Category: SARS

A histological analysis of SARS will be developed to clarify the main signs and symptoms of the disease, its epidemiology and etiology, the histological changes, and the existing treatments. SARS stands for severe acute respiratory syndrome. It is a viral respiratory disease that is usually caused by the presence of a coronavirus, known as an SARS-associated coronavirus, in a human organism (Centers for Disease Control and Prevention, 2013). Its fatality rate is approximately 10% (Van den Brand, Haagmans, van Riel, Osterhaus, & Kuiken, 2014).

Clinical Signs and Symptoms

Many people are not able to recognize SARS in its first stages because of its flu-like symptoms and signs. People may suffer from chills, pain in muscles, and possible diarrhea. Diarrhea is explained by the active viral replication that occurs in entrecote and disrupts the intestinal architecture (Van den Brand et al., 2014). Such symptoms as a fever up to 38⁰C, dry cough, and even shortness of breath are observed. In some cases, people with the SARS-associated coronavirus in their systems may have malaise, vomiting, and headache (Hui, Memish, & Zumla, 2014). All these signs could be observed among patients with different diseases.

Certain laboratory tests and radiological features have to be taken into consideration. Besides, people have to be careful with such risk factors as recent travels to the exotic or Asian countries, diabetes, smoking, heart diseases, and even hypertension (Doherty, 2013). Clinical and laboratory data on SARS is limited, and people continue developing the methods to recognize the disease under analysis. Therefore, SARS patients and their families are still under a threat of being maltreated or mistakenly diagnosed even in the hospitals with a good reputation.

Epidemiology

Adults are usually under a greater threat of having SARS in comparison to children (Hui et al., 2014). As for the gender factor, 57% of females and 43% of males are recorded as those who have SARS. Most cases of SARS were observed in young adults. Taking into consideration these criteria and risk factors, it is possible to say that smoking females between 25 and 35 years introduce a group of people that could be highly affected by the SARS-associated coronavirus and even die because of the development of this disease in their organisms.

According to the information given by the World Health Organization, the citizens of China and Hong Kong should be worried about the outcomes of the SARS epidemic (Van den Brand et al., 2014). In November 2002, the first recognized SARS epidemic was observed in the Guangdong Province with more than 1000 patients delivered to the hospital with several pneumonia signs. The laboratory results identified the presence of the SARS-CoV despite a number of positive antibodies to that virus. 55 people died during the first epidemic of SARS. The second outbreak of the epidemic was observed in Hong Kong. During that epidemic, 30 people died because of SARS. In several years, in Canada, 10 people died in the SARS epidemic.

The first steps which representatives of the infection control organizations had to take were the necessity to remove communication and any other form of contact between the diseased and healthy people. People-to-people transmission of the virus was a serious discovery that could not be neglected.

Etiology

The spreading of the disease among different countries in a short period of time tells about the necessity to investigate the etiology and the causes of SARS. The main cause of the SARS epidemic in any country is the already identified SARS-associated coronavirus also spelled as SARS-CoV. It is an RNA-type virus with certain peripheral corona-like outgrowth (Van den Brand et al., 2014). Unfortunately, the nature of the transmission of the virus between people was not completely understood. Still, it is believed that, in most cases, the virus could be delivered through water droplets which occur during coughing or sneezing. Therefore, if people want to reduce the possibility level of getting SARS, they have to keep their distance from the affected groups of people. Hand hygiene, masks, and even eye protection means could be defined as good contributors to the protection against SARS.

People could take molecular tests and serological tests to identify the presence or prove the absence of the SARS-CoV in an organism. The determination of cytokines in plasma is one of the first stages of lab analyses (Van den Brand et al., 2014). Blood tests and the analysis of cell culture should also help in identifying the virus and the development of the disease that could lead to death.

Affected Systems

Despite too general signs and frequent causes of the disease, it may have a crucial impact on the work of different systems in the human body. The SARS-CoV may influence the immune system because of the necessity of immune and inflammatory cells to work hard and deal with the lesions caused by the SARS infection (Van den Brand et al., 2014). The central nervous system is under threat as well because of the pathology and possible degeneration of neurons in the human brain. The SARS-CoV may cause kidney problems. Therefore, the urinary tract infection cannot be neglected. Such sign as diarrhea is the reason to worry about the work of the gastrointestinal tract. Centrilobular necrosis influences the work of livers as well. Finally, necrosis of skeletal muscle and the changes in tissue should be taken into consideration.

Again, it is necessary to underline that not all aspects of the SARS epidemic have been identified and investigated. It could happen that other systems may be affected by the presence of the virus. The genomic sequences of the SARS-CoV cannot be detected using the cases available. Besides, the responses of the systems could depend on the age of a patient.

Histological Appearance Changes

Regarding the histology of a normal lung, all sections of lung tissue may be compared with a fine lace because of thin-walled alveoli as the main composition of a human lung. Bronchioles and alveoli are the main lung components through which the exchange of air occurs. There is a single layer of squamous epithelium in alveoli. In Figure A, it is also possible to observe a thin layer of connective tissue between the alveoli. Besides, there are many capillaries. In Figure A, there are several bronchioles, which are characterized by different size. In comparison to capillaries which are lined with the squamous epithelium, bronchioles are lined with other types of epithelium, known as columnar and cuboidal.

Histopathologically, the changes in the respiratory tract are usually characterized by diffuse alveolar damage (DAD) as a form of pulmonary injury that is inherent to many SARS patients because of the existing immunopathogenetic factors (Gu & Korteweg, 2007). In Figure B, it is possible to observe severe damaged caused by lung tissue. These changes lead to the formation of a hyaline membrane, edema, and fibrin exudation (Gu & Korteweg, 2007). In Figure C, the changes in lungs and the creation of the multinucleated cells (marked by arrows) are introduced. Figure D demonstrates the development of viral genomic sequence and the combination in situ hybridization with antibodies. The first arrow in Figure D represents an infected cell known as pneumocytes. The second arrow in the same figure represents an inflammatory cell with SARS virus (Gu & Korteweg, 2007). The third arrow shows a cell without a virus. Figure E demonstrates different sequences of SARS-CoV in cells. The first arrow is the infection of T lymphocytes, the second arrow is an uninfected CD3-positive cell, the third arrow is an ISH-positive cell, the fourth arrow is a pneumocyte with a positive ISH, and the fifth arrow is an ISH-positive vascular endothelial cell. Figure F shows how spleen tissue changes lymphocytes. Finally, Figure G shows how ISH signals define patient’s brain tissue (Gu & Korteweg, 2007).

Current Treatments

The incubation period for patients with SARS can last from 2 up to 10 days. The isolation of patients should occur in a short period of time. It is suggested to use negative pressure rooms so that even nurses may avoid direct contact with patients. Radiography helps to find out the measurements of the respiratory phase when the patients may or may not be dangerous for other people around. Current chiropractic treatment for SARS patients that is characterized by the absence of any surgeries for improving work of the system includes antibiotics such as amoxicillin or clarithromycin and glucocorticoid, which help to control cytokine responses, which are caused by SARS-CoV. The promotion of intensive care treatment in the form of aerodynamic ventilation is also required (Van den Brand et al., 2014). Finally, antiviral therapy should be offered as a general method of treatment for people, whose changes in the organism are caused by the presence of a virus.

Interest in the Topic

There are several reasons for why the SARS epidemic is chosen for the analysis. People know about the existence of this disease and learn how dangerous it could be for people regarding their gender and age factors. Besides, the location of people may contribute the development of the disease. In case one person gets SARS-CoV, there is a threat that more people, who are or were in close contact with a patient, could get the same health problem. Still, not many investigations could be found on the chosen topic. Even the experts could fail to diagnose the disease in time. People die horribly because of SARS, and researchers could say a little about the case (Doherty, 2013). As a chiropractor, I am interested in SARS because this disease may cause myopathic and neuropathic complications which are hard to detect and treat in a chiropractic clinic. New methods of treatment have to be investigated soon to be ready to help people with different phases of SARS. At this time, the only way that could be used to support infected patients is the provision of an incubation place for treatment and the experiences with an anti-viral therapy based on well-known antibiotics.

