Report on SARS

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Beginning Feuary 00, newspaper and other media sources began reporting a rapid spreading of this unknown disease known as SARS. Cases were arising from areas all around the world and several people, even in Ontario, were to be quarantined. When I first began to hear these reports, I naively didnt think it would affect my life. Little did I know that I would be sent home from my co-op at the Emergency Ward of Victoria Hospital one Friday afternoon with the possibility of not receiving my co-op credits or graduating. Also, my English fieldtrip to Toronto to watch the play of Hamlet was cancelled. And who would have thought that at my part-time job at Pharma-Plus, I would be receiving phone calls and inquiries about facemasks and antibacterial hand creams so people could protect themselves from SARS? My point is that the whole world is affected by this illness. The Rolling Stones along with many other bands had to cancel shows due to SARS, NHL hockey players showed concern of contracting SARS in Toronto, etc. I feel that it is important to know what SARS is and what we can do as a community to control it.

What SARS Is

The World Health Organization (WHO) defines severe acute respiratory syndrome (SARS) as an "atypical pneumonia of unknown etiology." In other words, we know its a type of pneumonia but we dont yet know what causes it. It was first reported among the people of the Guangdong province (China), Hanoi (Vietnam), and Hong Kong. The first actually case was in Guangdong on November 16. 00. It has since spread to other countries including Taiwan, Singapore, Canada, the United States, Australia, Belgium,azil, France, Germany, Italy, the Republic of Ireland, Romania, Spain, Thailand and the United Nations. Worldwide (as of April 11, 00), SARS has claimed at least 111 lives and sickened more than ,700 people.

The symptoms of SARS are described as "flu-like". The incubation period (how long it takes someone who has been exposed to develop symptoms) ranges from to 7 days. Some authorities report that in some cases, symptoms have not been present until 10-14 days, although that is not the norm. The initial indication of infection is a fever of 100.4 degrees Fahrenheit (8 degrees Celeuis) or more and is usually followed by muscle discomfort, headaches and chills. After to 7 days, a dry unproductive cough develops. The cough can be accompanied by or eventually result in hypoxemia (a condition characterized by a reduced oxygen concentration in the blood). Approximately 10 to 0% of infected patients require some type of assistance ineathing- either through intubation or mechanical ventilation.

Treatment

Without a known cause, it is hard to pinpoint a cure. For now, the Center of Disease Control (CDC) and the World Health Organization (WHO) recommend that healthcare workers treat the symptoms of SARS in the same way they would treat any other unknown atypical pneumonia. Currently they have a choice of administering 1-antibiotics -antiviral agents like oseltamivir and ribavirn or -a combination of steroids and antimicrobials.

In the United States, over 000 drug tests are being done to find a cure for SARS. The National Institute of Allergies and Infectious Diseases is gathering up to 0 antiviral drugs on the market, about 800 drugs approved for other uses, and over 1000 that are still being developed. They are being tested in the US Army Medical Research Institution for Infectious Diseases in Fort Detrick, Md. The lab can test 150 to 00 drugs a week and has started with the most obvious antiviral medications. This is a remarkable rate since drugs often need at least five years from the point when they are designed on the computer to where they can be given to patients in need. So far, "nothing looks very promising, to be honest," Army research scientist Peter Jahrling said.

In Canada, medical officials say that the federal government should invest up to $100 million into trying to develop a SARS vaccine as quickly as possible because of the increasing difficulty of containing the disease. Dr. David Patrick, an epidemiologist dealing with SARS initish Colombia inputs that it would be in Prime Minister Jean Chr�tiens best interest to streamline the vaccination-development process to about six months from the usual three to five. This might be the most efficient way of dealing with the SARS outeak.

Possible Causes

Although scientists havent found a definite cause and SARS is still a relative mystery, researchers have made some significant progress. According to the CDC, scientists have found a "previously unrecognized corona virus" in patients with SARS. This corona is the leading contender in the list of possibilities. Named for its distinguishing crown-like appearance, corona viruses are commonly associated with upper-respiratory disease and have, on occasion, been connected to pneumonia. What makes this unusual is that in the previous cases of related pneumonia, many of the patients had weakened immune systems. . Most SARS cases have been found in adults who were healthy prior to infection. And, while corona viruses have been a known culprit in acute sickness among animals (such as dogs, cats and pigs), this has not been common among humans. Researchers are investigating the possibility that this corona virus jumped between species.

