Introduction:
The global outbreak of severe acute respiratory syndrome (SARS) started in March 2003. It is an airborne virus that can spread through small droplets of saliva. It can even spread indirectly through surfaces that have been touched by an infected person. There are different treatment modalities to reduce the spread of SARS. It includes behavior change, non-pharmaceutical interventions such as wearing masks, distancing, and ventilators, and pharmaceutical interventions such as antiviral agents, immunosuppressive agents, and the use of non-invasive positive pressure ventilation. The World Health Organisation and global outbreak alert and response network-initiated steps to combat SARS.
What Are the Signs and Symptoms of SARS?
It usually begins with a high fever of more than 100. 4 degrees F (Fahrenheit) and may have one of the following symptoms such as headache, sore throat, difficulty in breathing, low oxygen supply, cough, pneumonia, and diarrhea.
What Are the Management Measures for SARS?
Healthcare workers took measures to manage SARS by closure of hospitals, triage screening, and hospital visitor restrictions.
Interventions to reduce the spread of SARS
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Behavior changes.
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Non-pharmaceutical response.
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Pharmaceutical response.
Behavior Change to Reduce SARS
Changing human behavior is important to prevent transmission of SARS in the absence of pharmaceutical intervention. The virus is transmitted in communities through air from an infected person’s airways or surface contaminated by the virus that is touched by the recipient who then touches the mouth or nose. The primary route for viruses to cause infection is the mouth or nose. This virus then enters cells of mucous membranes and lung epithelial cells.
In order to block the transmission of the virus, governments have mainly used to keep the infected person isolated from others and to follow social distancing. These two measures are effective in reducing the spread of viruses. The other measures to control the spread of the virus is that an infected person should cough or sneeze in a tissue and that should be immediately disposed of so that further contamination does not cause contamination. The direct transmission of the virus through inhaled droplets can be avoided by physical distancing. The physical distance is around two meters. The virus can be controlled by washing hands with soap or hand sanitizer frequently and disinfecting objects and surfaces. The virus can survive on some surfaces for several days, so disinfecting is essential. Interventions to bring behavioral changes to reduce the transmission of viruses include education, persuasion, incentivization, training, and environmental reconstruction. Education and training are essential to all healthcare workers for infection control to avoid the risk of SARS infection. Education leads to positive behavioral changes in healthcare workers for infection control. Healthcare workers face anxiety, stress, fear of infection, financial loss, etc. Positive impacts on healthcare workers have increased awareness of infection control and learning experiences.
What Are the Non-pharmaceutical Interventions for SARS?
The following are the non-pharmaceutical interventions:
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Masks.
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Distancing and ventilation.
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Vaccines.
1. Masks:
Masks reduce the transmission of viruses. The release of virions in the air by the infected person can be blocked by wearing masks that will reduce the transmission of disease. In 2020, public health recommendations to the public to wear masks have helped in reducing the transmission of viruses. High-quality surgical masks provide better efficacy in controlling the virus. Standardization of recommendations for surgical masks that use electrostatic-based filtration should be used preferably.
2. Distancing and Ventilation:
RNA (ribonucleic acid) concentrations or higher viral inoculum are shown to be higher in SARS at a closer distance. So, the infected person should maintain a distance to control the virus.
Ventilation helps in reducing the viral particles which reduces the transmission of the virus. The non-pharmaceutical interventions by having all human interactions in outdoor spaces and structural changes by having indoor spaces adequate.
The efficacy of non-pharmaceutical interventions is increased when multiple strategies are combined. There is no single strategy to confer the efficacy of 100 percent in preventing SARS transmission.
3. Vaccines:
The high-efficacy vaccines for SARS include Novavax, Johnson and Johnson, Sputnik V, and AstraZeneca. In patients receiving the vaccine, asymptomatic infection could not be ruled out. Therefore, there is a need to adhere to non-pharmaceutical interventions to control the pandemic.
Pharmacological Interventions:
Treatment options like antiviral agents, immunosuppressive agents, covalent plasma, immunoglobulin, and noninvasive positive pressure ventilation (NIPPV) are introduced for different rationales. Initially, SARS has an initial viral replicative phase which peaks at around day 10. When the virus responds, there is an overproduction of cytokines which results in immunopathological damage.
- Antiviral agents:
Ribavirin was chosen due to its broad antiviral spectrum. it was assumed that it could provide coverage for the corticosteroid treatment. The lack of in vitro activity against SARS-coronavirus, ribavirin, has received a lot of criticism. In order to inhibit the virus, very high concentrations of Ribavirin are essential and it is difficult to achieve those levels clinically. There are a number of adverse effects with ribavirin. The most important side effects are anemia, decreased heart rate, raised serum transaminases, and teratogenic potential. The disadvantages of Ribavirin are it has low efficacy and it is toxic too.
- Corticosteroids:
Corticosteroids like Prednisolone at 0.5-1.0g/day (grams per day) are used in treatment when the patient deteriorates clinically in the second week. Methylprednisolone pulses are administered for anecdotal cases of SARS.
The use of corticosteroids for prolonged periods has several side effects such as increased glucose levels, hypertension, hypokalemia, gastrointestinal hemorrhage, and nosocomial infections. It has other complications such as avascular necrosis of bone otherwise known as osteonecrosis.
- Convalescent plasma:
Convalescent plasma is used as a last resort when all other drugs fail to act.
- Immunoglobulin:
Immunoglobulin is the salvage form of therapy. The side effect of immunoglobulin is venous thrombosis.
- Noninvasive positive pressure ventilation (NIPPV):
Noninvasive positive pressure ventilation has a face or nasal mask and ventilatory support to administer continuous positive airway pressure. It is mostly used in patients with respiratory failure.
In case of critical SARS, pulse methylprednisolone 250-500 mg/day (milligram per day) for three to six days is given.
Conclusion:
There is no effective treatment or vaccine against SARS. Public health measures and non-pharmaceutical interventions are vital to reduce the infection and mortality rate and some pharmaceutical interventions for the treatment of SARS.
