Severe Acute Respiratory Syndrome Epidemics Research Articles

Psychological impact on healthcare workers, general population and affected individuals of SARS and COVID-19: A systematic review and meta-analysis.

Any infectious disease outbreak may lead to a negative detrimental psychological impact on individuals and the community at large, however; there was no systematic review nor meta-analysis that examined the relationship between the psychological/mental health impact of SARS and COVID-19 outbreak in Asia. A systematic search was conducted using PubMed, EMBASE, Medline, PsycINFO, and CINAHL databases from 1/1/2000 to 1/6/2020. In this systematic review and meta-analysis, we analyzed the psychological impact on confirmed/suspected cases, healthcare workers and the general public during the Severe Acute Respiratory Syndrome (SARS) outbreak and Coronavirus disease (COVID-19) epidemics. Primary outcomes included prevalence of depression, anxiety, stress, post-traumatic stress disorder, aggression, sleeping problems and psychological symptoms. Twenty-three eligible studies (N = 27,325) were included. Random effect model was used to analyze the data using STATA. Of these studies, 11 were related to the SARS outbreak and 12 related to COVID-19 outbreaks. The overall prevalence rate of anxiety during SARS and COVID-19 was 37.8% (95% CI: 21.1-54.5, P < 0.001, I2 = 96.9%) and 34.8% (95% CI: 29.1-40.4), respectively. For depression, the overall prevalence rate during SARS and COVID-19 was 30.9% (95% CI: 18.6-43.1, P < 0.001, I2 = 97.3%) and 32.4% (95% CI: 19.8-45.0, P < 0.001, I2 = 99.8%), respectively. The overall prevalence rate of stress was 9.4% (95% CI: -0.4 -19.2, P = 0.015, I2 = 83.3%) and 54.1% (95% CI: 35.7-72.6, P < 0.001, I2 = 98.8%) during SARS and COVID-19, respectively. The overall prevalence of PTSD was 15.1% (95% CI: 8.2-22.0, P < 0.001) during SARS epidemic, calculated by random-effects model (P < 0.05), with significant between-study heterogeneity (I2 = 93.5%). The SARS and COVID-19 epidemics have brought about high levels of psychological distress to individuals. Psychological interventions and contingent digital mental health platform should be promptly established nationwide for continuous surveillance of the increasing prevalence of negative psychological symptoms. Health policymakers and mental health experts should jointly collaborate to provide timely, contingent mental health treatment and psychological support to those in need to reduce the global disease burden. CRD42020182787, identifier PROSPER.

Progress in mental health research and service provision in China: Lessons learnt from COVID-19 and SARS epidemics

The Novel Coronavirus Disease 2019 (COVID-19 hereafter) was first reported in Wuhan, China at the end of 2019. In 2003, China was also struck by another coronavirus disease, the Severe Acute Respiratory Syndrome (SARS). COVID-19 and SARS have similar routes of transmission and clinical manifestations, although COVID-19 is more contagious and has a longer incubation period. Mental health problems are common during epidemics due to the fear of contagion and psychological consequences of a novel and highly infectious disease.

Comparison of spatiotemporal characteristics of the COVID-19 and SARS outbreaks in mainland China

BackgroundBoth coronavirus disease 2019 (COVID-19) and severe acute respiratory syndrome (SARS) are caused by coronaviruses and have infected people in China and worldwide. We aimed to investigate whether COVID-19 and SARS exhibited similar spatial and temporal features at provincial level in mainland China.MethodsThe number of people infected by COVID-19 and SARS were extracted from daily briefings on newly confirmed cases during the epidemics, as of Mar. 4, 2020 and Aug. 3, 2003, respectively. We depicted spatiotemporal patterns of the COVID-19 and SARS epidemics using spatial statistics such as Moran’s I and the local indicators of spatial association (LISA).ResultsCompared to SARS, COVID-19 had a higher overall incidence. We identified 3 clusters (predominantly located in south-central China; the highest RR = 135.08, 95% CI: 128.36–142.08) for COVID-19 and 4 clusters (mainly in Northern China; the highest RR = 423.51, 95% CI: 240.96–722.32) for SARS. Fewer secondary clusters were identified after the “Wuhan lockdown”. The LISA cluster map detected a significantly high-low (Hubei) and low-high spatial clustering (Anhui, Hunan, and Jiangxi, in Central China) for COVID-19. Two significant high-high (Beijing and Tianjin) and low-high (Hebei) clusters were detected for SARS.ConclusionsCOVID-19 and SARS outbreaks exhibited distinct spatiotemporal clustering patterns at the provincial levels in mainland China, which may be attributable to changes in social and demographic factors, local government containment strategies or differences in transmission mechanisms.