Conclusion

In general, the analysis of the SARS epidemic developed in this paper helps to clarify the weaknesses of research done on the topic and underline the major facts people have to be aware of. It is easy to get the virus, and it is hard to get rid of it without certain losses.

References

Centers for Disease Control and Prevention. (2013). About severe acute respiratory syndrome (SARS). Web.

Doherty, P.C. (2013). Pandemics: What everyone needs to know. New York, NY: OUP USA.

Gu, J., & Korteweg, C. (2007). Pathology and pathogenesis of severe acute respiratory syndrome. The American Journal of Pathology, 170(4), 1136-1147.

Hui, D. S., Memish, Z. A., & Zumla, A. (2014). Severe acute respiratory syndrome vs. the Middle East respiratory syndrome. Current Opinion in Pulmonary Medicine, 20(3), 233-241.

Van den Brand, J. M. A., Haagmans, B. L., van Riel, D., Osterhaus, A. D. M. E., & Kuiken, T. (2014). The pathology and pathogenesis of experimental severe acute respiratory syndrome and influenza in animal models. Journal of Comparative Pathology, 151(1), 83-112.

Since the illness was first reported in Asian in 2003, the severe acute respiratory syndrome (SARS) has been studied in depth, especially at the microscopic level. Within a short period, the disease spread over all the continents except Africa, but was successfully contained. Nevertheless, it is still one of the major threats to the world health because it has a rapid rate of infection, spreading and a very high mortality rate (Peiris, Lai, Poon, et al 2003).

SARS is a viral disease caused by the SARS-associated coronavirus (SARS-CoV) of the viral order Nidovirales, Family Coronaviridae, Subfamily Coronaviridae, Genus Bectacornavirus and Species SARS Coronavirus. The virus belongs to the Group IV ((+)ssRNA), meaning that is it a positive single stranded RNA virus (Thiel 2012). The SARS Coronavirus is a large virus, with about 29kb long genome. So far, 13 genes and 14 proteins have been identified by molecular studies conducted since 2003. In addition, studies have shown that the genomes 5’UTR and 3’UTR have about 265 and 342 nucleotides respectively (Snijder et al. 2003). Like other members of the coronavirus family, the SARS virus expression begins with a single translation of 1a and 1b polyproteins from two large ORFs (Rota et al. 2003).

According to McBride and Fielding (2012), most of the protein functions of the genome products of the virus have been elucidated and are well known. For instance, the two large ORFs, 1a and 1b encode an enzyme replicas, as well as the codes for the proteins that end up making the structure of the virus. Although major studies have been conducted to examine these sections, the functions of the 8 proteins are not well understood.

Like other members of the family, the SARS virus expresses the ORF1a polyprotein (pp1a) and the pp1b polyprotein joined together (Rota et al 2003). The large proteins are then cleaved into 16 smaller functional subunits by proteins PLpro and 3CLpro (Thiel 2012). After this, the normal replication process of positive single stranded RNA viruses takes place, producing a large number of viruses that are highly infectious.

The disease resulting from an infection with the SARS virus is simply known as SARS. The initial symptoms are fever, headache and muscular pain. After about 2 days to 2 weeks of the first symptoms, the patients show a number of other conditions associated with respiratory system, which include pneumonia, cough and dyspnea (Thiel 2012). Hematologically, the patients experience a rapid reduction in the volume of lymphocytes within their circulatory systems.

The highest recorded mortality rate due to the condition was recorded in 2003 and was about 50% among the people aged 50 and above (Thiel 2012). In younger generations, the mortality rate was often low, mostly less than 45% in various nations in Asia (Thiel 2012).

In conclusion, SARS is a viral disease with a high rate of spreading and a high mortality rate. Alongside Ebola and H1N1, the virus poses a major threat to the population in the modern world.

References

McBride, R & Fielding, BC 2012, “The role of severe syndrome (SARS)-coronavirus accessory proteins in virus pathogenesis”, Viruses vol. 4, no. 11, pp. 2902–23. Web.

Peiris, JS, Lai, ST, Poon, LL, et al. 2003, “Coronavirus as a possible cause of severe acute respiratory syndrome”, Lancet, vol. 361, no. 9366, pp. 1319–25. Web.

Rota PA, Oberste MS, Monroe SS, Nix, WA, Campagnoli, R, Icenogle, JP & Bellini, W, 2003, “Characterization of a novel coronavirus associated with severe acute respiratory syndrome”, Science, vol. 300, no. 5624, pp. 1394-1399. Web.

Rota, PA, Oberste, MS, Monroe, SS, et al., 2003, “Characterization of a Novel Coronavirus Associated with Severe Acute Respiratory Syndrome”, Science, vol. 300, no. 5624, pp. 1394–9. Web.

Snijder, EJ, Bredenbeek, PJ, Dobbe, JC, Thiel, V, Ziebuhr, J, Poon, L, & Gorbalenya 2003, “Unique and conserved features of genome and proteome of SARS-coronavirus, an early split-off from the coronavirus group 2 lineage”, Journal of molecular biology, vol. 331, no. 5, pp. 991-1004. Web.

Thiel, V 2012, Coronaviruses: Molecular and Cellular Biology, Caister Academic Press, London. Web.

Just two years after the reign of terror brought about by the September 11 terrorist attacks at the World Trade Center, people were again scared as they scurried to take precautions in protecting themselves against a fatally virulent respiratory illness that is as readily acquired as the common cold. Only known as the Severe Acute Respiratory Syndrome (SARS), the disease has spread all over the globe killing hundreds of people and scaring thousands more. Many people are clueless about the nature of this disease that sparked in 2003, they had no choice but to wear face masks, avoid traveling, wash their hands cautiously, and call their doctors at the first sign of runny nose (Rados, 2003). Indeed, SARS is a deadly global threat that has challenged global health standards about handling such an epidemic.

According to the latest World Health Organization (WHO) Guidelines for SARS (2004), SARS was first recognized as a global threat in mid-2003. However, the first known cases of SARS occurred in Guangdong province of China, in 2002. Scientists have determined that the etiological agent of SARS is a coronavirus (SARSCoV), which is believed to be an animal virus that “crossed the species barrier to humans recently due to ecological changes or changes in human behavior that increased opportunities for human exposure to the virus and virus adaptation, enabling human-to-human transmission” (Antia, 2003 as cited by WHO, 2004). By July 2003, the international scope of SARS resulted in 8,098 cases in 26 countries, tolled 774 deaths worldwide. According to the WHO, the last human chain of transmission of SARS in that epidemic had been broken in 2003 (WHO, p. 6).

The symptoms of SARS may be hardly seen in people during its initial stages because it can be mistaken for a common cold. SARS symptoms include high fever, coughs, headache, body aches, diarrhea, and overall discomfort. A small percentage of cases experienced diarrhea. SARS cases develop a deep cough and pneumonia. However, about 10% of SARS cases end in death. The incubation period can be as long as fourteen days.

SARS is transmitted by “close person-to-person contact” and is characterized as a “propagated outbreak”. The SARS virus can be transmitted directly by respiratory droplets that result from sneezing and coughing at close proximity (up to 3 feet). It is also thought that the SARS virus can be transmitted indirectly by coming into contact with droplets on contaminated surfaces. Corollary to this, experts who studied the origins of SARS reiterated that the natural reservoir of SARS-CoV has not been identified, yet a number of wildlife species like the Himalayan masked palm civet (Paguma larvata), the Chinese ferret badger (Melogale moschata), and the raccoon dog (Nyctereutes procyonoides), which are all consumed as delicacies in southern China have shown laboratory evidence of infection with a related coronavirus. Also, domestic cats living in the Amoy Gardens apartment block in Hong Kong were also found to be infected with SARS-CoV. More recently, ferrets (Mustela furo) and domestic cats (Felis domesticus) were infected with SARS-CoV experimentally and found to efficiently transmit the virus to previously uninfected animals housed with them. However, these possible “transmissions” of SARS from animals to humans or to other animal species still needed to be investigated further (WHO 2004, p. 6).

