Environmental and Global Health Issues

Increased mobility of human populations allows disease to spread quickly around the world. Severe Acute Respiratory Syndrome (SARS) is one such communicable disease that came to worldwide attention in 2003 with >8000 cases and approximately 800 deaths. How such a disease can move so rapidly and be transmitted to so many people becomes apparent and necessitates that reporting criteria be required. Respiratory issues affect how we live and breath. Modifications may become necessary to care from health care providers due to concerns for clients.

Communicable disease outbreak: Severe acute respiratory syndrome, abbreviated as SARS is known as an atypical pneumonia. Pneumonia is an inflammation of the air sacs in the lungs generally caused by an infection. SARS is considered atypical because it is not caused by the usual viruses or bacteria. It is a viral respiratory illness caused by a coronavirus, SARS-associated coronavirus (SARS-CoV). (Centers for Disease Control and Prevention February 20, 2013). SARS first came to worldwide attention in February 2003 in Southeast Asia (MediResource, Inc. 1996-2013).

World Health Organization (WHO) received reports of >8,000 SARS cases and approximately 800 deaths during the winter of 2002 through the spring of 2003. (Centers for Disease Control and Prevention July 7, 2012). The first recognized case was in a middle-aged business man who traveled extensively in South-East Asia before being admitted to a hospital in Hanoi on February 26, 2003. He was admitted with a high fever, dry cough, muscle aches and sore throat. He subsequently developed symptoms of adult respiratory distress syndrome which required ventilatory support, and severe thrombocytopenia.

Pan American Health Organization, 2008-2009) The incubation period of SARS is usually 2-7 days but estimates state may be as long as 10 days. At illness onset a fever, which is often high, is accompanied by chills/rigors and sometimes headache, body aches and fatigue. A lower respiratory period usually begins within 3-7 days with the onset of a non-productive, dry cough or difficulty breathing. This may be accompanied by or lead to hypoxemia. The respiratory illness can be severe enough or lead to intubation or mechanical ventilation. Pan American Health Organization, 2008-2009).

The largest period of communicability from respiratory tract excretion is found to be within 6-14 days of disease onset, although viral excretion starts at 0-2 days and declines between days 15-17. Viral shedding from stool is at it highest days 6-14. (K. Kutsar, 2004). The SARS coronavirus (SARS-CoV) is a new variant of virus possibly transmitted to humans from animals. It is believed to be spread by close contact with an infected person. The virus seems to be spread through exhaled droplets and body secretions.

When an infected person coughs or sneezes you may come in contact with their respiratory secretions. These aerosolized droplets land on surfaces such as doorknobs and elevator buttons where you can then come into contact with them. It is also theorized that SARS may be spread when fecal matter containing the virus is ingested (contaminated food or water supply e. g. , poor sewage treatment). The epidemiological data of the SARS outbreak indicated a significant delay in reporting to the necessary health officials, resulting in improper handling of this event in early onset.

The first individual was in public and the transmission of this virus started to take place. Due to close proximity and large populations coupled with ease of travel the virus became intercontinental rapidly. Policies were developed to break the human chain of transmission and there have been no reported cases since 2004. Extensive data analysis has been completed by many specialists as they have concern this can reoccur and they want to have in place the best method of practice.

A SARS outbreak in my community could have large numbers of fatalities as I live in a suburban population of 200,000. Public schools, community centers, grocery stores, theaters and shopping malls attract a large number of people daily who come in close proximity of one another. An infected person could easily come in contact with 100-200 people in a single day. Estimate 25% of those become contaminated via airborne droplet, which would be 25-50 and 10% become contaminated via surface contact, another 10 to 20; we now have 35-70 who will expose approximately the same number of people.

If only the first group of exposed people became infected and required hospitalization it would take two total floors out of the five that are utilized for this type of patient at one of the two largest hospitals in our community. The health care system would be overwhelmed by this outbreak just in room capacity not to include how many of the infected may actually be the health care providers themselves. Reporting Protocol Suspicion that a family returning from overseas travel has contracted SARS coupled with several other community members presentation of the same symptoms leads the clinic to conduct testing whereby SARS is confirmed.

Any potential SARS cases should be immediately reported to the local health district or Epidemiology Program. Reporting is required of suspected cases within one working day during business hours or if after hours (weekend or holiday) report to the health district or State Epidemiology Program the next working day. Reports should include disease being reported along with the patient and physician information. (OEFI, 2010). Air Quality Index Air quality changes from day to day and affects how people live and breathe. The U. S.

Environmental Protection Agency (EPA) and the local air quality agency are working together to make information available and understandable for the public on the outdoor air quality. (U. S. Environmental Protection Agency, August 2009). The news has announced the air quality index is poor. I would contact my patients and their families to provide education on understanding air quality and the effects it has on patients with respiratory disease and have them follow alerts via the internet, e-mail, television, radio and/or newspaper.

As the community health nurse having concern for my patients who have respiratory disease I would encourage them to modify the amount of time they spend outdoors and decrease their activity levels while outside. In some cases, it may be necessary to limit all outdoor exposure. In these cases, modifications to care made be required for things such as bringing meals in, home delivery of medications, assistance with shopping, personal cares and home maintenance.

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