Engineering control of respiratory infection and low-energy design of healthcare facilities

Indoor microorganisms and infection have become an emerging direction in indoor air quality research science. Airborne droplet nuclei can serve as carriers of respiratory infectious diseases. The study of expiratory droplets and their exposure control has received particular attention since the 2003 severe acute respiratory syndrome epidemics and the 2009 influenza pandemics. Little is known about how effective the commonly used indoor environment control strategies are for infection control. Significant questions also exist on the ventilation requirements for airborne infection control. There is a broad range of relevant important issues, including the exposure risk, and effective control methods in various indoor settings, such as hospitals, homes, schools, and offices. What is known is that the minimum required ventilation rate for infection control in hospitals can be much higher than the general health and comfort requirement in homes and offices. This has resulted in significant energy-efficiency issues in healthcare facilities. This review considers the current knowledge on airborne transmission of infection and the potential implications of a move to low-energy design, particularly in hospitals, on the risk of infection. The review outlines active research and development on reducing hospital energy use while improving infection control and discusses the potential for conducting “clinical trials” to gain the necessary evidence to support changes in hospital ventilation design.

Ventilation Control of Indoor Transmission of Airborne Diseases in an Urban Community

Following the recent severe acute respiratory syndrome epidemics and worldwide concern about the next pandemic, whether influenza or multiple drug resistant tuberculosis, has underlined the importance of effective interventions into airborne disease transmission in indoor environments in a community. The engineering control measures available include ventilation dilution, use of high-efficiency particulate air filters in a room or in the heating, ventilation, and air-conditioning (HVAC) system, and use of ultraviolet germicidal irradiation devices in ceiling area of a room or in the HVAC system. These methods are known to be effective in controlling or delaying airborne disease transmission in a single enclosure in both healthcare facilities and the community. However, there have been no studies of their relative effectiveness at the community level. This paper presents mathematical modeling of some engineering control strategies with a focus on ventilation and corresponding analysis of their relative effectiveness compared with other public health interventions in disease control in indoor environments at the community level. The results should help us to determine the most effective intervention strategies. We conclude that the engineering intervention methods such as building ventilation can be as effective as public health interventions and the ventilation rates specified in the existing standards such as ASHRAE 62 may be too low for the purpose of preventing or controlling airborne infectious diseases in indoor environments.

Pandemic planning in China: Applying lessons from severe acute respiratory syndrome

There were three events of severe acute respiratory syndrome (SARS) in China from 2003 to 2004. Starting from 2002, we are also aware of the increasing alert of an avian flu pandemic. Epidemics of SARS and avian flu have posed huge threats to social stability, economic prosperity and human health in this country. What we have experienced during SARS outbreaks has great implications for the protection of people against a resurgence of SARS and potential attacks of high-pathogenic avian flu viruses. To that end, China has been preparing to contain future pandemics by applying lessons learnt from SARS.

Changes in attitudes toward wildlife and wildlife meats in Hunan Province, central China, before and after the severe acute respiratory syndrome outbreak

