The incubation period for severe acute respiratory syndrome (SARS) typically spans from 2 to 10 days. During this phase, individuals may have contracted the SARS coronavirus (SARS-CoV) but do not yet display symptoms of the illness. This period is crucial, as it marks the time between exposure to the virus and the onset of symptoms.

Understanding the duration of the incubation period aids healthcare professionals in identifying and monitoring individuals who may have been exposed to SARS-CoV, facilitating prompt testing, isolation, and preventive measures.

In addition, knowledge of the incubation period assists public health authorities in implementing effective strategies to control the spread of SARS during outbreaks.

The mode of transmission

The mode of transmission for Severe Acute Respiratory Syndrome (SARS) primarily involves droplet infection, facilitated especially by close contact in confined or poorly ventilated environments. Here’s an expanded explanation:

• Droplet Transmission: SARS-CoV, the virus responsible for SARS, is primarily transmitted through respiratory droplets expelled when an infected individual coughs, sneezes, or talks. These droplets contain viral particles and can travel through the air and infect others who are in close proximity, typically within a distance of about six feet.
• Air Travelers as Vectors: Air travel plays a significant role in the global spread of SARS. Infected individuals traveling by air can transmit the virus to others on the same flight, particularly if they are in close proximity for an extended period of time. The recirculation of air within aircraft cabins can also contribute to the spread of the virus among passengers.
• Promotion in Closed Environments: The spread of SARS-CoV is particularly promoted in closed environments where people gather in close quarters, such as airplanes, buses, trains, hospitals, and crowded public spaces. In these settings, respiratory droplets can easily spread from person to person, increasing the risk of transmission.
• Poor Ventilation: Inadequate ventilation in indoor spaces can exacerbate the spread of SARS-CoV by allowing respiratory droplets to linger in the air for longer periods of time. Proper ventilation, which involves the exchange of indoor air with outdoor air, helps dilute and remove infectious droplets, reducing the risk of transmission.
• Surface Contamination: While droplet transmission is the primary mode of SARS-CoV transmission, the virus can also spread through contact with contaminated surfaces or objects. Infected individuals may deposit viral particles onto surfaces through respiratory secretions, and others can become infected by touching these surfaces and then touching their mouth, nose, or eyes.
• Preventive Measures: To mitigate the transmission of SARS-CoV, especially in high-risk environments like healthcare settings and public transportation, preventive measures such as wearing masks, practicing good hand hygiene, maintaining physical distance, and improving ventilation are crucial. These measures help reduce the likelihood of respiratory droplets reaching susceptible individuals and minimize the risk of surface contamination.

Signs and symptoms

The signs and symptoms of severe acute respiratory syndrome (SARS) encompass a range of manifestations that typically emerge following exposure to the SARS coronavirus (SARS-CoV). Here’s an expanded explanation of these symptoms:

• Fever: A patient with SARS will present with a high fever, typically exceeding 38 degrees Celsius (100.4 degrees Fahrenheit). And also, fever is one of the hallmark symptoms of the illness and may persist for several days.
• Sneezing: Some patients infected with SARS-CoV may experience sneezing, which is characterized by the sudden, forceful expulsion of air through the nose and mouth. Sneezing can contribute to the spread of respiratory droplets containing the virus to others nearby.
• Dry Cough: A dry, non-productive cough is a common symptom of SARS patients. This type of cough is characterized by the absence of mucus or phlegm and may be persistent and irritating.
• Loss of Appetite: SARS can lead to a decreased desire to eat, resulting in a loss of appetite. This symptom may be accompanied by nausea or gastrointestinal discomfort.
• Weight Loss: Significant weight loss may occur in patients with SARS, particularly due to the combined effects of decreased appetite, fever, and metabolic changes associated with the illness.
• General Body Malaise: SARS is often associated with a general feeling of illness or malaise, characterized by fatigue, weakness, and overall discomfort. This symptom can significantly impact the individual’s daily activities and quality of life.
• Headache: Headache is a common complaint among patients with SARS and may vary in intensity from mild to severe. Headaches may be accompanied by other symptoms, such as fever and muscle aches.
• Joint Pains: Some patients with SARS may experience joint pains, also known as arthralgia. These pains can affect multiple joints throughout the body and may contribute to overall discomfort and mobility issues.