As of this time, no clear treatment has been recognized for SARS. In fact, accurate and rapid screening diagnostic tests for SARS have been developed but are not yet licensed in the United States. During the epidemic, healthcare workers generally relied on clinical symptoms for detection. WHO defined a suspected SARS case as someone with a temperature over 38 degrees Celsius (100.4 degrees Fahrenheit), a cough or difficulty breathing, and one or more of the following exposures: close contact with a person who is a suspect or probable SARS case, or someone who has lived in or visited a region with SARS transmissions. A “probable case” is a suspected case with radiographic evidence of pneumonia or positive laboratory tests that may take days to weeks to complete. No proven therapy is available for severe SARS pneumonia cases. Most doctors recommend respiratory support, antibiotics, fever reduction, and hydration. Some Chinese doctors have used steroids and the antiviral drug ribavirin with varying degrees of success (National Intelligence Council, 2005).

As an infectious disease, SARS can have affected the health standards of every nation. Most SARS cases occur in people who care for or live with SARS patients or have direct contact with infectious materials. Experts only recommend the isolation of individuals with SARS but not quarantine. This is why more studies and research about SARS are needed to fully understand this fatal disease. Health professionals should also be educated to be prepared for scenarios in the future course of SARS and all governments should unite in finally eliminating this dreaded virus.

Bibliography

Antia R., Rogoes R.R. & Koella, J.C., & Bergstrom, C.T. 2003. The role of evolution in the emergence of infectious diseases. Nature, 426, 658-661.

National Intelligence Council. 2005. SARS is a continuing threat. In V. Wagner (Ed.), At Issue: Do Infectious Diseases Pose a Serious Threat? San Diego: Greenhaven Press.

Rados, C. 2003. SARS protecting against a deadly disease. FDA Consumer, 37, 14-15.

World Health Organization (WHO). 2004. WHO guidelines for the global surveillance of severe acute respiratory syndrome (SARS). Web.

Introduction

SARS first broke out in November 2002 in Foshan, which is near Guangzhou, in the Chinese province of Guangdong. The virus made its way to other parts of the Pearl River Delta by February 2003. China’s Ministry of Health informed WHO in mid- February 2003 of the occurrence in Guangdong province of 305 cases of “atypical pneumonia” and reported that the spread of the illness was “under control.” (John, 2004) Local media reported the outbreak, and the news spread around the Pearl River Delta region through thousands of cell phone text messages. Hong Kong was alerted by the news that people across the border were stocking up on Chinese herbal medicines and boiling vinegar as a folk remedy to ward off the deadly unknown illness. Because the world was kept in the dark about the seriousness of the outbreak in Guangdong, Hong Kong was caught unprepared when SARS first appeared in the territory via an elderly medical doctor from Guangzhou who had been treating “atypical pneumonia” patients. (David, 2004) The doctor checked into room 911 of the Metropole Hong Kong Hotel on 21 February 2003 to attend a wedding reception, and he was admitted to a nearby hospital the next day. He informed the medical staff that he was highly infectious, and he was promptly isolated. He later died after infecting a nurse in the hospital.

The Guangzhou doctor, during his 1-day stay at the hotel, infected at least 10 other guests staying on the same floor of the hotel. All these guests were overseas visitors except for a Hong Kong resident who was visiting the hotel. The infected visitors subsequently ignited outbreaks in Vietnam, Singapore, and Toronto, and the local resident (an airport worker) became the index patient at the Prince of Wales Hospital. The airport worker developed SARS symptoms on 24 February but did not seek treatment at the hospital until 4 March. He was admitted into Ward 8A, where he infected over 100 people, including patients, visitors, medical students, nurses, and doctors. Hospital emergency services had to be suspended temporarily. (David, 2004) In mid-March 2003, the Hong Kong public was told that the outbreak was confined to hospitals and was not spreading in the community. No isolation measures were adopted; for instance. Prince of Wales Hospital was not cordoned off. The authorities had to face reality when SARS broke out in a multistoried housing estate, Amoy Gardens. On 29 March, 22 of the 45 new SARS cases hospitalized in Hong Kong were residents of Amoy Gardens. On the following day, 36 of the 60 new patients admitted to the hospital with probable SARS were residents of Amoy Gardens, bringing the cumulative total of infected residents to 213. Of these 213 patients, 107 resided in Block E of Amoy Gardens. In addition, most of them lived in flats that were oriented vertically relative to each other, which suggested that besides close person-to-person contact, SARS might have been spreading by other environmental means. (John, 2004).

The Hong Kong Department of Health issued an unprecedented quarantine order to prevent the further spread of SARS in the community. The isolation order required residents of Block E of Amoy Gardens to remain in their flats for 10 days. When the police carried out the order, they found no one home in well over half of the block’s 264 apartments. Residents had learned about the Amoy Gardens outbreak via the media and many had left their homes long before the authorities arrived. SARS was clearly spreading in the community.

Fear of the SARS virus took root in the whole city. Face masks were selling briskly and could be seen everywhere. Public places were disinfected several times a day. People washed their hands much more frequently and avoided going out to crowded places. Restaurants, shops, cinemas, and other entertainment venues were deserted. Many businesses suffered severe losses of income. Schools were finally closed to limit the spread of the virus.

All household contacts of confirmed or suspected SARS patients were required to remain isolated in their homes for monitoring and treatment, up to a maximum of 10 days. At the end of the outbreak, a total of 1,262 persons from 493 households were affected by this isolation order, and 34 of them subsequently came down with SARS (John, 2004). The government did not compensate the individuals for their confinement, but it did provide daily necessities and financial assistance. The police enforced the order by checking up on confined individuals at their homes. Violators were sent warning letters.

Since 29 March 2003, health officials have tried to identify travelers who displayed SARS symptoms at the airport and other border control points. All incoming travelers are now required to complete a health declaration form. Temperature checks for all arriving, departing, and transit passengers at the airport were implemented in mid-April 2003. Temperature screening devices were installed at other border control points in late April of that year. As of 7 September, 83 persons had been referred to hospitals for suspected SARS, and 2 of them were later confirmed to have been infected (David, 2004). Since these measures were implemented, no SARS cases have been reported as having originated from Hong Kong.

The SARS outbreak among Amoy Gardens residents and medical staff in Hong Kong peaked by late April 2003. At the final count. Hong Kong had a cumulative total of 1,755 SARS cases, accounting for 20.8 percent of the world’s total of 8,422 cases. Of Hong Kong’s total cases, 386 were health care workers, 321 were Amoy Gardens residents, and the rest were from the general community. The high number of infected health care workers suggests that to minimize the risk of exposure, all hospital staff must meticulously follow stringent infection control measures. The number of infected health care workers each day was very high during the early days of the outbreak but later declined substantially.

Channels Through Which SARS Impacts

There are a number of channels through which SARS can affect the economy. These channels involve aggregate demand, aggregate supply, and the financial market.

Firstly, SARS primarily affects economic growth through the aggregate demand side. Aggregate demand refers to the total quantity of goods and services, including consumption expenditure, investment expenditure, government expenditure, and net exports.