This would not be the first time a disease has migrated from animal to man. All of these conditions were first evident in animals

· Buffalo pox

· Creutzfeldt-Jakob disease (also known as Mad-Cow disease)

· Ebola haemorrhagic disease

· HIV-AIDS

· Nipah virus

Clinical research has also detected a paramyxovirus in specimens from patients infected with SARS. Among humans, viruses in this family cause conditions such as the mumps and measles. The presence of these viruses is a pivotal clue in the SARS investigation, but researchers still have a long way to go. SARS could be connected to a completely new corona virus, a new paramyxovirus, or possibly a previously identified paramyxovirus thats mutated into something new. It could even be a combination of the two viruses working together. Or it could be something entirely different.

Amidst all this uncertainty, there is something that we can count on Scientists will continue to research SARS until we discover a cause and cure. For now, since there is no specific antiviral treatment, the most effective combatant is control. To curtail the spread of SARS, healthcare workers are adhering to strict safety procedures. But as weve seen, the condition has already spread around the world.

How SARS Spread So Rapidly

As far as can be determined, the factory-dense city of Foshan is ground zero in the SARS outeak. On November 16, 00, two or three residents were stricken with what is now known as SARS. "We did not take it seriously as the beginning," said an official from the Guangdong Provincial Center for Disease Control and Prevention.

The pathogen picked the perfect city to incubate, mutate and spread. Foshan is a metropolis of .5 million, engulfed by the urban sprawl of Guangdongs nearby capital. Yet it remains fringed by traditional peasant farms where people live in close proximately of pigs, amoung other animals. Foshan is a third-world city with the usual sanitation problems, but is unique since many of the residents are rich enough to travel frequently and far.

The mystery pathogen made its way to a hospital in the provincial capital, where a Chinese doctor was infected and carried the virus to a Hong Kong Hotel, setting in motion a catastrophic chain of events that would end up with more than ,00 people infected worldwide and 78 dead. Many people say China failed the world. "If they would have acknowledged this early, and we could have seen the virus as it occurred in south China, we probably could have isolated it before it got out of hand," said Dr. Stephen Cunnion, an infectious disease expert.

But China hid SARS, fearing the disease would cause damage to their economy, tourism as well as their reputation worldwide. It wasnt until Jan. that SARS was first reported in the Chinese media, and it was far from accurate. "No epidemic disease is being spread in Heyuan…Symptoms like cough and fever appear due to relatively colder weather." Eventually, Beijing admitted it had 1,10 suspected cases and 46 deaths, many more than previous acknowledged. For the first time, it reported SARS cases in Shanghai and three new provinces, Guangxi, Sichuan and Hunan. After stalling the World Health Organization for nine critical days, China finally allowed the team to enter Guangdong.

But do not be fooled! The media is to some extend using China as a scapegoat for SARS. Other nations that didnt deal with SARS as a potential fatal disease are to blame as well, including Canada. It was a doctor in China, Carl Urbani, who first identified the disease, putting himself at risk by exposing himself to SARS patients and eventually dying of the disease. Before passing away on March , 00, he was quoted saying, "We must not be egotistical about this, I have to think of others."

Much like other respiratory illnesses, SARS seems to be spread by close contact. For example, a person infected with SARS could cough or sneeze, contaminating the immediately surrounding air with tiny droplets of infected matter. Someone in close proximity of the infected person could theneathe in air that has been contaminated. Because the cause of the SARS infection is yet unknown, scientists are considering other possibilities of communication. According to the CDC, it is possible that SARS can also spread moreoadly through the air or by touching an object that has been contaminated. A recent update on the WHO Web site addresses some other possibilities

The SARS outeak in Hong Kong SAR has developed an unusual pattern of transmission. This pattern is different from what is being seen in the vast majority of other SARS outeaks, and is not yet fully understood. The number of cases is continuing to increase significantly, and there is evidence that the disease has spread beyond the initial focus in hospitals.

These developments raise questions related to other routes of transmission, in addition to well-documented face-to-face exposure to droplets released when an infected person coughs or sneezes. Epidemiologists are considering whether SARS is being transmitted in Hong Kong by some environmental means for which no satisfactory explanation has been found.

To illustrate the communicability of SARS, consider this According to the New York Times, as of March th, 4 individual cases of SARS could all be traced to one man. Thats an incredible amount of people infected by one person. Of those infected, 14 were medical personnel or health-care workers.

Both the CDC and the WHO are working hard to reduce the spread of SARS by informing healthcare workers and the general public about the condition. Some of the recommendations for medical personnel in direct contact with SARS patients are

· Follow standard precautions (like hand hygiene).

· Wear N-5 respirators (not face-masks).

· Wear a disposable gown and gloves, removing and replacing soiled items regularly.

· Wear eye protection

SARS patients and the family members and healthcare workers in contact with them should take precautionary measures for at least 10 days after SARS symptoms have passed. The CDC and the WHO recommend recovering patients and people in contact with them

· Wash and disinfect hands frequently.

