Impact Of Severe Acute Respiratory Syndrome Research Articles

Attenuated replication and damaging effects of SARS-CoV-2 Omicron variants in an intestinal epithelial barrier model.

Many COVID-19 patients suffer from gastrointestinal symptoms and impaired intestinal barrier function is thought to play a key role in Long COVID. Despite its importance, the impact ofsevere acute respiratory syndrome coronavirus 2(SARS-CoV-2) on intestinal epithelia is poorly understood. To address this, we established an intestinal barrier model integrating epithelial Caco-2 cells, mucus-secreting HT29 cells and Raji cells. This gut epithelial model allows efficient differentiation of Caco-2 cells into microfold-like cells, faithfully mimics intestinal barrier function, and is highly permissive to SARS-CoV-2 infection. Early strains of SARS-CoV-2 and the Delta variant replicated with high efficiency, severely disrupted barrier function, and depleted tight junction proteins, such as claudin-1, occludin, and ZO-1. In comparison, Omicron subvariants also depleted ZO-1 from tight junctions but had fewer damaging effects on mucosal integrity and barrier function. Remdesivir, the fusion inhibitor EK1 and the transmembrane serine protease 2 inhibitor Camostat inhibited SARS-CoV-2 replication and thus epithelial barrier damage, while the Cathepsin inhibitor E64d was ineffective. Our results support that SARS-CoV-2 disrupts intestinal barrier function but further suggest that circulating Omicron variants are less damaging than earlier viral strains.

The impact of SARS and COVID-19 on major trauma in Hong Kong.

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has been enormously disruptive and harmful to people around the world, but its impact on other illnesses and injuries has been more variable. To evaluate the ramification of infectious disease outbreaks on major traumatic injuries, we compared changes in the incidence of major trauma cases during the 2003 Severe Acute Respiratory Syndrome (SARS) period with COVID-19 in 2020.MethodsData were analyzed from the trauma registry of a major, tertiary-care teaching hospital in Hong Kong. Patients presenting with major traumatic injuries during the first six months of 2001–03 and 2018–20 were retrieved for analysis. Patient characteristics, injury mechanism, admitting service, and emergency department (ED)/hospital lengths of stay (LOS) were recorded. Raw and adjusted survival rates (using the modified Trauma Injury Severity Score (TRISS)) were recorded.ResultsThe number of trauma cases fell dramatically during 2003 and 2020 compared with previous years. In both 2003 and 2020, the number of trauma registry patients fell by 49% in April (compared to the preceding reference years of 2001/02 and 2018/19, respectively). Patient characteristics, treatments, and outcomes were also different during the outbreak years. Comparing 2003 to 2020 relative to their respective reference baselines, the percentages of injuries that happened at home, patients without co-morbidities, and patients' mean age all increased in 2003 but decreased in 2020. Work-place injuries drastically dropped in 2003, but not in 2020. Average ED LOS dropped in 2003 by 36.4 min (95% CI 12.5, 60.3) but declined by only 14.5 min (95% CI -2.9, 32.1) in 2020. Both observed and expected 30-day mortality declined in 2020 vs. 2003 (observed 4.5% vs. 11.7%, p = 0.001, OR 0.352, 95% CI 0.187, 0.661) (expected 4.5% vs 11.6%, p = 0.002, OR 0.358, 95% CI 0.188, 0.684).ConclusionMajor trauma cases dropped by half during both the peak of the 2003 SARS and 2020 COVID-19 pandemics in Hong Kong, suggesting a trend for future pandemic planning. If similar findings are seen at other trauma centers, proactive personnel and resource allocations away from trauma towards medical emergency systems may be more appropriate for future pandemics.

The sequel to COVID-19: the antithesis to life

The sequel to COVID-19: the antithesis to life

Exploring determinants of acceptance of the pandemic influenza A (H1N1) 2009 vaccination in nurses

This study investigated the anticipated vaccination rate against pandemic human influenza A (H1N1) 2009 in the health care setting. Self-administered questionnaires were used to assess nurses' acceptance of vaccination against seasonal flu and H1N1. They were sent to nurses by post through various nurses' unions before initiation of the vaccination program. Only 13.3% of the respondents planned to receive the H1N1 vaccine, compared with 37.5% for the seasonal influenza vaccine. Vaccination against seasonal influenza in the preceding season strongly predicted the likelihood of H1N1 vaccination. The main reason cited for H1N1 vaccination was self-protection, and reasons for rejecting vaccination included possible side effects, ineffectiveness of the vaccine, and the mild nature of the disease. Personal contact with patients with H1N1 or severe acute respiratory syndrome at work did not significantly increase the likelihood of receiving the H1N1 vaccine. More than 40% of the respondents were undecided at the time of the survey. The promotion of vaccination against seasonal influenza may play a role in improving H1N1 vaccination coverage. Efforts are needed to address concerns about vaccination risk and to incorporate H1N1 vaccination in standard infection control practice with policy support.