The tourist industry and tourism-related service sectors, including airlines, hotels, catering, entertainment, and retailing sector are to be particularly hard hit. Fewer people go to stores, supermarkets, restaurants, and entertainment venues for fear of possible infection, leading to a decline in private consumption spending. A survey by the China Economic Monitoring Center shows the occupancy of 20 four and five-star hotels in Beijing has fallen by 30 percent since April compared to the same period last year (Loh, 2004). The revenue from the seven-day Labor Day holiday usually accounts for 40 percent of the year’s total. However, the central government shortened the holiday to 5 days and called for no travel. Therefore, the travel agencies will suffer huge losses this year. It is estimated that the decision to shorten the Labor Day cost the tourist industry 20 billion yuan (US$2.4 billion). (Lai, 2003) Although the service trade contributes a tiny proportion to the GDP of China, the chain function on other related sectors, especially the negative impact on the manufacturing industry, could not be ignored.

Exports are also suffering. Although the Chinese Export Commodities Fair, or Canton Fair, was held as scheduled in Guangzhou from April 15, the number of contracts that were signed plummeted because many foreign buyers canceled their trips to China. Personal flow is the basis of international trade and investment. The travel restriction owing to SARS certainly decreases the growth of exports. As China has become a part of the supply chain for many multinational corporations, and a halt inflow of goods due to the epidemic would incur losses. In an effort to avoid such risks, multinational corporations may have no choice but to shift a part of the production to other countries. Hence, the growth of China’s export this year is likely to decline because business travels are canceled and demand for goods made in China falls. Furthermore, tourism-related service exports have been heavily hit.

The outbreak of SARS has a negative impact on investment. The investment will decline because of reduced overall demand, enhanced uncertainties, and increased risks. A decline in China’s foreign business activity means that the inflow of foreign investment will also be delayed or reduced. It is pointed out that “the SARS crisis may prompt foreign investors not to put all their eggs in one basket, possibly resulting in businesses changing their plans to invest in China” (Berger, 2004). If the outbreak persists, investors’ confidence could be further reduced, causing weaker domestic investment and foreign direct investment (FDI).

Government expenditure has to be reallocated to combat the outburst of SARS and hence affects the multiplier effect. The multiplier effect can be defined as equilibrium expenditure increases by more than the increase in autonomous expenditure. The central government and provincial governments have to increase expenditures for the improvement of medical facilities, enforcement of quarantines and other health measures, financial assistance to SARS victims among the poor and vulnerable groups, and funds for medical research. The emergency packages such as preferential tax plans to alleviate the economic fallout of the outbreak will reduce the government revenue. The diversion of some government expenditures away from investment in public services such as infrastructural projects, which have higher multiplier effects, to SARS-related expenditures will reduce the equilibrium expenditure and then the GDP. Of all the components of aggregate demand that SARS has affected, consumption expenditure has been the major part of the impact.

The second channel that SARS affects the economy is through the aggregate supply side. Aggregate supply is the sum of all goods and services that all firms in the economy plan to produce. There are three main factors that influence both long-run and short-run aggregate supply. They are the labor force, capital stock, and technology. The outbreak reduces labor productivity because of illness or precautionary measures. Therefore the outputs of both the services sectors and manufacturing industry will decrease. The possible decrease of FDI has affected China’s economic growth not only on the demand side but also on the supply side.

Finally, SARS affects the economy through financial markets. Shares in Shanghai fell and yuan forward contracts are of little chance of any currency appreciation. (Groneberg, 2004) If the outbreak cannot be contained in a short time, fear of the disease may continue to grow, weakening market confidence and depressing stock prices. The contracting wealth effect certainly reduces the consumption expenditure. Through these channels, the outbreak of SARS imposes a negative impact on China’s economy. The degree of the negative impact will be analyzed in the following part.

The limited impact of SARS

Although the outbreak of SARS has a negative impact on China’s economy, the impact will be limited and in the short run. The impact depends on the seriousness and duration of SARS, the structure of China’s economy, particularly the proportion of service sectors in GDP.

The serious impact of SARS will last for the second quarter and then diminish in the third quarter of this year because of the severe enforcement of effective containment measures taken by governments. SARS seems to spread more slowly than the influenza pandemic. The incidence of the disease has decreased quickly in recent days. Fortunately, the epidemic condition is very slight in rural areas and is mainly restricted in urban cities. Thus the outbreak of SARS is serious, but the spread of SARS can be contained in a limited space and period.

The decline in consumption is temporary and small. A recent survey of several furniture malls in Beijing shows that customers are purchasing durable consumer goods in accordance with their purchase plans rather than at random (Thomas, 2007). The SARS disease won’t influence consumers’ long-term purchase plans such as buying automobiles, apartments, and luxurious furniture. The elasticity of demand for foods and daily necessities is relatively inelastic. The outbreak causes a drastic rise in the consumption of drugs and disinfectants and other SARS-related goods. The demand for telecom and online services increases due to the outbreak. As a whole, consumption expenditure will decrease, but the decline is relatively small.

The service sectors such as the tourism, catering, transportation, recreation, and exposition industries, have been the most hit by the disease, but they only contribute a small proportion of China’s GDP.

In terms of exports, the epidemic situation in most of China’s major manufacturing bases, such as the Yangtze River Delta, Shandong province, and Zhejiang province, is relatively slight. Even in Guangdong province, where SARS was first detected last November, the disease has not affected production. However, the new export orders have decreased since the outbreak. There will be a small decrease in the export this year.

The impact on foreign direct investment is relatively limited. China’s fast economic growth, low labor costs, and huge consumption market are extremely attractive for foreign investors. The Chinese economy is at a climbing stage of the economic cycle, and the economic growth is continuing in spite of some exiting deep-rooted problems. SARS may delay or cancel foreign investors visits’ to China. However, the influx of foreign investment would not be significantly changed, for SARS is not one of the determinants for investment. The determinants are the huge Chinese market volume and the low labor cost. Moreover, a slight fall in foreign direct investment (US$52.7 billion in 2002) will cause a very slight fall in China’s economic growth since China’s fixed-asset investment exceeds US$400 billion a year. (Berger, 2004).

Viewing from the overall situation, SARS’ impact on China’s economy will be quite limited. The World Bank is predicting that China’s economy will still experience growth of about 7.3 percent in 2003 (Arthur, 2006).

Measures To Reduce The Adverse Impact

There are two reasons that justify government intervention to combat SARS. The first is that the dissemination of information on SARS has the characteristics of a public good. The second is that there are negative externalities because the disease affects the third parties whose interests are not reflected in market transactions. There are market failures when there are public goods and externalities. Hence the measures taken by the government become necessary to allocate resources efficiently.

Transparent information on SARS is essential to reduce public fear, and to recover the public confidence in government, thus decreasing the economic cost of SARS. There is a lesson at the beginning of the outbreak in Guangdong that the lack of transparency in providing information caused greater panic and accelerated the spread of the disease. Therefore governments need to disseminate accurate and timely information so as to ensure rational behaviors and to restore the confidence of consumers and investors.

It is of paramount importance that governments persist in the efforts in containing the SARS outbreak. Stringent public health measures, including quarantines and travel restrictions, should be effectively enforced to control the further spread of the disease.

Some fiscal and monetary measures should be taken by governments to contain the economic fallout of the disease. The expansionary fiscal and monetary policy should continue to expand the aggregate demand. An expansionary fiscal policy, that is, an increase in government expenditure on goods and services or an increase in transfer payments, or a decrease in taxes, affects aggregate demand by increasing autonomous expenditure. It is reported that “Taxes and administrative fees levied by the Chinese Government on some industries affected by the outbreak of SARS will be waived or reduced” (Arthur, 2006). The preferential tax policies for civil aviation, tourism, catering, commerce, and other sectors heavily hit by SARS will be adopted. A group of scholars from Peking University suggests that the government take certain consumption-stimulating measures, such as providing more housing and automobile loans to spur the domestic demand (Mark, 2004).

The essential health measures and a transparent information policy adopted by governments are crucial to contain the disease and decrease the economic cost. The expansionary fiscal and monetary policy will bring substantial benefits to the economy and sustain growth.

