Developing a Surveillance and Monitoring Program
What action can you take when an outbreak is reported close to home?
Background
SARS (Severe Acute Respiratory Syndrome) is a highly contagious respiratory disease caused by the SARS Coronavirus. Coronaviruses are mostly found in poultry with only a few strains hosted by humans. In the past, Coronaviruses only caused mild flu infections. However, in recent years, the coronaviruses SARS and MERS (Middle East Respiratory Syndrome) have been associated with causal problems for acute respiratory conditions. Further scientific reports have shown that SARS Coronavirus is a new mutant strain origination from animal hosts (Chan & Chan, 2013).
Symptoms
SARS symptoms include headaches, muscle aches, chills, and fatigue. However, in other cases some patients may experience diarrhea and vomiting. Important to note is that different people infected with the same Coronavirus can show different symptoms because the virus not only affects the respiratory system, but also the digestive system and this depends on the patients precondition before developing SARS (Tyshenko & Paterson 2010, p.86). After 2-7 days of infection, the patients develop a dry cough accompanied by hypoxia. As a result, 20% of these patients need mechanical ventilation and most of them develop pneumonia (CDC, 2012a). The patient will start spreading the disease to others when he or she becomes symptomatic.
How it spreads
The virus is airborne and spreads through physical contact, or through an infected person upon sneezing. Thus, people spending a lot of time in hospitals without masks risk contracting the virus. In addition, people in countries reported to be SARS hotspots are at a higher risk of infection than those residing in less prone areas. Therefore, people traveling from one country to another can spread the virus; hence, the need for surveillance at country entrance points. An example was in February 2003, when a SARS outbreak, which began in Asia, spread to about 24 countries in different continents before it was contained (Wright et al. 2012).
Steps to take after an Outbreak Report
An important step that I will take to control the spread of SARS is to set up Emergency Operation Centers (EOC) to centrally manage the emergency. Such Centers will be located at the airports and borders. The Emergency Operation Centers will deploy epidemiologists and medical officers to, the ground to conduct investigations. These professionals will then submit their information to clinical officers for comparison with laboratory tests to ascertain the cause of the disease. (CDC, 2012b)
Surveillance Programs
According to Thacker, Qualters and Lee (2012), future outbreaks of SARS can be detected early and contained by the use of surveillance mechanisms. Public health surveillance involves data collection, analysis, interpretation, and submission to health facilities for intervention. Surveillance systems are useful in detecting outbreaks and epidemics. Such surveillance systems can either be hospital-based or behavior-based (Huang et al. 2014). Hospital-based surveillance systems collect data on new admissions of patients with respiratory diseases while behavior-based surveillance systems analyze information from drug sales or vinegar sales (Macdonald, 2011, p. 10). In addition, laboratory-based surveillance can be carried out by running tests on patient samples to determine the actual cause of infection (Macdonald, 2011, p. 29). It is challenging to carry out surveillance if patients are infected but do not seek medical attention. In such situations, community-based surveillance can be done. Trained volunteers who report infection cases to the health professionals in the hospitals do it.
Developing a Surveillance System
When developing a new surveillance system, I will consider a few factors: the surveillance program will incorporate common data elements and the collection of data will be time-sensitive. Additionally, it will be accessible to the appropriate stakeholders and be flexible for future modifications (Lee 2010, p. 44). Because the outbreak is an emergency, I will use an active surveillance system because it will produce results faster. The data collected for the surveillance system will be handled with confidentiality to protect the rights of the patient. The purpose of the surveillance system is to collect data from patients to discover if they are infected with the SARS Coronavirus and how to carry out interventions. I will collect information about hospital admissions and chemist drug sales and compare with laboratory results of these patients.
How the Data Will Help Public Health Officers
The data collected from the surveillance system will be analyzed and used to make decisions to contain the spread of the virus (Lee 2010, p. 45). The public health officers will use this information to discover hot-spot areas and will create quarantines. The hospitals will prevent visitors from coming to see patients in hospitals and airports will cancel all flight to and from hot-spot destinations. It is possible for SARS patients admitted for other conditions to infect fellow patients. Therefore, health professionals will observe all patients will be screened and the infected ones will be separated before they become symptomatic. In addition, a screening will be done at all borders and airports to make sure that infected people are separated from others.