Post‐SARS knowledge sharing and professional commitment in the nursing profession

The aim of the present study was to examine the 2003 severe acute respiratory syndrome (SARS) crisis in relation to the degree of knowledge sharing and professional commitment, as perceived by the current nursing staff in Taiwan. The mortality rate for medical personnel during the SARS outbreak in Taiwan, which began in April 2003, was the highest among Asian countries. The SARS crisis severely challenged not only the medical skills of nurses, but also their professional commitment. Survey. This study was conducted between August-December 2005, in Taiwan. Data were collected by structured questionnaire. The questionnaire was distributed by post to 8056 nurses nationwide; 2833 nurses completed and returned the questionnaire for a valid response rate of 39%. The results showed that knowledge sharing correlated positively with professional commitment but negatively with the impact of SARS. Professional commitment negatively correlated with SARS impact (r = -0.074, p < 0.001); however, as knowledge sharing was a controlled variable, the partial correlation between SARS impact and professional commitment was -0.039 with a p-value of 0.045, indicating virtual insignificance. That is, knowledge sharing was an antecedent variable for both SARS impact and professional commitment. This cross-sectional study provides preliminary evidence that knowledge sharing is significantly correlated with impact of SARS and professional commitment of nursing personnel. Hospitals and healthcare services can enhance retention of medical personnel by encouraging knowledge sharing, which enhances professional commitment and alleviates the impact of newly introduced contagious diseases.

Impact of SARS on development of childhood acute lymphoblastic leukaemia

Acute lymphoblastic leukaemia (ALL) is the commonest malignancy in children. The aetiology of childhood ALL is not clear, but it is postulated to be multiple-hit with interaction of genetic and environmental factors. One subtype of ALL, 'Common' ALL, is more common in resource-rich countries. There were studies suggesting population mixing at young age associated with higher incidence of Common ALL.1, 2 There were also reports on exposure of some common infection during infancy protecting children from development of ALL in later age.3 Two local studies in Hong Kong supported the hypothesis of population mixing and the protective effect of early exposure to infection.4, 5 Most of the epidemiological studies were studied in a relatively stable community without significant changes in lifestyle. In the first half of 2003, Hong Kong experienced the worst hit of severe acute respiratory syndrome (SARS) in the world. From 28 February 2003 to 2 June 2003, a total of 1755 patients were diagnosed with SARS with 300 mortalities.6 With the high number of patients infected in the community, the Hong Kong Government had instituted extraordinary measures to prevent the spread of the infection. During that period, classes were suspended and schools were closed for 2 months. After resuming classes, there were strict measures to prevent spread of communicable infections. Schools were required to cleanse and disinfect the facilities daily, and maintain good indoor ventilation. Students were required to wear masks in schools. Body temperature checking was compulsory for all students before going to school. Children with fever or respiratory infections were not allowed to attend schools. The hand-washing campaign was a major public event during the SARS period. Most people avoided going to public areas and group activities were all cancelled. The strict infection control measures lasted for about 6 months.

The Mental Health of Hospital Workers Dealing with Severe Acute Respiratory Syndrome

Background: The aim of this study was to explore the impact of the severe acute respiratory syndrome (SARS) on health care workers in Taiwan. The possible predisposing and perpetuating factors in developing mental symptoms were investigated. Methods: Participantsconsisted of 135 health care workers who had had contact with or took care of patients who were probable or suspected SARS cases, during the SARS outbreak, at a teaching hospital in southern Taiwan. All participants completed questionnaires, including the Chinese Health Questionnaire, Eysenck Personality Questionnaire and Parental Bonding Instrument. Results: Twenty-two participants (17.3%) developed significant mental symptoms, and 105 participants (82.7%) showed no obvious symptoms. The structural equation model showed that maternal care (β = –0.18, p = 0.011) and neuroticism (β = 0.54, p < 10^–6) directly influenced the ability of health care workers to deal with the impact of SARS. Maternal overprotection (β = 0.30, p < 10^–4) had an indirect influence on the ability to cope with the impact of SARS. Conclusion: Both neuroticism and maternal attachment influenced the mental health of health care workers during the SARS epidemic. The results can be a helpful reference for intervention and prevention programs for health care workers facing disasters in the future.