Medical Management

When evaluating a patient suspected of having severe acute respiratory syndrome (SARS), healthcare providers should conduct a comprehensive history and physical examination to assess for relevant symptoms and risk factors. Here’s what can be included.

History

• Symptoms Onset: Ask the patient about the onset and duration of symptoms, including fever, cough, shortness of breath, and any associated symptoms such as headaches or muscle aches.
• Travel History: Ask about the patient’s recent travel history, particularly to regions with known SARS outbreaks or areas experiencing community transmission of respiratory illnesses.
• Exposure History: Determine if the patient has had close contact with people diagnosed with SARS or if they have been in settings where SARS transmission is likely, such as healthcare facilities or crowded public spaces.
• Occupational History: Assess the patient’s occupation and any potential occupational exposures that may increase the risk of SARS transmission, such as working in healthcare or travel-related industries.
• Medical History: Review the patient’s medical history, including any underlying health conditions or immunocompromising conditions that may predispose them to severe illness from SARS, such as HIV/AIDS.
• Contact with Animals: Ask the patient about any recent contact with animals, particularly exotic animals, as certain zoonotic coronaviruses have been associated with animal-to-human transmission.

Physical Examination

• Vital Signs: Measure the patient’s vital signs, including temperature, pulse rate, respiratory rate, and blood pressure. Elevated temperatures above 37.5 degrees and respiratory rates may indicate fever and respiratory distress, respectively.
• Respiratory Examination: Perform a thorough respiratory examination, including auscultation of lung sounds, assessment of respiratory effort, and observation for signs of respiratory distress such as tachypnea, dyspnea, or use of accessory muscles.
• General Appearance: Evaluate the patient’s general appearance and level of consciousness for signs of distress or lethargy. Pallor, diaphoresis, and altered mental status may indicate a severe illness.
• Examination of Other Systems: Conduct a focused examination of other organ systems, as warranted by the patient’s symptoms and clinical presentation. Pay particular attention to findings suggestive of systemic involvement or complications, such as rash, lymphadenopathy, or signs of multiorgan dysfunction.
• Skin Examination: Assess the patient’s skin for signs of rash or petechiae, which may indicate an underlying viral infection or coagulopathy.
• Neurological Examination: Perform a brief neurological examination to evaluate cognitive function, cranial nerve function, motor strength, sensation, and coordination.

Investigations

When evaluating a patient suspected of having Severe Acute Respiratory Syndrome (SARS), several investigations may be conducted to confirm the diagnosis, assess disease severity, and guide management. These investigations typically include the following:

Laboratory Tests

• Polymerase Chain Reaction (PCR): Nasopharyngeal or throat swab samples are collected and tested using PCR to detect the presence of SARS coronavirus (SARS-CoV) genetic material. This test is crucial for confirming the diagnosis of SARS.
• Complete Blood Count (CBC): A CBC will reveal leukopenia (low white blood cell count), which is commonly observed in patients with SARS. Thrombocytopenia (low platelet count) and lymphopenia (low lymphocyte count) may also be present.
• Biochemical Profile: Blood tests may be performed to assess liver and kidney function, electrolyte levels, and markers of inflammation such as C-reactive protein (CRP) and procalcitonin.

Imaging Studies:

• Chest X-ray: A chest X-ray may be obtained to evaluate for the presence of pneumonia or other pulmonary abnormalities associated with SARS. Findings may include patchy or diffuse infiltrates consistent with viral pneumonia.
• Computed Tomography (CT) Scan: CT imaging of the chest may provide a more detailed assessment of lung involvement and help differentiate between viral pneumonia and other respiratory conditions.

Viral Culture

• Viral culture may be attempted to isolate and grow SARS-CoV from respiratory specimens. However, this method is less commonly used due to its lower sensitivity and longer turnaround time compared to PCR testing.

Serological Tests

• Serological tests measure the presence of antibodies against SARS-CoV in the blood. However, these tests are not typically used for acute diagnosis of SARS due to delayed antibody production during the course of infection.

