“SARS is a warning,” said Dr. Brundtland, Director General of WHO, or the World Health Organization on July 5th, 2003, “We have an opportunity now, and we see the need clearly, to rebuild our public health protection. They will be needed for the next global infection.” Everybody has heard of COVID-19, but how about something that has caused the same hysteria almost 18 years ago? How about…SARS?
What Is SARS?
SARS, or Severe Acute Respiratory Syndrome, was a pandemic that occurred from 2002 to 2003. It was an infectious viral disease caused by an RNA coronavirus called SARS associated coronavirus, or SARS – CoV for short. Coronaviruses are a type of virus that usually associates with pneumonia and colds and is named for its appearance in electron microscopes as images of a crown on its surface. The SARS coronavirus is profoundly complex, occupying multiple factors leading to severe injury in the lungs and the dissemination of the virus to several other organs. It mainly targets the epithelial cells of the respiratory tract, resulting in diffusion damage of the alveoli in the lungs. At the same time, several other kinds of cells may also be infected throughout the illness, including the mucosal cells of the intestines, the tubular epithelial cells of the kidney, neurons of the brain, etc. Meanwhile, certain organs may also suffer from direct injury causing complications such as respiratory failure, liver failure, heart failure, and kidney problems. The time range of the SARS pandemic started from November 16th, 2002, where the first case of atypical pneumonia was reported in Foshan, Guangdong province in Southern China, and lasted until July 17th, 2003, when the SARS pandemic was officially declared over by WHO. The pandemic ended with reports of SARS from 33 countries and 5 continents, in which 8086 people were diagnosed, resulting 774 deaths.
What Are the Symptoms of SARS?
When infected with SARS, a main symptom shown in the beginning is high fever with a temperature above 38 degrees Celsius or 100.4 degrees Fahrenheit. Common symptoms that develop 2 to 3 days after that are dry coughing, headaches, muscle aches, pneumonia, and tiredness. On the other hand, less common symptoms include diarrhea, nausea, and vomiting, which occurs in about 10 to 20 percent of patients.
How Does SARS Spread?
According to the CDC, SARS is spread through respiratory droplets produced when an infected person coughs or sneezes. These droplets spread come from a short distance, generally up to 2 to 3 feet and cause an infection when the droplet is deposited on mucous membranes of the mouth, nose, and eyes of people. In addition, it is stated that it is possible that the SARS – CoV can spread through airborne, but there is no scientific evidence that supports this theorem yet.
How Is SARS Diagnosed?
There are several common tests done to diagnose SARS.
Firstly, a blood routine is done and the results that show SARS is a decrease of white blood cell counts such as lymphocytes and platelets. At the same time, the CD3, CD4, and CD8 T cells will also show a significant decrease.
Secondly, a blood biochemical test is done and an immense decrease in blood oxygen saturation will be revealed if diagnosed in the blood gas analysis.
Thirdly, a molecular, biology test will be carried out to test for the reverse transcription-polymerase chain reaction to examine the presence of the RNA of SARS – CoV in the patient’s blood.
Fourthly, a film degree exam is tested on the patients because a vast majority of patients had abnormal x-ray examinations at the early stage which shows large patches of shadow in the lungs.
How Is SARS Treated?
There are a variety of different treatments given to patients based on their sickness level.
During general treatment, oxygen therapy is carried out during the shortness of breath in order for oxygen to be given out continuously throughout a nasal cannula. This method is also beneficial by keeping the airway open by discharging respiratory secretions. Then, there will be an application of antibiotics such as macrolides, penicillin, etc. to cover common pathogens of normal pneumonia.
But during severe cases, patients will be placed in the ICU or insensitive care unit to provide dynamic monitoring. Meanwhile, there will also be the use of the Non-Invasive Positive Pressure Mechanical Ventilation or NPPV to improve oxygen saturation. If the patient has not improved, then there will be the use of Invasive Positive Pressure Mechanical Ventilation to prevent Acute Respiratory Distress Syndrome.
What Is the Death Rate of SARS?
During the 2003 pandemic of SARS, the overall death rate of SARS was about 9 to 12 percent of those diagnosed, and statistics of death resulted from SARS has shown who was the most vulnerable to SARS – CoV according to host factors such as age, gender, and pre-existing conditions. For example, evidence has shown that the fatality rates were less than 1 percent for people younger than 25, 6 percent for those who aged from 25 to 44 years old, 15 percent for those who aged from 45 – 64, and 55 percent for people of 65 or older.