Conclusion

SARS impacts the economy through the channels such as aggregate demand, aggregate supply, and the financial market. SARS will not possibly have a major impact on China’s economy and the disease is likely to ail China’s economy for the short term. Given the externalities related to SARS, governments should take a transparent information policy and severe health measures to contain the disease. The expansionary fiscal and monetary policy will persist to cushion the impact of the outbreak and maintain the growth of China’s economy.

References

Loh, Christine & Civic Exchange. (2004) At the epicenter: Hong Kong and the SARS outbreak. Hong Kong: Hong Kong University Press.

Lai MM. (2003) SARS virus: the beginning of the unraveling of a new coronavirus. Journal of Biomedical Science. 10(6:2):664-75.

Berger A, Drosten CH, Doerr HW, Stürmer M, Preiser W.(2004) Severe acute respiratory syndrome (SARS): paradigm of an emerging viral infection. Journal of Clinical Virology. 29(1):13-22.

Groneberg DA, Zhang L, Welte T, Zabel P, Chung KF. (2003) Severe acute respiratory syndrome: global initiatives for disease diagnosis. QJM. 96(11):845-52.

Thomas Abraham. (2007) Twenty-First Century Plague: The Story of SARS. The Johns Hopkins University Press.

Arthur Kleinman, James Watson. (2005) SARS in China: Prelude to Pandemic? Stanford University Press.

Karl T. Greenfeld. (2006) China Syndrome: The True Story of the 21st Century’s First Great Epidemic. HarperCollins.

Mark A.F. Bond. (2004) China in the Age of SARS. PublishAmerica.

John Wong , Zheng Yongnian. (2004) The SARS Epidemic: Challenges To China’s Crisis Management. World Scientific Publishing Company.

David P. Fidler. (2004) SARS, Governance and the Globalization of Disease. Palgrave Macmillan.

Introduction

Communicable diseases are infectious diseases transmitted from one person to another. One such disease is the Severe Acute Respiratory Syndrome (SARS) that had an outbreak in China in 2002. This paper will discuss issues regarding SARS out break, the epidemiological indicators, epidemiological data analysis, as well as modes of SARS transmission.

SARS Outbreak

There was an outbreak in China in 2002; country delayed in submitting the initial report to the World Health Organization (WHO). It was only after continued pressure and numerous cases that PRC notified WHO, and even so, the country disclosed information about the provinces of Guangdong only as it was believed that the disease had its origin there. This led to international criticism and the government changed its perspective, allowing the press to release information concerning the disease and conduct supervision (Wong and Zheng, 2005, p. 123).

Epidemiological Indicators of SARS

SARS is a viral disease and the virus responsible for its transmission is known as coronaviruses. The main epidemiological indicators are mortality, morbidity, and surveillance. According to Webb (2005, p. 77), Surveillance refers to “continuous assessment of the occurrence and distribution of diseases as well as other conditions of ill health, and their causes for effective control and prevention.” Surveillance entails gathering of information, analyzing it and interpreting relevant information and the subsequent dissemination of such information to the parties. Surveillance may be active, passive or sentinels systems. Mortality refers to number of death per certain period.

Infant mortality rate is mostly witnessed in the cases related to SARS; high infant mortality rate shows that the environmental conditions are unconducive and there are health needs that need to be addressed (Maurer and Smith, 2005, p. 165). Morbidity refers to an ill health incidence and it can be measured in several ways; morbidity rate shows a proportionate comparison of those people who are sick to the healthy ones.

Analysis of Epidemiological Data on the Outbreak

In data collection and analysis of SARS outbreak, there is a process to be followed in order to determine the cause and severity of the disease. First, an electronic patient database is kept in a central control position and all patients suspected to have the infectious SARS should be entered in the database; in the case of SARS, a SARSID (SARS Integrated Database) was created. After database creation, the case is defined and analyzed for clinical symptoms.

According to McLean (2005, p. 62), World Health Organization (WHO) defined the case in two ways; first, any person found after 1st November 2002 to have a cough, difficulty in breathing or high body temperature and had an exposure(s) ten days before onset of symptoms.

Second, anybody who had died after the same date had exposure before onset of symptoms, the cause of death was acute unexplained respiratory illness, and no autopsy was done. Clinical symptoms included presence or radiographic infiltrates after a chest x-ray, positive SARS-CoV, and autopsy results similar to pathology of RDS whose cause could not be established. The main symptoms include cough, high fever, headache, malaise, and diarrhea. In addition, the number of the deaths induced by the aetiological agent is established and it is known as case fatality rates. According to information released by WHO in 2003, SARS case fatality rate was 15% with high adult mortality as compared to infant mortality; the infectious period shows the period it takes an infectious agent to spreads prior to and after onset of symptoms (McLean, 2005.pg 62).

Transmission Routes

Respiratory droplets

This route is the most widely known mode of transmission. If an infected person coughs or sneezes and the droplets lands on mucus membrane of a healthy person, the healthy person is infected. Such membranes include the eyes, mouth or nose.

Direct contact

Direct contact with an infected person physically or direct contact with body fluids or respiratory secretions of the person also leads to transmission. Circumstances of direct or close contact include kissing, hugging, touching someone directly and so on.

Effect of SARS Outbreak on the Community

Outbreak of SARS would lead to psychological stress to the patients, health workers and even friends and relatives. The nature of the disease dictates isolation of patients that could eventually lead to lack of social support from friends and relatives who fear infection.

It would also lead to decline in economic growth since it would call for commitment of financial resources in paying hospital bills and purchase of necessary medical equipments. Human resource would also be affected since the sick will not work while others may die leading to reduced productivity. Moreover, investments by foreigners would also cut down since foreigners will not come in fearing infection.

Protocol for Reporting a Possible Outbreak

Reporting SARS possible outbreak after it has been confirmed would first involve verification to ascertain the truth. This would involve use of additional cases and use of past history data to compare the situation at hand and in the past. After verification, that information is reported to the health department immediately with specimen to support the report. The agent is then identified and a routine surveillance conducted. All concerned staff is informed to stay alert in case of additional cases. The cases are then categorized on bases of each person, place, and time and then obtained data is analyzed and reviewed to ascertain existence of a problem. If there is a problem, hypothesis testing is done to determine the root cause.

How to modify care of people with respiratory diseases in times of poor air quality

Poor air quality poses risks to patients suffering from communicable diseases such as asthma. To improve their care during such times, the following mechanisms can be utilized. Ventilation is most important at such a time, thus patients should stay in clean and well-ventilated rooms that are not congested. Use of strong scented air fresheners and conditioners should be avoided since this might induce sneezing.

The architecture of hospitals or rooms where such people are kept should be designed with a lot of care. Movement of air from one room to another may be caused by pressure that may be induced by natural forces such as wind and those airflows are sensitive to open doors or windows. Such airflows may alter the air pressure in other rooms thus reducing or reversing airflow directions. It is therefore advisable to keep their rooms’ doors and windows closed in order to reduce airborne concentrations.

The challenge in designing a ventilation system is in ensuing that each individual inhales only fresh air and no hazardous air is inhaled. This can be achieved in any of the three ways: first, contaminated air can be mixed with uncontaminated air, which aims to decrease the concentration of contaminated air by making it more pure. Another approach is that of dilution and it implies use of fresh air to dilute the contaminated air. Normally, ventilation is designed with at least 12 air exchanges. The final approach entails control of airflow in a way that air moves from health care workers to the sick. This approach dictates that exhaust vents and patients are close (Tang et al, 2006).

They should also be encouraged to cover their mouth when coughing and sneezing ensuring proper disposal of the sputum. Proper protective clothing should be used such as gowns and gloves. In addition, direct contact with body fluids and respiratory droplets should also be eliminated and use of filtered piece facemasks encouraged. Finally, they should be advised to maintain proper body hygiene and ensure that they wash their hands after getting into contact with any mucous fluid and before eating. This will reduce risk of infection to health workers taking care of them

Conclusion

Communicable diseases have no boundaries irrespective of age, gender, or geographical location. An outbreak of a disease such as SARS would have various costs both financial and psychological. Therefore, an understanding of the causes, mode of transmission and prevention would therefore be important in prevention and control.

