased and SARS was considered a virus with a low contagion rate. (Kamps, B. & Hoffman, C., 2003). The initial outbreak of SARS, having occurred in the Guangdong Province, China, was not originally reported to the WHO until February of 2003. This failure to report the outbreak affected the qualitative factors. Earlier detection of the virus could have led to hospital isolating and increasing precautions with these patients thus preventing spread of the virus through their families or through the healthcare workers themselves.
DATA
The SARS virus’s first case occurred in November of 2002 in a province in southern China called Guangdong. A farmer presented with an unusual pneumonia and died shortly after admission to the hospital. By the time China reported the virus to the WHO organization, there were 305 cases with 5 deaths. Many of the cases were hospital workers and their household members. (Kamps & Hoffman, 2003). In February of 2003 a physician from Guangdong traveled to Hong Kong and stayed in a hotel for one night. Subsequently 16 people were infected with the SARS virus. The doctor was soon hospitalized in Hong Kong and died from the virus. These 16 hotel patrons traveled to their respective homes and countries. These countries included Viet Nam, Singapore, Canada and Taiwan. From November 2002 to July 2003 there were a total of 775 deaths reported to the WHO from the SARS virus. China and Hong Kong had the highest number of fatalities, 349 and 299 respectively. After the outbreak of the virus was reported to the WHO and was identified, the WHO instituted travel restrictions along with an improvement of health care protocols to include airborne and contact precautions. Of the 8098 people reported with the disease from November 2002 to July 2003, 9.6% of these cases were fatal. (Severe Acute Respiratory Syndrome, 2013).
ROUTE OF TRANSMISSION
The SARS virus is spread predominantly by droplets or by direct and indirect contact between people. This mode of transmission is presumed because the majority of new infections have presented in people who were in close contact with these patients. These people were usually household members, healthcare workers, or other patients who were not protected by contact or respiratory precautions. There has been some indication that the virus may spread via fecal matter, but this has not been fully substantiated. (Kamps & Hoffman, 2003).
GRAPHIC REPRESENTATION
See attached power point picture
EFFECT ON COMMUNITY
The effect of SARS on a community would individually and collectively create an environment filled with stress and fear and have numerous implications. The following implications could be expected if a SARS outbreak were to occur: fear, isolation, economic, overloaded medical systems, panic, grief, and discrimination. People in the community could become fearful of contracting SARS. If many people have contracted SARS there could be business and school closings. Loss of wages and productivity could result leading to a loss for the local economy as less money is spent. Small business would have greater difficulty staying open if less money is coming in or if the workers decided to stay home to avoid possible exposure to the SARS virus. Education could be delayed as well. Fear could lead to people isolating themselves for fear of exposure and those exposed would be isolated and might face discrimination from community members. As people suspect they have SARS the medical system could become overloaded with additional doctor office and emergency room visits. Some members of the community might panic and refuse to go to work, school, or engage in volunteer activities to prevent themselves from being exposed to the virus. Grief over the loss of loved ones due to the virus would sadly be a result of SARS infecting a community.
PROTOCOL
Whether in a healthcare setting or the community many protocols, in the event of a SARS outbreak, remain the same. Dissemination of accurate information to the community or to hospital personnel is imperative. Accurate information creates a sense of trust from the community to community leaders. Accurate information also allows for appropriate measures to be implemented to aid in slowing or stopping the spread of the SARS virus and decrease the reactionary fear which might occur. Education of what SARS is, how you contract it, early symptoms, preventative measures, and places for assistance are an important component of educating people with accurate information.
In the healthcare setting, isolating patients with the virus or suspected of having it prevents further exposure to those around them. While they are isolated appropriate treatment can be given to them. Also, during this time people they may have exposed to SARS can be identified and they can be on the look-out for any of the early symptoms. Since SARS can present early on as a bad cold or the flu, it is very important to identify anyone who may have been exposed to the virus and therefore at risk for developing SARS. Plans should also be in place in healthcare settings to deal with any type of disease outbreak. These emergency plans could include devoting a specific wing to the patients with the disease. Part of the staff could be kept from caring for these patients to insure healthy staff, some may even be kept home to create a pool of healthy workers in the event many staff becomes ill. The implementation of strict contact and airborne isolation is imperative in scenarios such as this. Limiting visitors to those in isolation is also a viable strategy. Keeping exposure and transmission of the disease as limited as possible is imperative to keeping the overall effect of an epidemic to a minimum.
Confirmed cases where there is a positive SARS-coV test result need to be reported to the Centers for Disease Control and the Public Health Department. These agencies monitor the locations of outbreaks and help to determine modes of transmission, causative agents, and issue appropriate preventative measures for communities and healthcare workers. They have emergency response plans in place which can be activated.
The community health nurse remains on the front-line of defense for the community against communicable diseases. If the nurse suspects a person or family has SARS, early detection becomes key to containing the outbreak. Implementing isolation protocols is also appropriate in this case until the SARS virus presence is confirmed and if present, continuing the isolation until the patient is no longer contagious.
MODIFICATION OF CARE
The local air-quality index has been reported as poor. The community health nurse recognizes that this can produce adverse effects for his/her patients with respiratory diseases or asthma. Prevention is imperative for patients with any type of respiratory issue. This nurse has had much experience with respiratory illness as two children deal with asthma on a daily basis.
Educating the patients to monitor the AQI daily is important in warding off exacerbations of their disease process. When the AQI is good, outside activities are possible. As the AQI decreases to poor, it is advised the patient stay inside. Activity should be kept to a minimum during these times as well. Instructing the patient to breathe through their nose allows their body to use a natural filtration system for inhaled air. Teaching the respiratory patient to be watchful of the following symptoms allows them to treat any impending attack sooner: shortness of breath, chest tightness, difficulty taking a deep breath, throat irritation or coughing. An increase in medication usage, rescue inhaler, and an increase in respiratory symptoms are all possible occurrences when the AQI rating is poor. Proper medication compliance is also extremely important for these patients. Taking preventative medications can decrease the number of respiratory distress episodes. Being proficient in the use of a rescue inhaler and keeping one with them at all times is also very important for this segment of the population. The community health nurse should encourage medication compliance, observe the patient for proper inhaler use, check for expired inhalers, and encourage keeping their inhaler constantly with them. With encouragement and education from the community health nurse, patients with respiratory issues can experience a decrease in respiratory episodes.

REFERENCES
Kamps, B. & Hoffman, C. (Eds.). (2003). SARSReference. Retrieved from http://www.sarsreference.com/index.htm Severe Acute Respiratory Syndrome. (2013). Retrieved from
http://en.wikipedia.org/wiki/Severe_acute_respiratory_syndrome_(SARS)#Outbreak_in_south_China