Other Investigations:

• Arterial Blood Gas (ABG) Analysis: ABG analysis may be performed to assess respiratory status and oxygenation in patients with severe respiratory distress.
• Coagulation Studies: Coagulation studies, including prothrombin time (PT) and activated partial thromboplastin time (aPTT), may be indicated to evaluate for coagulopathy associated with severe SARS.

Infection Control Measures:

• In addition to diagnostic investigations, healthcare providers should implement appropriate infection control measures, including isolation of suspected cases, use of personal protective equipment (PPE), and adherence to strict hand hygiene protocols, to prevent the spread of SARS-CoV in healthcare settings.

Treatment

Treatment for Severe Acute Respiratory Syndrome (SARS) primarily focuses on symptomatic management, supportive care, and infection control measures. Here’s an expanded explanation of treatment options:

Symptomatic Relief

• Analgesics: Pain relievers such as acetaminophen (e.g., Panadol) can be prescribed to alleviate fever, headache, muscle aches, and other symptoms of discomfort associated with SARS.
• Nasal Drops: Nasal decongestants or saline nasal drops should be recommended to relieve nasal congestion and facilitate easier breathing, especially in patients experiencing respiratory symptoms.

Respiratory Support

• Oxygen Therapy: Patients with severe respiratory distress or hypoxemia may require supplemental oxygen therapy to maintain adequate oxygenation levels and alleviate breathing difficulties.
• Mechanical Ventilation: In severe cases of SARS with respiratory failure, invasive mechanical ventilation via endotracheal intubation may be necessary to support breathing and ensure adequate gas exchange.
• Tracheostomy: In rare instances where prolonged mechanical ventilation is required or if there are complications related to endotracheal intubation, a tracheostomy procedure may be performed to establish a secure airway.

Antimicrobial Therapy

• Broad-Spectrum Antibiotics: While SARS is caused by a virus, bacterial coinfections or secondary bacterial pneumonia can occur, particularly in hospitalized patients. Broad-spectrum antibiotics may be prescribed empirically to prevent or treat bacterial infections and reduce the risk of complications.

Antiviral Therapy

• Antiviral Medications: Although no specific antiviral drugs have been approved for the treatment of SARS-CoV infection, experimental antiviral agents such as ribavirin, lopinavir/ritonavir, and interferons have been investigated in clinical trials for their potential efficacy in managing SARS.

Isolation and Infection Control

• Isolation Precautions: Patients diagnosed with SARS should be placed in airborne isolation rooms or designated isolation areas to prevent the transmission of the virus to healthcare workers and other patients.
• Personal Protective Equipment (PPE): Healthcare providers caring for patients with SARS should adhere to strict infection control protocols, including the use of appropriate PPE such as N95 respirators, gloves, gowns, and eye protection.

Supportive Care

• Fluid and Nutritional Support: Adequate hydration and nutritional support are essential for patients with SARS to maintain hydration, support immune function, and promote recovery.
• Monitoring and Surveillance: Close monitoring of vital signs, respiratory status, laboratory parameters, and clinical progression is essential to detect any deterioration in the patient’s condition and adjust treatment accordingly.

Experimental Therapies

• Clinical Trials: Patients with severe or refractory SARS may be eligible to participate in clinical trials evaluating novel therapeutic agents or investigational treatments for SARS-CoV infection.

Nursing Management

Patient Isolation

• Implement strict airborne isolation precautions for patients diagnosed with SARS.
• Ensure that patients are placed in negative-pressure rooms with appropriate ventilation.
• Provide education to patients and visitors about the importance of adhering to isolation protocols, and make sure the room where the patient with SARS is marked.
• Use personal protective equipment (PPE), such as N95 respirators, gloves, gowns, and eye protection, when entering the patient’s room.

Infection Prevention

• A nurse should promote hand hygiene practices among healthcare staff, patients, and visitors.
• A nurse should implement environmental cleaning and disinfection protocols for surfaces and equipment.
• A nurse should monitor and enforce compliance with infection control measures.
• A nurse should educate patients and families about respiratory etiquette, including covering coughs and sneezes with tissues or elbows.