The impact of SARS on China's human resources: implications for the labour market and level of unemployment in the service sector in Beijing, Guangzhou and Shanghai

In this paper, we examine the effects of SARS (Severe Acute Respiratory Syndrome) on China's human resources, its labour-market and its level of employment and unemployment, looking specifically at what was one of its economically most vulnerable points, the hotel industry. The paper hypothesizes that the greatest impact would be on human resources in the service-industries and on particular sub-sectors, such as employment in hotels, located in three main cities in the PRC, in Beijing, Guangzhou and Shanghai, catering to both overseas as well as domestic tourism. It tentatively concludes that the almost dramatic demand and supply ‘shocks’ may have directly affected both the demand for and the supply of labour in the sub-sector, with discernable employment consequences.

Epidemic Modelling using Sars as a Case Study

The recent Severe Acute Respiratory Syndrome (SARS) epidemic has highlighted a new dimension to the risks confronting insurance companies. Conventional approaches to insurance pricing take an almost exclusively retrospective view of future mortality experience, extrapolating past mortality trends into the future. Such an approach fails to take account of mortality shocks such as epidemics, which may arise spontaneously and that are not reflected in past experience. If actuaries are to maintain their position as risk experts in an ever-changing world, it is important for the actuarial profession to adopt a more comprehensive approach to assessing risks that goes beyond past experience. This paper will take a look at the modelling of epidemics, using SARS as a case study, and will examine the potential impact of SARS and similar epidemics on insurance companies.

The impact of SARS on epilepsy: The experience of drug withdrawal in epileptic patients

SummaryBackgroundDuring the 2003 severe acute respiratory syndrome (SARS) outbreak, many patients avoided hospital visit because of fear of infection. Antiepileptic drug (AED) withdrawal is a risk factor for seizure recurrence. Therefore, seizure control during the SARS outbreak is a good model for examining the impact of drug withdrawal in seizure control.MethodsAll seizures experienced by each patient before, during, and after the SARS outbreak periods were registered in each patient's seizure diary. The patients were divided into four groups according to the presence of drug withdrawal as well as seizure attack. In each group, seizures occurring during three different periods were compared. Risk factors for seizure recurrence were also examined.ResultsOf 227 cases, 49 stopped taking medication during the outbreak. Among them, 28 suffered seizure attacks during AED withdrawal. Four cases developed cluster attacks and two cases had status epilepticus after AED withdrawal. AED withdrawal produced a significant increase in seizure frequency. The major risk factors for withdrawal seizures were symptomatic etiologies, polytherapy and non-seizure free before AED withdrawal.ConclusionsThe SARS outbreak adversely affected seizure control because of AED withdrawal. Patients with polytherapy, non-seizure free and symptomatic etiologies were more susceptible to recurrence of seizures after AED withdrawal.

Comments on “the impact of SARS on medical house staff ...”

To the Editor:—We were moved by the honest account by Rambaldini et al.1 of the impact of Severe Acute Respiratory Syndrome (SARS) on medical house staff in the university hospitals in Toronto. As medical educationists faced with the same catastrophic outbreak in Singapore, we identified with the reported struggles and barriers to traditional clinical teaching, and fully agreed with the authors' call for new strategies to deal with future health threats. In line with the authors' suggestion that more creative educational mechanisms be developed, we would like to share our experience with an innovative method employed to teach cardiac auscultation during the SARS crisis in Singapore.2 Clinicians in full personal protective equipment used electronic stethoscopes to record the heart sounds of patients with echocardiographically proven heart disease at the 6 classically taught precordial positions for cardiac examination. Cardiologists validated the sounds, which were then used to teach students in simulated “bedside” sessions. Students took turns to act as “patient” and “auscultator.” While the auscultator simulated the clinical examination routine on his/her “patient,” the soundtrack corresponding to each area of auscultation was played through the stethoscope earpieces. Students thus learned to examine real people while picking up real auscultatory signs, a process similar to actual patient encounters. Peer-to-peer teaching helped to overcome the shortage of teaching staff. Soundtracks could be downloaded, stored, “beamed” from one stethoscope to another, and reused to teach large groups of students, thus maximizing the limited clinical material available. Objective outcome measures and subjective feedback proved that the method was effective and well-received by the students. Since then, we have applied this simulated learning method in retraining doctors in basic skill competency during continuing medical education.3 Although this new teaching method was developed in response to the SARS crisis, we have seen that there are applications in modern everyday medicine as well. With patients becoming less tolerant of multiple examinations, illustrative clinical signs becoming rarer with effective disease prevention strategies, and teaching resources growing increasingly limited, more innovative educational strategies are clearly needed. Rather than waiting for the next public health crisis, we believe that the time to develop and apply these new teaching methods is now. We thus join voices with the authors in urging educationists everywhere to think creatively in developing new teaching methods, and to start doing so without delay.

