SZT3 SARS
Joy Ross
Western Governors University
Community and Population Health
SZT1

January 21, 2014

SZT3 SARS
In November of 2002, an outbreak of what was later determined to be SARS was first reported in Guangdong Province in Southern China.("SARS" 2012) By the time it was contained and over, a mere 8 months had passed. It was July of 2003 and over 8,000 people had been infected. Out of those infected, 776 people died.
During that time, SARS was all over the news. Panic from the epidemic was everywhere. Fortunately, the World Health Organization’s response (Knobler, Mahmoud, & Lemon,), led by the Global Outbreak and Alert Response Network (GOARN), contained the disease quickly and so effectively that, to this day, the virus is considered obsolete outside of laboratories. (Adams,)
SARS generally starts with symptoms of a high fever, body aches, and all over malaise. About a fifth of patients develop diarrhea. After about a week, coughing and other respiratory symptoms such as hypoxia develop. A large majority of patients develop pneumonia.("SARS," )
According to NIH, the SARS epidemic had five phases. The first phase (Intra-epidemic/sporadic cases) happened in March 2003 and followed the reports of “atypical pneumonia” in Guangdong Province from November 16th, 2002. ("SARS: Timeline of an Outbreak" 2014) A teaching hospital was host to a massive outbreak among staff, medical students, and patients in March 2003. (Hung, 2003) In phase one, the index patient was a professor who had treated the previously reported cases of atypical pneumonia. He traveled from Southern China to Hong Kong bringing with him the disease. Seven people who were staying on the same floor of the professor’s hotel room contracted the disease. Three of the seven were from Singapore, two were Canadian, one was Vietnamese, and one was a local from Hong Kong. The foreign guests are suspected of spreading SARS internationally while the local Hong Kong resident was admitted to the Prince of Wales Hospital at Shatin on March 4, 2003 and subsequently infected over 100 people, including medical personal and staff.
Phase two (confirmed person to person transmission) started in April with the disease spreading to infect the community. In this phase, the index patient was a man who had been having his kidney disease treated at the Prince of Wales Hospital. He traveled frequently to visit his brother at a housing community called Amoy Gardens. The brother owned an apartment in an area of the complex called block E. He was visiting his brother on the 14th of March when the first symptoms of SARS manifested as diarrhea. The index patient used the toilet there and visited again on the 19th of March. By mid-April, there were 321 people with SARS in the Amoy Gardens complex, including the brother and sister in law. 41% of the cases were located in block E. An investigation conducted by the World Health Organization discovered that two-thirds of the people affected in the Amoy Gardens community had diarrhea as a symptom and the virus is found in feces. A thorough study of the building’s drainage system supported the theory that environmental factors contributed to its spread.
The third phase (international transmission) began in March. The World Health Organization issued travel recommendations “to alert health authorities, physicians and the traveling public to what was perceived to be a worldwide threat to health.” (SARS Reference, 2006, para. 2) The primary areas of infection were Toronto, Hong Kong, Hanoi, and Singapore with healthcare workers being the majority of the persons infected.
Phase four (slowing down of the outbreak) happened around July. Thanks to the travel advisories and quick involvement of international health agencies, transmission had slowed down exponentially. In Toronto there had been no cases of infection for almost a month before a 96 year old man with what was mistakenly believed to be post-operative complications apparently was the index patient for a secondary outbreak. Still, compared to the 321 people infected in a month’s time at the beginning of the epidemic in the Amoy Gardens Complex, things have really slowed down. Throughout the end of 2003 and the beginning of 2004, there are a few isolated cases of infections throughout areas of China. These cases are primarily linked to lab workers and healthcare workers.
Finally in Mid May 2004, phase 5 occurred (the end of SARS infections/SARS becomes obsolete) when WHO announced that China was free from SARS infections.
It is frightening how fast a highly communicable disease such as SARS spreads. It is even more frightening to think of how devastating the loss of life would have been had the WHO not been so fast to put into place interventions to prevent the spread of such a disease. As a nurse, I could come into contact with a new and unknown highly communicable disease at any time. Fortunately, standard precautions are mandatory and can help keep a large amount of infections, especially contact infections at bay. However, if I were to come into contact with an air or droplet born pathogen unknowingly, it would likely spread rapidly among my co-workers and patients at the hospital as well as to my family. It would potentially then spread among the children at my son’s elementary school and the teachers and their families as well as my mother and her co-workers and their families and so on. An outbreak could easily devastate my community as it easily devastated the community in Hong Kong and communities in Southern China. In my opinion, Stephen King’s novel “The Stand” demonstrated with his fictional “super-flu” how quickly an air born pathogen can spread. Of course the novel is an exceedingly extreme example but it demonstrates how an index patient (in the novel’s case, the man who escaped the Army base with his family) can spread the disease to people he comes into contact with and they in turn spread it to those they come into contact with and so on. It also demonstrates how truly difficult quarantine is in today’s society. (King,)

Once the primary instance or case of SARS has been identified, it would be reported to the local health department and then to the CDC. At the same time, the affected patients and most probably those who have come into contact with them in such a way as to have been affected too would be isolated and quarantined. Next, communication with the public would happen with the media alerting people to the presence of the disease and educating them about the signs and symptoms and how they can protect themselves. A travel advisory would be put into place. ("," n.d.)Hopefully, the outbreak would be contained before it turned into another pandemic. Fortunately, SARS has been eradicated and this will only be a scenario for scholastic exercise. It is good to know however, that should such an outbreak occur, that we have such strong resources and have learned from the past so that the public can be protected.

References
Adams, M. (, March 4,2005). . NaturalNews.com. Retrieved from http://www.naturalnews.com/005250.html
Hung, L. S. (2003, ). The SARS Epidemic in Hong Kong: What Lessons Have We Learned? . http://dx.doi.org/PMCID: PMC539564
King, S. (). The Stand ( ed.). : . []. http://dx.doi.org/. Retrieved from
Knobler, S., Mahmoud, A., & Lemon, S. (). The Public Health Response to SARS. In The Public Health Response to SARS (, pp. -p. , ). : . []. http://dx.doi.org/ Retrieved from
Public Health at the Local, State. National, and Global Levels. (n.d.). In (Chapter 3pp. 45-73). Retrieved from http://www.ashp.org/DocLibrary/Bookstore/P1725/P1725SampleChapter.aspx
SARS Frequently Asked Questions. (2012). Retrieved from http://www.cdc.gov/sars/about/faq.html
SARS Reference. (2006). . In B. Kamps, & C. Hoffman (Eds.), SARS Reference (, pp. p. , ). : . []. http://dx.doi.org/ Retrieved from
SARS: Timeline of an Outbreak. (2014). Retrieved from http://www.webmd.com/lung/news/20030411/sars-timeline-of-outbreak
SARS- Frequently ask Questions. (). Retrieved from http://www.cdc.gov/sars/about/faq.html