In addition, public health officers will inform the public about the outbreak so that they may avoid the hot-spot areas. The screening will be carried out in public places such as schools to isolate infected children so that they can be put on treatment. All public events will be canceled to reduce the risk of infection. Health education campaigns can also be carried out to inform the public about health practices that can reduce infection risk and what to do in case of infection (Gostin, 2008). Such health practices include frequent washing of hands with soap and water, avoiding crowded places, cough etiquette among others (Chan et. al., 2015). Additionally, the people will be advised to avoid using public means of transport.
Reflective Journal
SARS is a contagious airborne virus that infects the respiratory system. It eventually causes hypoxia and pneumonia. I have learnt that SARS outbreaks can be controlled if the appropriate measures are taken. Public health officers use surveillance programs to gather information from patients regarding patient admission trends and drug sales. With this information, they can protect other members of the community from infection. In case if an outbreak, I would suggest that public health officers’ work in partnership with government agencies to run laboratory tests on patients, create quarantines and provide treatment options to infected patients. I have also learnt that surveillance systems are important because they provide the specific information required to identify hot-spot areas and control infectious diseases (Magnus, 2012, p. 108). Either active or passive surveillance systems can be used to obtain the information depending on the urgency of the situation. Such information can be used to create work guidelines for health professionals depending on the nature of the disease. For instance I would suggest that health professionals put on masks and gloves while caring for infected patients. Also, they could clean their hands with alcohol before attending other patients to prevent infection. Finally, I have learnt that surveillance systems help public health officers to collect information that can be used in case of future outbreaks for comparison and analysis (Magnus, 2012, p. 108).
Bibliography
Centers for Disease Control and Prevention (CDC), 2012a. Frequently asked questions about SARS. Available at: http://www.cdc.gov/sars/about/faq.html [Accessed 1 August 2016]
Centers for Disease Control and Prevention (CDC), 2012b. SARS basics fact sheet. Available at: http://www.cdc.gov/sars/about/fs-sars.html [Accessed 1 August 2016]
Chan, E.Y., Cheng, C.K., Tam, G., Huang, Z. and Lee, P., 2015. Knowledge, attitudes, and practices of Hong Kong population towards human A/H7N9 influenza pandemic preparedness, China, 2014. BMC public health, 15(1), p.1. DOI: 10.1186/s12889-015-2245-9
Chan, P.K. and Chan, M.C., 2013. Tracing the SARS-coronavirus. Journal of thoracic disease, 5(Suppl 2), p.S118. doi: 10.3978/j.issn.2072-1439.2013.06.19
Huang, Q.S., Baker, M., McArthur, C., Roberts, S., Williamson, D., Grant, C., Trenholme, A., Wong, C., Taylor, S., LeComte, L. and Mackereth, G., 2014. Implementing hospital-based surveillance for severe acute respiratory infections caused by influenza and other respiratory pathogens in New Zealand. Western Pac Surveill Response J, 5(2), pp.23-30. doi: 10.5365/wpsar.2014.5.1.004
Lee, L.M., 2010. Principles and practice of public health surveillance. Oxford University Press, Oxford, USA.
MacDonald, P.D., 2011. Methods in Field Epidemiology. Jones & Bartlett Publishers, Burlington, Massachusetts.
Thacker, S.B., Qualters, J.R., Lee, L.M. and Centers for Disease Control and Prevention, 2012. Public health surveillance in the United States: evolution and challenges. MMWR Surveill Summ, 61(Suppl), pp.3-9. Available at: http://dx.doi.org/10.1016/j.jbi.2014.03.011 [Accessed 1 August 2016]
Tyshenko, M.G. and Paterson, C., 2010. SARS unmasked: risk communication of pandemics and influenza in Canada (Vol. 34). McGill-Queen's Press-MQUP, Canada.
Wright, K.B., Sparks, L. and O'hair, H.D., 2012. Health communication in the 21st century. John Wiley & Sons, Hoboken, New Jersey.
Reflective Journal Bibliography
Magnus, M., 2012. Essential readings in infectious disease epidemiology. Jones & Bartlett Publishers, Burlington, Massachusetts.