Two surveys of opinions about wildlife conservation were carried out in Hunan Province, China, before and after the severe acute respiratory syndrome (SARS) epidemic. Hunan is the northern neighbor of Guangdong Province, where the first SARS case was reported. The custom of consuming wild meat was not common in Hunan 30 years ago. However, in recent years, consumption of wildlife such as snakes has spread to northern China. We handed out 1300 questionnaires between 22 February and 10 May 2002, before the SARS epidemic. Survey sites included the provincial capital, major cities, towns, and villages in Hunan. Another 1300 questionnaires were distributed between 10 March and 10 May 2004, after the SARS epidemic. The 2004 survey covered the same sites as the 2002 survey. Questionnaire recovery rates for the 2002 and 2004 surveys were 81.2% and 84.6%, respectively. The valid return rate was 73.0%. Frog, snake, hare, and pheasant were the wild meats most frequently eaten by local people. At the time of the first survey, more than 80% of interviewees claimed to have eaten frogs. That number had reduced to 60% by the time of the second survey. Monkey, Chinese pangolin, and bear paw were the wild meats least frequently eaten. Although palm civet was suspected to be the carrier of SARS, it was interesting to note that, after the SARS epidemic, the proportion of people surveyed who ate palm civets had declined only slightly. The results of the surveys indicate a low level of conservation consciousness; however, after the SARS and bird flu epidemics, there were obvious changes in the conservation consciousness of people in Hunan Province. We recommend some measures that could be taken to change the habits of people who consume wildlife.

Molecular mechanisms of severe acute respiratory syndrome (SARS)

Severe acute respiratory syndrome (SARS) is a new infectious disease caused by a novel coronavirus that leads to deleterious pulmonary pathological features. Due to its high morbidity and mortality and widespread occurrence, SARS has evolved as an important respiratory disease which may be encountered everywhere in the world. The virus was identified as the causative agent of SARS due to the efforts of a WHO-led laboratory network. The potential mutability of the SARS-CoV genome may lead to new SARS outbreaks and several regions of the viral genomes open reading frames have been identified which may contribute to the severe virulence of the virus. With regard to the pathogenesis of SARS, several mechanisms involving both direct effects on target cells and indirect effects via the immune system may exist. Vaccination would offer the most attractive approach to prevent new epidemics of SARS, but the development of vaccines is difficult due to missing data on the role of immune system-virus interactions and the potential mutability of the virus. Even in a situation of no new infections, SARS remains a major health hazard, as new epidemics may arise. Therefore, further experimental and clinical research is required to control the disease.

Universal SARS preventive measures in an obstetrics unit: Experience of health care staff

BackgroundSevere acute respiratory syndrome (SARS) epidemics have affected populations in many countries, including Hong Kong. This disease is infectious, especially in hospital settings. Health care workers have expressed great concern, including those working in obstetrics wards, defined as high-risk areas.MethodFour weeks after implementation of universal precautionary measures at a teaching hospital in Hong Kong, a survey of the health care staff was conducted to identify their feelings and opinions.ResultsIn spite of general knowledge about SARS epidemics and related mortality, most respondents stated that universal precautionary measures were not very necessary, especially in the obstetrics ward. In addition, respondents were generally dissatisfied with the measures, as most items imposed extra work, inconvenience, and burdens on the staff.ConclusionOur findings reported the views and satisfaction levels of the front-line staff of an obstetric unit concerning precautionary measures against SARS. The importance of individualized design and implementation of infection control measures is highlighted and discussed.

Predicting super spreading events during the 2003 severe acute respiratory syndrome epidemics in Hong Kong and Singapore.

One of the intriguing characteristics of the 2003 severe acute respiratory syndrome (SARS) epidemics was the occurrence of super spreading events (SSEs). Here, the authors report the results of identifying the occurrence of SSEs in the Hong Kong and Singapore epidemics using mathematical and statistical analysis. Their predicted occurrence of SSEs agreed well with the reported occurrence of all seven super spreaders in the two cities. Additional unidentified SSEs were also found to exist. It was found that 71.1% and 74.8% of the infections were attributable to SSEs in Hong Kong and Singapore, respectively. There also seemed to be “synchronized” occurrences of infection peaks in both the community and the hospitals in Hong Kong. The results strongly suggested that the infection did not depend on the total number of symptomatic cases, with only a very small proportion of symptomatic individuals being shown to be infectious (i.e., able to infect other individuals). The authors found that the daily infection rate did not correlate with the daily total number of symptomatic cases but with the daily number of symptomatic cases who were not admitted to a hospital within 4 days of the onset of symptoms.