· Wear facemasks when in close contact with others.

· Avoid sharing household items like cutlery, bath towels, or bedding.

· Regularly cleanse and disinfect household surfaces like sinks, toilets, and countertops.

Travel Advisory

According to a recent press release, WHO now recommends that individuals should suspend travel to Hong Kong Special Administrative Region and Guangdong Province of China, unless it is absolutely necessary. This is the first time in at least 1 years (and possibly ever) that the World Health Organization (WHO) has made this sort of recommendation because of a disease. WHO regularly makes travel recommendations to curtail the infection of travelers by posting alerts in regard to various areas, regions and countries. Usually, the organization provides information regarding vaccinations. Because there is no vaccination or even any definitive medicinal treatment for SARS at this time, the World Health Organization really has no other choice but to advise travelers to avoid the area entirely.

Canada has suffered greatly since the SARS outeak and since WHO announced that travelers should avoid Toronto since there is a threat of contracting SARS. Toronto has had the biggest hit, losing over $0 million in the economy, tourism, restaurants, hotels, etc. Ethnic Chinese in Canada say theyve been stigmatized as carriers and that their businesses have suffered. Seeking to ease concern, Prime Minister Jean Chretien dined in Torontos Chinatown and urged others to do the same.

In the media coverage, particularly in Toronto, the impact of SARS on nurses has been largely glossed over. Because they work most closely with the sick patients at the onset, nurses account for the majority of suspected cases; most are recovering, but some are gravely ill. Hundreds of others without obvious symptoms have gone under quarantine.

What upsets nurses most about SARS is that it follows them home from work, putting their children and loved ones at risk. Many horror stories have been told nurses whose husbands were sent home from work, children of nurses shunned at school, nurses refused rides by taxi drivers, single parent nurses unable to get a babysitter, pregnant and immuno-compromised nurses forced to go to work despite concerns or forced to use big chunks of sick leave, casual (part-time) nurses who will no longer have means of income, nurses of Asian heritage subject to discrimination, routine life turned upside down by the fear of the unknown. Nurses become leppers in our community because they simply did their jobs.

Nurses and citizens alike havent seen a disease similar to SARS in eighty-five years. In late August of 118, Boston was the first major North American city to be hit by a new and deadly respiratory tract virus. Within a few weeks, as many as 100 young men a day were dying at a nearby military base, their bed sheets stained with the frothy blood and mucus that spilled from their mouths.

Over the next year, the virus would sweep the world, leaving only a few isolated countries untouched. The Spanish Flu pandemic of 118-11 was the deadliest plague in history, killing about 0 million people. In Canada, as many as 50,000 perished.

Ominous similarities exist between the 118 flu and SARS including

·Both diseases were highly transmissible. It is not certain that either SARS or the Flu of 118 are airborne, but both are believed to be and that would account for the rapid spread of both diseases. (SARS is actually deadlier than the flu of 118, killing 4% of victims compared with .5%).

·Both viruses start off weak and get stronger. This is favoured in evolution since it gives the organism a chance to spread the disease before it dies.

·SARS and the Spanish flu affected people of big cities and rural areas.

·In both cases, a new virus hit populations that had no previous exposure and therefore no resistance to it. There was no cure for the 118 influenza and there is not cure for SARS.

·Canadians tried to control the epidemic of 118 with masks and quarantines (the same methods used today) but with no success. Eventually the fluoke down the health care system and the strongest survived.

·Both viruses appeared to have evolved in animals before infecting people (SARS from cows and birds, the 118 flu from pigs and birds).

·It is thought that the origin of the 118 flu appeared in Guangdong, China; where SARS is thought to have originated.

Despite our medical huis, epidemics remain a potent force in history. Plague killed nearly a quarter of all white folk in Europe during the14th Century and rearranged that continents political and economical furniture. Syphilis introduced menace to sexual relations in the 16th century, while smallpox terrorized the 17th century. Influenza started this century off with a sneeze by dispatching more people than the battlefields of the First World War. After killing one out of every 100 people on the planet, it somehow became the "forgotten epidemic."

It is unlikely that SARS will become such a history shaper. But the current outeak is a fair preview of things to come, including a bioterror attack. In fact, most scientists believe we are overdue for another big killer flu pandemic. Given how SARS has already overburdened our health-care system so quickly, its pretty obvious we are not ready for such a gravedigger. Historically, we never have been.

References

1. www.howstuffworks.com/SARS

. www.sars.gc.ca

. www.lehigh.edu/jgm4/virology/history.html

4. The Globe and Mail newspaper

5. The London Free Press newspaper

6. The Toronto Star newspape

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