Reference list

Maurer, F, & Smith, C, 2005. Community/public health nursing practice: health for families and populations. NY, Elsevier Health Sciences. Web.

McLean, A., 2005. SARS: a case study in emerging infections Oxford biology readers. NY, Oxford University Press. Web.

Tang, J. et al. 2006. Factors involved in the aerosol transmission of infection and control of ventilation in healthcare premises. Journal of Hospital Infection, 64(2): 100-114.

Webb, P., Bain, C., & Pirozzo, S., 2005. Essential epidemiology: an introduction for students and health professionals. Cambridge, Cambridge University Press. Web.

Wong, J., & Zheng, Y., 2004. The SARS epidemic: challenges to China’s crisis management. New Jersey, World Scientific. Web.

Introduction

• SARS is a coronavirus, first identified in 2003, that emerged from an uncertain animal reservoir.
• Symptoms: high fever, cough, lung inflammation, chills, headaches, muscle aches, etc. (SA Health, 2012).
• Epidemics originated in the Guangdong Province of China in 2002 and, in 2003, spread to over 30 countries, including Singapore.
• Singapore epidemics: 238 probable cases of SARS, 8 imported cases, and 33 deaths.

Severe Acute Respiratory Syndrome (SARS) is a recently emerged viral disease associated with severe symptoms of distress in the lower respiratory tract. According to Abdullah, Tomlinson, Cockram, and Thomas (2003), the first outbreak originally occurred “in November 2002 in the Guangdong Province of China and, by February 2003, had spread to Hong Kong and subsequently to 32 other countries or regions, infecting approximately 8,459 patients and resulting in >800 deaths” (p. 1042). The SARS epidemic under discussion actively progressed in Singapore from March until May 2003, resulting in 238 probable cases of the infection, 8 imported cases, and 33 deaths (Goh et al., 2006). At the present moment, the possibility of a SARS outbreak is considered to be adequately contained both in the country and within the region in general. However, the related bio-safety concerns remain.

Causes: Individual, Community, and Cultural Levels

• Individual level:
  • SARS is spread through animal-to-human and human-to-human interactions.
• Community level:
  • Multigenerational family structure leads to greater SARS exposure due to frequent contact with family members.
  • Health practitioners face a greater risk of infection.
• Cultural level:
  • Singapore has a high number of traditional wet markets.

In their 2004 study, Peiris, Guan, and Yuen stated that SARS is caused by “a previously unrecognized animal coronavirus that exploited opportunities provided by ‘wet markets’ in southern China to adapt to become a virus readily transmissible between humans” (p. S88). The researchers observed that many of the first individuals to be affected were involved to some extent in the live-game trade (Peiris et al., 2004). These findings indicate a probable interspecies path for the virus’s transmission and suggest that people involved in work with live and dead animals (for example, farmers, butchers, and market vendors) may face the threat of exposure to the virus. At the same time, at the micro and macro community levels, SARS can be spread through human-to-human interactions. For example, the virus is reported to be prone to “cause clusters of disease in families and healthcare workers” (Peiris et al., 2004, p. S88), meaning that densely inhabited households and public settings with a high inflow of people are at greater risk of SARS transmission.

Causes: Environmental Level

• SARS is characterized by high environmental resistance.
• The virus survives in biological fluids (respiratory secretions or feces) (Geller, Varbanov, & Duval, 2012).
• Its infectivity maintains in a relatively humid (50–70%) and warm climate (4–37°C) (Geller et al., 2012).

SARS is associated with a significant environmental resistance, which means it can be transmitted by way of surfaces as well. For example, the investigation of the index case in Singapore (a previously healthy young woman) revealed that the virus could be spread through indirect contact with contaminated biological fluids. The affected woman stayed in a hotel in Hong Kong during the epidemic along with a Chinese physician who was considered to be the source of infection (Hsu et al., 2003). She was consequently admitted to a hospital in Singapore with severe pneumonia-like symptoms and thus could have caused the further spread of the disease because, at that time, the highly infectious nature of SARS was not known (Hsu et al., 2013). Moreover, viral infectivity is better preserved in environments with 50% relative humidity and a temperature between 4°C and 37°C (Geller, Varbanov, & Duval, 2012). The evidence suggests that desiccation may help reduce the chance for virus survival considerably.

Factors of Exacerbation: Environment and Healthcare

• No treatment options for SARS exist in modern medicine.
• The virus is resistant to disinfection.
• High population density as well as a tropical rainforest climate in Singapore may aggravate the situation in the country in the case of a new epidemic.

Currently, no data exists regarding an ongoing transmission of the virus in Singapore or elsewhere, and it is not clear if the SARS epidemic will ever be repeated. Nevertheless, some factors, mainly environmental and healthcare-related, may contribute to the exacerbation of SARS. First, it is important to note that no effective treatment options for the virus currently exist, and the majority of antiseptics showed insignificant effectiveness in decreasing SARS infectivity (Geller et al., 2012). Second, Singapore is the third most densely populated county in the world with 8,274 of people per square kilometer (“Countries in the world by population,” 2018). Along with these factors, the country’s tropical rainforest climate, which is warm and humid, increases the risk for fast transmission of SARS at both the individual and community levels.

Factors of Exacerbation: Individual and Social-Cultural Levels

• Individual level:
  • Health beliefs and individual health-seeking behaviors define one’s health prognosis and infection risks.
• Social-cultural level:
  • Some population groups have limited access to healthcare and show reduced health literacy levels.

At the individual level, a physiological factor such as the development of neutrophilia due to infection is associated with poor patient outcome in the case of SARS (Leong et al., 2006). Not only may it be caused by a high viral load exposure but also by an individual’s health-seeking behaviors. For instance, while it is reported that many young individuals tend to avoid referring to hospitals when experiencing mild symptoms, a significant percentage of adults with a positive economic status, sufficient educational level, and favorable housing conditions in Singapore tend to play an active role in seeking treatment (Chan, Lee, & Low, 2018). The situation is different in less-advantaged populations, as well as in the case of immigrant workers, who usually show a limited awareness of available healthcare service options and are associated with a reduced level of access due to financial and other constraints (Ang et al., 2017).

Action Plan

• Education:
  • Convey messages that may positively influence individuals’ health-related behaviors.
  • Provide relevant training for medical personnel to increase their SARS prevention, diagnosis, and treatment skills.
• Communication:
  • Use satellite broadcasts and webcasts to review infection control practices, level of community containment, and more.
• Epidemic relief:
  • Develop local networks that would promote community resiliency during SARS.
  • Practice desiccation of settings and quarantine.
• Technology:
  • Research and develop new effective vaccines and antiviral agents.

Any action plan devoted to the prevention and elimination of SARS epidemics should focus on the identified risk factors. According to Person et al. (2004), “fear of being socially marginalized and stigmatized as a result of a disease outbreak may cause people to deny early clinical symptoms and may contribute to their failure to seek timely medical care” (p. 360). Therefore, community education should aim to positively influence individuals’ health-related behaviors. For example, one recommendation would be to convey ethical and culturally-sensitive messages through media and web resources. Moreover, since most healthcare practitioners lack sufficient experience in dealing with SARS, appropriate training in the diagnosis, prevention, and treatment of the virus must be provided as well.

References

Abdullah, A. S. M., Tomlinson, B., Cockram, C. S., & Thomas, G. N. (2003). Lessons from the severe acute respiratory syndrome outbreak in Hong Kong. Emerging Infectious Diseases, 9(9), 1042–1045.