At the same time, it is also shown that the male cases had a significantly higher mortality rate than female cases. Another example is that patients with pre-existing conditions such as diabetes, cardiac, diseases, and chorionic hepatitis furthermore showed a higher mortality rate. Evidence to this is in an analysis of 1755 patients, the fatality rate for patients with pre-existing conditions to be 46 percent, which is about 36 percent higher than those without conditions.
Where Does SARS Come From?
After years of research following the SARS pandemic, it is suggested that SARS – CoV jumped into humans from an animal that is believed to be horse show bats. For this to happen, genetic changes are required in the virus, which is suggested to have occurred in the palm civets, since SARS – CoV present in the horse show bats cannot affect humans directly.
The main research that is used to support this claim is the Chinese researchers in the Yunnan, China wearing N95 respirators, gloves, protective outwear, and safety glasses trapping horse show bats, and collecting swab samples by putting plastic sheets under roosting sites from April 2011 to October 2015. Results from the analysis showed that out of the 602 samples collected, 84 were tested positive for coronaviruses. Sequencing found that most were SARS related viruses by showing that most have the essential building block of the SARS – CoV.
On the other hand, the Palm Civets played a great role in the cause of the SARS pandemic because 3 species of Palm Civets found in Guangdong, China, where the first case was reported, were infected with viruses related to SARS – CoV. And more than one-third of the earliest SARS cases that have emerged before February 2003 occurred among workers who handled wild animals in Guangdong, which further suggests this statement. Meanwhile, the rate of detection was higher because the number of Palm Civets traded in the Southern People’s Republic of China exceeds any other wildlife groups.
What Actions Were Taken to Control the Spread of SARS?
Actions and precautions to obtain the pandemic SARS were taken afterward the outbreak of the virus. One effective action is GROAN or Global Outbreak Alert and Response Network, recruiting more than 60 teams of medical experts to assist the infection control of SARS affected areas. At the same time, GROAN also established a virtual network of 11 leading infectious disease laboratories in 9 countries. Their laboratories were connected by a secure website daily teleconferences, the objective of the laboratories was to identify the causative agent of SARS. In exactly one month after the laboratory was established, its researchers had conclusively identified SARS – CoV as the causative agent.
Meanwhile, WHO has also taken action by calling on a global alert on March 12th, 2003 to issue a direct response to the threat by SARS. In addition, WHO has also developed a specific and detailed surveillance system of cases of SARS throughout the countries who are having outbreaks. The importance of this system is to provide a 24-hour travel advisory in order to protect the health of travelers and decrease international spread.
What Are the Impacts of SARS?
There are numerous and vast social, economic, and psychosocial impacts that resulted from the SARS pandemic.
The main social impact brought by SARS is it exposed weaknesses in the health infrastructure of not only China but also worldwide. Some main points that were reflected were the poor state of funding, the lack of effective surveillance systems, and the severe shortage of facilities and medical staff prepared for an epidemic infectious disease outbreak. Therefore, to address these weaknesses and deficiencies highlighted by SARS, governments established a case reporting structure, strengthened its emergency response system, dismissed key officials who mismanaged the crisis during its initial months, and increased the recognition and understanding of the importance of infectious disease control and prevention.
The economic consequence of SARS is estimated of a global cost on the expenditures and losses in key sectors such as medical expenses, travel, and consumer confidence is approximately $80 billion. In addition, it is estimated that the global investment into SARS is around $40 billion to $54 billion which shows how SARS gas impacted the economy negatively in the world.
Statistics of a survey in a convalescent hospital in Hong Kong showed the psychosocial impacts that approximately 50 percent of the SARS recovered patients showed anxiety, 20 percent were fearful, and 20 percent showed some negative psychological effects. Meanwhile, some serious cases could not get rid of the memories of them fighting SARS that it disrupted their daily activities. Evidence suggested that some psychosocial problems may due to the side effects of SARS medications, which caused hair loss, memory loss, impaired concentration, and depression.
Bibliography
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Written by Never Is Forever
The Anonymous Helpers (TAH)
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