Epidemics, labour markets and unemployment: the impact of SARS on human resource management in the Hong Kong service sector

This article examines the links between epidemics and their economic consequences, specifically in terms of their impacts on labour markets and jobs. To exemplify the above, we examine the effects of SARS (Severe Acute Respiratory Syndrome) on the Hong Kong economy, its labour market and its level of employment and unemployment. The article hypothesizes that the greatest impact would be on human resource management (HRM) in the service industries and on particular sub-sectors, such as the hotel sector. It concludes that the dramatic demand and supply ‘shocks’ significantly affected both the demand for and the supply of labour in the sector, with discernible HRM consequences.

The Consequences of the SARS Epidemic for China's Employment and Human Resources

Abstract This article deals with the impact of SARS (severe acute respiratory syndrome) on the Chinese employment. We look, first, at the broader economic impact and second, discuss the sectorial and industrial effects and then third, focus specifically on the implications in terms of employment and human resources for the service industries, such as hotels and hospitality. The tentative conclusions of our study point to SARS having a discernable but short-term impact on the tertiary sector, its service industries and their Human Resource Management.

Severe Acute Respiratory Syndrome Preparedness, Management, and Impact

Approximately 21 months have passed since the World Health Organization officially confirmed the severe acute respiratory syndrome (SARS) outbreak. Originating in the southern Chinese province of Guandong, from a putative animal source, the transmission of SARS from an infected physician to other guests at the Hotel Metropol in Hong Kong led to global spread. Eight thousand ninety-six individuals were infected and 774 died.1 Characterizations of the etiologic agent2 along with initial clinical descriptions of the syndrome3,4 were followed by reports of outcomes of affected patients.5 As the outbreak progressed, it became clear that this was largely a healthcare facility–based outbreak, with healthcare workers, patients, and visitors being at risk. The bulk of the evidence, namely the descriptive epidemiology and related observational studies, suggests that droplet spread is the most common form of transmission.6,7 Although airborne transmission has been proposed as a mode of spread, the extent to which this occurred remains controversial.8 Why did SARS not become more widespread in the community? The answer lies in both the characteristics of the SARS coronavirus and the efforts made in the hospital to reduce spread. The SARS coronavirus is not highly transmissible. The relatively low reproductive number (the number of secondary cases generated by an infectious case) contributed to the lack of community-wide spread.9 The fact that the viral load was low initially then increased (rather than being high initially then decreasing, like other respiratory viruses) may have played a role.10 Because the transmissibility of the virus was highest after 5 days of symptoms, isolation of new cases acquired in the hospital was possible with diminished spread. There is empiric evidence to substantiate this, an increase in secondary cases of SARS when time to isolation with respect to onset of symptoms lasts beyond 5 days.1 Nosocomial spread was also characterized by superspreading events. Although devastating to individuals in hospitals, superspreading where there is high variance in the number of secondary cases that arise, somewhat counterintuitively, is not an efficient strategy for viral epidemic spread.9 Efforts to reduce spread in the hospital undoubtedly prevented transmission and saved lives. It has been estimated that delaying the institution of control measures by 1 week would have nearly tripled the size of the epidemic and would have increased the expected duration of the epidemic by 4 weeks.11 In contrast, the role of mass quarantine in the community has been more controversial, particularly given that it is likely that the numbers quarantined in many jurisdictions were excessive.12 However, at the time of the outbreak, decisions made necessarily needed to be conservative given the incomplete knowledge about aspects of the transmission of SARS, such as the role played by asymptomatically infected individuals. A hard lesson learned from SARS was our lack of preparedness for emerging infectious diseases. In Canada, this was evident through failure to achieve a coordinated response at municipal, provincial, and national levels. This led to the creation of a new national public health agency. Given that hospital transmission was such a key characteristic of the spread of SARS, an important lesson for hospital infection control has been the artificial division between “public health” and “infection control”—infection control is “hospital public health.” In this issue of Infection Control and Hospital Epidemiology, preparedness, management, and the impact of SARS are addressed in three articles. In the first of the three articles, Srinivasan et al.