Ang, J. W., Chia, C., Koh, C. J., Chua, B. W. B., Narayanaswamy, S., Wijaya, L., … Vasoo, S. (2017). Healthcare-seeking behaviour, barriers and mental health of non-domestic migrant workers in Singapore. BMJ Global Health, 2(2), e000213.

Centers for Disease Control and Prevention. (2005). SARS educational tools and resources. Web.

Chan, C. Q. H., Lee, K. H., & Low, L. L. (2018). A systematic review of health status, health seeking behaviour and healthcare utilisation of low socioeconomic status populations in urban Singapore. International Journal for Equity in Health, 17(39), 1-21.

Countries in the world by population (2018). (2018). Web.

Geller, C., Varbanov, M., & Duval, R. E. (2012). Human coronaviruses: Insights into environmental resistance and its influence on the development of new antiseptic strategies. Viruses, 4(11), 3044-3068.

Goh, K. T., Cutter, J., Heng, B. H., Ma, S., Koh, B. K. W., … Chew, S. K. (2006). Epidemiology and control of SARS in Singapore. Annals of the Academy of Medicine, Singapore, 35(5), 301-316.

Hsu, L.-Y., Lee, C.-C., Green, J. A., Ang, B., Paton, N. I., Lee, L., … Leo, Y.-S. (2003). Severe acute respiratory syndrome (SARS) in Singapore: Clinical features of index patient and initial contacts. Emerging Infectious Diseases, 9(6), 713-717.

Leong, H. N., Earnest, A., Lim, H. H., Chin, C. F., Tan, C. S. H., Puhaindran, M. E., … Leo, Y. S. (2006). SARS in Singapore – Predictors of disease severity. Annals of the Academy of Medicine, Singapore, 35(5), 326-331.

Peiris, J. S. M., Guan, Y., & Yuen, K. Y. (2004). Severe acute respiratory syndrome. Nature Medicine, 10(12), S88-S97.

Person, B., Sy, F., Holton, K., Govert, B., Liang, A., Garza, B., … Zauderer, L. (2004). Fear and stigma: The Epidemic within the SARS outbreak. Emerging Infectious Diseases, 10(2), 358-363.

SA Health. (2012). Severe acute respiratory syndrome (SARS) – Including symptoms, treatment and prevention. Web.

“Overview of SARS-Cov-2 and COVID-19 Vaccine” by Alharbil summarizes the information on vaccines developed against COVID-19. The author analyzes its main characteristics by framing the vaccine as a crucial tool to fight the disease. Despite some content limitations, the paper provides a valuable and efficient summary of the current status of immunization efforts against COVID-19.

Namely, the author starts the discussion by describing the origins and symptoms of the COVID-19 disease and then explains the inoculation development process and types. More importantly, the author provides an overview of the five prominent vaccines – BNT-162b2 (Pfizer), mRNA-1273 (Moderna), AZD-1222 (AstraZeneca), Ad26.COV2. S (Johnson & Johnson), NVX-CoV2373 (Novavax). The author classifies the vaccines according to their categories, including genetically encoded, viral vector, protein subunit, viral antibody types (Alharbil 512-513).

The author also includes logistical considerations such as transportation and storage into the summary (Alharbil 512-513). In addition, the paper presents an overview of the pharmaceutically-modified-non-injectable types of shots, emphasizing the major developers and the preliminary research results (Alharbil 514). Thus, the author effectively encapsulates the information about the current vaccines and those planned to be used.

In terms of evaluation, the paper indicates that there are no sponsorships or conflicts of interest involved. Hence, the credibility of the author and article can be considered high. Moreover, the author has a Doctorate level in Medicine and Medical Sciences, thus, has sufficient knowledge and authority. The major limitation of the paper is that the author fails to include the analysis of other prominent non-western vaccines. For instance, the Chinese vaccine Sinovac and the Russian vaccine (Gam-COVID-Vac-Lyo/Sputnik V) are widely distributed, and their efficacy rate was around 90% (Jones and Roy 643). Hence, adding information about these vaccines into the overview could have strengthened the paper.

Thus, this overview can help obtain a sufficient understanding of the prominent vaccines against COVID-19. Medical professionals, policymakers, and scholars can apply the information in this article to get basic information about COVID-19 vaccines. Although the author is reliable, they could extend the paper’s content by incorporating other prominent vaccines into the analysis.

Works Cited

Alharbil, Nada Abdullah. “Overview of SARS-Cov-2 and COVID-19 Vaccine”. Bahrain Medical Bulletin, vol. 43, no. 2, 2021, pp. 511-515. EBSCOhost. Web.

Jones, Ian, and Polly Roy. “Sputnik V COVID-19 Vaccine Candidate Appears Safe and Effective.” The Lancet, vol. 397, no. 10275, 2021, pp. 642–643. Web.

The paper is based on scientific facts and was not affected by any political and religious views of the author.

The author of the article “Overview of SARS-CoV-2 and COVID-19 Vaccine” does not appear to be associated with any special-interest groups; the views presented in the paper are fully objective. Since the author provides an overview of COVID-19 vaccines, various sides of the issue are presented and evaluated. Alharbi discusses all vaccines in the same manner and includes numbers and statistics, demonstrating objectivity.

Alharbi uses scientific language in order to present the characteristics of COVID-19 vaccines; the language does not show any signs of bias. The author’s thesis statement is that there are several vaccines that are expected to be widely used. However, researchers still need to define the most effective and suitable vaccine and overcome possible challenges associated with its use.

Alharbi supports the claim of the article with evidence and includes the basic characteristics of vaccines, such as the principle of work, dosage, storage regulations, and other facts. Moreover, the author discusses the process of testing and includes statistics to show the efficacy of each vaccine. Information about possible difficulties, such as logistics and the financial aspect, is also used as evidence. It is possible to say that the author includes reliable statistics that are generally consistent with other sources. Not all academic sources were explicitly shown in the article. However, it is fair to mention that among the literature Alharbi cited were reliable and up-to-date sources, such as the U.S. National Library of Medicine.

The author’s assumptions do not appear to be questionable since they are based on facts and statistics, and therefore, are logical and trustworthy. It is difficult to talk about the opposing arguments in this paper because the article is written in the form of an overview. However, in addition to four major vaccines, pharmaceutically modified non-injectable vaccines are also discussed in detail. Therefore, it is possible to suggest that the author accepts different points of view.

Reference

Nada Abdullah Alharbi, Overview of SARS-CoV-2 and COVID-19 Vaccine. Bahrain Medical Bulletin, Vol. 43, No. 2, 2021.

Introduction

Acute respiratory failure (ACR) is a pathological condition in which the external respiratory apparatus cannot provide the body with sufficient oxygen and perform carbon dioxide elimination with average energy expenditure. ACR can shorten lives, so practicing physicians and nurses need a complete understanding of how pathophysiological mechanisms work and how to normalize them. This paper aims to analyze acute respiratory failure concepts that will allow us to recognize the pathology and quickly help the patient.

Pathophysiology of Acute Respiratory Failure

The main pathogenetic factors of external respiration disorders are impaired lung ventilation, impaired diffusion of gases through the alveolar-capillary membrane, impaired pulmonary blood flow, and respiratory regulation. Alveolar hypo- and hyperventilation, pulmonary hypertension, and impaired gas exchange with increased working breathing are commonly considered to be the predominant processes that occur during acute respiratory failure (Swenson, K. E., & Swenson, E. R., 2021). In addition, pulmonary edema in the first stages causes compression and cessation of normal ventilation.