Disease Notification

• A nurse should notify public health authorities promptly of suspected or confirmed cases of SARS.
• A nurse should provide accurate and timely information to healthcare staff, patients, and families about the status of SARS cases and any updates to infection control measures.
• A nurse should collaborate with local health departments to facilitate contact tracing and outbreak investigation.
• A nurse should ensure the confidentiality of patient information in accordance with healthcare privacy regulations.

Maintenance of the Airway

• A nurse should assess and monitor the patient’s respiratory status, including respiratory rate, effort, and oxygen saturation, using a pulse oximeter.
• Make sure to position the patient at a 90-degree angle to comfortably optimize airway patency and lung expansion.
• Administer supplemental oxygen therapy as prescribed to maintain adequate oxygenation, if oxygen levels are below 95%.
• Initiate respiratory treatments such as nebulization or chest physiotherapy to assist with airway clearance, if indicated.

Maintenance of Breathing

• A nurse should monitor respiratory rate, depth, and pattern regularly to prevent respiratory failure.
• A nurse should encourage deep breathing exercises and coughing to mobilize secretions and maintain lung function.
• Administer prescribed bronchodilators or mucolytic agents to improve airway clearance and breathing comfort.
• Provide respiratory support, such as non-invasive ventilation, if respiratory distress worsens.

Maintenance of Circulation

• Monitor vital signs closely, including blood pressure, heart rate, and peripheral perfusion.
• Assess fluid balance and intervene as needed to maintain hydration and electrolyte balance.
• Administer intravenous fluids and medications as prescribed to support circulation and manage hemodynamic stability.
• Collaborate with the healthcare team to address any signs of cardiovascular compromise promptly.

Environment

• Maintain a clean and well-ventilated environment to reduce the risk of transmission.
• Ensure adequate spacing between patient beds to minimize close contact and promote social distancing.
• Make sure the ward is free from noise to reduce noise and promote restful sleep for patients.
• Monitor and control environmental factors such as temperature and humidity to optimize patient comfort and recovery.

Observation

• Conduct frequent assessments of the patient’s clinical status, including respiratory status, vital signs, and neurological status.
• Monitor for any signs of respiratory distress, deterioration, or complications, such as pneumonia or acute respiratory distress syndrome (ARDS).
• Document and communicate findings accurately to the healthcare team to facilitate appropriate interventions and decision-making.
• Use standardized assessment tools and scoring systems as appropriate to track changes in patient conditions over time.

Psychological Care

• Provide emotional support and reassurance to patients and families experiencing anxiety or distress.
• Encourage open communication and active listening to address concerns and fears related to the illness.
• Offer psychological interventions such as relaxation techniques, mindfulness exercises, or counseling referrals as needed.
• Collaborate with interdisciplinary team members, including social workers or psychologists, to address psychosocial needs effectively.

Hygiene

• Promote adherence to hand hygiene practices among healthcare staff, patients, and visitors.
• Provide education on proper handwashing technique and the use of hand sanitizer.
• Ensure the availability of hand hygiene supplies at all points of care.
• Monitor and reinforce compliance with hygiene protocols through regular audits and feedback.

Nutrition

• Assess the patient’s nutritional status and dietary intake regularly.
• Provide nutritional counseling and support to ensure adequate calorie and protein intake to promote quick healing.
• Offer small, frequent meals and snacks to maintain energy levels and prevent malnutrition.
• Collaborate with dietitians or nutritionists to develop individualized meal plans and address any dietary restrictions or preferences.

Elimination

• Monitor urinary output and bowel function regularly.
• Encourage adequate fluid intake to maintain hydration and promote urinary output.
• Assist patients with toileting needs and provide appropriate hygiene care.
• Implement measures to prevent urinary retention or constipation, such as regular toileting schedules and mobility promotion.

Medication

• Administer prescribed medications accurately and timely, ensuring adherence to dosing schedules.
• Monitor for potential drug interactions or adverse effects of medications.
• Educate patients about the purpose, dosage, and side effects of prescribed medications.
• Document medication administration and response to treatment in the patient’s medical record.

Advice at Discharge

• Provide education and support to patients and families facing social or economic disadvantages.
• Assist with access to community resources such as social services, financial assistance programs, or support groups.
• Advocate for patients’ needs and rights within the healthcare system.
• Collaborate with case managers or social workers to address barriers to care and promote health equity.