The impact of SARS on a tertiary care pediatric emergency department

The Greater Toronto Area (GTA) was considered a "hot zone" for severe acute respiratory syndrome (SARS) in 2003. In accordance with mandated city-wide infection control measures, the Hospital for Sick Children (HSC) drastically reduced all services while maintaining a fully operational emergency department. Because of the GTA health service suspensions and the overlap of SARS-like symptoms with many common childhood illnesses, this introduced the potential for a change in the volumes of patients visiting the emergency department of the only regional tertiary care children's hospital. We compared HSC emergency department patient volumes, admission rates and length of stay in the emergency department in the baseline years of 2000-2002 (non-SARS years) with those in 2003 (SARS year). The data from the prior years were modeled as a time series. Using an interrupted time series analysis, we compared the 2003 data for the periods before, during and after the SARS periods with the modeled data for significant differences in the 3 aforementioned outcomes of interest. Compared with the 2000-2002 data, we found no differences in visits, admission rates or length of stay in the pre-SARS period in 2003. There were significant decreases in visits and length of stay (p < 0.001) and increases in admission rates (p < 0.001) during the periods in 2003 when there were new and active cases of SARS in the GTA. All 3 outcomes returned to expected estimates coincident with the absence of SARS cases from September to December 2003. During the SARS outbreak in the GTA, the HSC emergency department experienced significantly reduced volumes of patients with low-acuity complaints. This gives insight into utilization rates of a pediatric emergency department during a time when there was additional perceived risk in using emergency department services and provides a foundation for emergency department preparedness policies for SARS-like public health emergencies.

Impact of a severe acute respiratory syndrome outbreak in the emergency department: an experience in Taiwan

Objectives: To evaluate the impact of a severe acute respiratory syndrome (SARS) outbreak in the emergency department (ED). Methods: Computerised records of all ED visits in January and May 2003...

Impact of SARS on an emergency department in Hong Kong.

To report on the impact of a Severe Acute Respiratory Syndrome (SARS) outbreak on the attendances of a major teaching hospital ED. Two periods were studied. The first was prior to the closure of the ED due to SARS and the second was after re-opening of the ED. Data on attendances, discharge against medical advice, triage categories, trauma and ambulance cases were retrieved from the computer and compared with the data in the same periods in 2002. In the first period, when compared with 2002 there was a significant decrease in the mean daily attendance (397 vs 524), trauma cases (68 vs 111), minor cases (category 4: 283 vs 361, and category 5: 20 vs 43). In the second period, there was a significant decrease in the mean daily attendance (265 vs 545), trauma cases (40 vs 111), minor cases (category 4:181 vs 376, and category 5: 12 vs 45), discharge against medical advice (4 vs 6 daily) and ambulance cases (70 vs 86 daily). Patients requiring immediate care however, remained similar. There was a significant drop in the overall ED attendance, trauma cases and minor cases after the outbreak of SARS. Possible causes include changes in community behaviour, resulting in a lower incidence of trauma and disease and fear of presenting to hospital and contracting SARS.

The Impact of SARS on Childbirth Education

The SARS (Severe Acute Respiratory Syndrome) crisis in Toronto in the spring of 2003 had major consequences for prenatal learners. Classes in hospitals were cancelled; many couples were left without any prenatal education. This paper outlines the decision-making process of one programme that was determined to keep classes open. The impact of SARS on hospital procedures is also described. Childbirth educators are encouraged to prepare for future public health emergencies. Strategies to prepare for conducting childbirth education classes during times of crisis are outlined.

The Impact of SARS on Childbirth Education.

The SARS (Severe Acute Respiratory Syndrome) crisis in Toronto in the spring of 2003 had major consequences for prenatal learners. Classes in hospitals were cancelled; many couples were left without any prenatal education. This paper outlines the decision-making process of one programme that was determined to keep classes open. The impact of SARS on hospital procedures is also described. Childbirth educators are encouraged to prepare for future public health emergencies. Strategies to prepare for conducting childbirth education classes during times of crisis are outlined.

Road to recovery [SARS and effect on the electronics sector

How quickly can the electronics sector expect to get over the effects of SARS? The author investigates the impact of SARS (Severe Acute Respiratory Syndrome) on the global electronics industry with particular emphasis on the electronics sector's Asian manufacturing heartlands, where China, Hong Kong, Singapore and Taiwan are the worst affected countries. He states that the World Bank remains confident that the combination of SARS and the conflict in the Gulf will cause only a temporary blip in East Asia's economic growth rate.