Ventilatory Pulmonary Damage

Alveolar hypoventilation is a decrease in alveolar ventilation per unit time below that the body requires under given conditions. A distinction is made between obstructive and restrictive types of hypoventilation, each of which may be characteristic of ARF depending on the cause of the pathology. The obstructive type is associated with decreased airway patency and increased air resistance (Swenson, K. E., & Swenson, E. R., 2021). As a result, the respiratory muscles are forced to work hard during exhalation and energy expenditure increases. Lung elasticity decreases, hypoxemia, and hypercapnia are observed; blood analysis demonstrates acidosis and a rightward shift in oxyhemoglobin dissociation. Restrictive alveolar ventilation is associated with limitation of lung expansion due to intrapulmonary and extrapulmonary causes. Inflammatory processes develop in the pleura, and hydrothorax and hemothorax occur, which interfere with the average hemoglobin affinity for oxygen (Faverio et al., 2018). Alveolar hypoventilation and hypoxia cause spasms of the arterioles of the small circle of circulation, limiting blood flow through poorly ventilated lung areas and preventing discharge of venous blood in the great cycle.

Alveolar hyperventilation increases the volume of alveolar ventilation per unit time compared to that required by the body under given conditions. It is characterized by hypocapnia and respiratory alkalosis, which leads to a shift of the oxyhemoglobin dissociation curve to the left. Hypocapnia results in decreased excitability of the respiratory center and cerebral vasospasm (Swenson, K. E., & Swenson, E. R., 2021). The damage to the respiratory center is thought to be the major obstacle to the cure of ARF because it mediates nerve plexus lesions.

Inflammation

Inflammatory processes are the main features of irregular breathing regulation in ARF. Inflammatory processes begin immediately after introducing a pathogen that disrupts regular lung tissue activity. It is expressed by receptor binding to pathogens, which serve as danger signals. Through cellular signaling, information is transmitted, and anti-inflammatory processes are triggered, leading to the increased release of cytokines and chemokines (Matthay et al., 2019). As a result of increased production of these mediators, endothelial injury can occur, resulting in worsening lung damage.

Disruption of Respiratory Regulation

Disruption of respiratory regulation develops as a result of increased permeability of the epithelium, which leads to the formation of sticky compounds capable of creating large globules that interfere with the passage of oxygen through the alveoli. The alveolar epithelium is damaged, so there is a decrease in the production of surfactant that would allow the lungs to maintain their elasticity (Swenson, K. E., & Swenson, E. R., 2021). Instead, the lungs become more vulnerable and incapable of eliminating the preceding inflammation. As a result of the fluid clearance of pulmonary edema increased sodium and chloride transport into the interstitium, there is an artificial gradient for water resorption.

Methods of Patient Evaluation

The main clinical manifestations of ARF are hypoxia and hypercapnia; in ventilation disorders and hypoxia without hypercapnia in alveolar-capillary diffusion disorders. ARF developed with insufficient blood supply to tissues due to low cardiac output is manifested by hypoxemia with normo- and hypocapnia (Kassirian et al., 2020). Depending on the severity of pathophysiological shifts, respiratory acidosis develops. The main laboratory tests widely used are blood gas tests and blood pH-metric, oxy- and carbometric monitoring with non-invasive methods. Taking into account the clinical data and additional forms of research, one classifies ARF by severity.

In addition to the laboratory tests, general picture assessment is used: the first clinical symptom of ARF is often the feeling of shortness of breath (dyspnea). Breathing becomes at first deep, then rapid (Fernando et al., 2021). In upper airway obstruction, dyspnea is predominantly aspiratory; in bronchial obstruction, it is expiratory. Depending on whether hypoxemia with hyper- or hypocapnia is observed, there are three stages in which the patient’s condition gradually worsens (Ervin et al., 2020). In combination with hypercapnia, there is hyperexcitability with bilious and crimson body covering and persistent tachycardia. The state is also agitated in various hypocapnia, and convulsions and cyanosis are observed.

Medical Management

The medical management of a patient with ARF begins with a primary assessment and then referral to the intensive care unit. In the ICU, the patient’s lung function is maintained, and the underlying cause of the pathology is gradually treated. First, respiratory and airway patency tests are performed (Ergan et al., 2018). In the first minutes, vital functions are maintained, and infusion therapy is started to normalize the cardiac output (Griffiths et al., 2019). Then medications are prescribed to prevent blood clots and sedatives from relieving pain. For this purpose, narcotic analgesics and heparin are used (in addition to pain relief, they reduce hypercatecholamineemia and improve the rheological properties of blood) (Fernando et al., 2021). Finally, patients are shown activity and breathing exercises to prevent fluid stasis in the lungs and preserve respiratory muscle function.

Care Plan

A plan of care may consist of the following steps:

1. Assessment of subjective and objective data.
2. Creating an optimal position in bed while maintaining motor activity readings (Ergan et al., 2018).
3. Performing a complete respiratory evaluation and administering supplemental oxygen if necessary (Kassirian et al., 2020).
4. Nutritional support.
5. Educating the patient and relatives: teaching stimulating spirometry, breathing exercises, and taking medication.

In addition to the above, it is recommended to resort to other ways of treatment and support patients with ARF. These include conservative pain management, extracorporeal membrane oxygenation, and the use of steroids (Griffiths et al., 2019). In addition, continuous suctioning of lung fluids and avoiding contact with other liquids to prevent complications are recommended (Ervin et al., 2020). Overall, care should be aimed at maintaining existing average values and improving those in critical values through medication, timely tests, and optimal respiratory support.

Conclusion

Thus, acute respiratory failure is a severe pathology that can lead to significant lung damage. The pathophysiological process consists of the gradual suppression of respiratory centers with the connection of hypo- or hyperventilation of alveolar nature and the development of lung epithelium damage. Management of patients with ARF consists of immediate transfer to the intensive care unit using clot-dissolving drugs and pain management. The nursing care plan aims to organize the patient’s space, diet, and medication adherence.

References

Ergan, B., Nasiłowski, J., & Winck, J. C. (2018). How should we monitor patients with acute respiratory failure treated with noninvasive ventilation?European Respiratory Review, 27. Web.

Ervin, J. N., Rentes, V. C., Dibble, E. R., Sjoding, M. W., Iwashyna, T. J., Hough, C. L., Ng Gong, M., & Sales, A. E. (2020). Evidence-based practices for acute respiratory failure and acute respiratory distress syndrome.CHEST, 156(6), 2381-2393. Web.

Faverio, P., De Giacomi, F., Sardella, L., Fiorentino, G., Carone, M., Salerno, F., Ora, J., Rogliani, P., Pellegrino, G., Sferrazza Papa, G. F., Bini, F., Bodini, B. D., Messinesi, G., Pesci, A., & Esquinas, A. (2018). Management of acute respiratory failure in interstitial lung diseases: overview and clinical insights.BMC pulmonary medicine, 18(1), 70. Web.

Fernando, S. M., Ferreyro, B. L., Urner, M., Munshi, L., & Fan, E. (2021). Diagnosis and management of acute respiratory distress syndrome. CMAJ: Canadian Medical Association journal = journal de l’Association medicale canadienne, 193(21), 761–768. Web.

Griffiths, M. J.D., McAuley, D. F., Perkins, G. D., Barret, N., Blackwood, B., Boyle, A., Chee, N., Connolly, B., Dark, P., Finney, S., Salam, A., Silversides, J., Tarmey, N., Wise, M. P., Baudouin, S. V. (2019). Guidelines on the management of acute respiratory distress syndrome.BMJ Open Respiratory Research, 6. Web.

Kassirian, S., Taneja, R., & Mehta, S. (2020). Diagnosis and management of acute respiratory distress syndrome in a time of COVID-19.Diagnostics (Basel, Switzerland), 10(12). Web.

Matthay, M.A., Zemans, R.L., Zimmerman, G.A., Arabi, Y. M., Beitler, J. R., Mercat, A., Herridge, M., Randolph, A. G., & Calfee, C. S. (2019). Acute respiratory distress syndrome.Nature Reviews: Disease Primers, 5(18). Web.

Swenson, K. E., & Swenson, E. R. (2021). Pathophysiology of acute respiratory distress syndrome and COVID-19 Lung Injury. Critical care clinics, 37(4), 749–776. Web.