Army Action Plan: Standard Operating Procedures for Severe Acute Respiratory Syndrome

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Army Action Plan: Standard Operating Procedures for Severe Acute Respiratory Syndrome at the detainee Hospital at Guantanamo Bay

Doc_type: 
Non-legal Memo
Doc_date: 
Tuesday, April 29, 2003
Doc_rel_date: 
Tuesday, November 29, 2005
Doc_text: 

Severe Acute Respiratory Syndrome (SARS) SOP: 042 Pap I .f
NH G1110 AND DETAINEE HOSPITAL SOP NO: 942GUAN'TANANO BAY, CUBA.

Tide: Severe Acute Respiratory Syndrome (SARS)
Page I of 6 Effective Date: 29 Apr 93 SCOPE: Norval Respites! GTMO and the Detentioa Hospital
EOGII.(I) jrno://vmw.cdc.uovincidod/ssorrofectioncbord.hun
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(4)IdliramustramagidigamograbourjuM(5)www.cdc,govincidodbarsi
(6) ingEt&twasgtvinsidegaiuduaribboim
I.
BACKGROUND:
... SARS or Severe Acute Respiratory Syndrome is an emerging respiratory infection that was first described in Asia. This is a novel infection among humans, whidi is caused by a previously unrecognized commit's. Infection may occur in all age groups and ma; cases have occurred equally in nodes and females to dale. Symptoms include high fevers
( 100.4F), headache, malaise, end body aches; these $) .h MRS
ms amulet distinguis mid
ftom odier viral infections. After 2-7 dsys, some patients may develop a dry cough dyspnea and hypoxaniL The incubation period from infection to the development of
symptoms is 2-10 days.
IL PURPOSE:
Although no cases have been isolated in Cuba to elate, a high awareness of this infectiousdisease is necessary given its rapid global spread. This SOP serves to increase awareness of this infection disease and to set forth a protocol for isolation and evaluation of a
suspected case of SARS.

Styes Acute Rapiratery Syndrome (SARS) .
SOP: 042 Pigs 2 of
11. PROCEDURES:
A. Mineral Information:
1.
All suspected cases of SARS will be immediately isolated in his/her own mom snd the hadtheare staff will take the appropriate preesudons outlbied below to prevent the spread of this viral infection.
2.
The chain of command will be immediately briefed on any suspected
• PM •
3.
The Wand medicine and infectious diseases specialist should beconsulted on any suspected case of MRS.
4. Preventive Medicine should be contacted regarding Impeded cases for
public health msnagement of contacts.
B. Case Definition:
t..
The CDC cue definition for a suspected case:
a.
Temperature100.4F or 311Cand

b.
Respiratoty illness (cough, SOB, hypoxia, and/or CXR

findings)
and

c. Travel within 10 days of onset of syMpioms to an area• withdocumented or suspected community transmission of SARS or
close contact within 10 days of onset of symptoms with a SARS case. Note: Travel to an affected area includes transit in an
airport
•SARS has occurred in the Peoples' Republic of Chins (China andHong Kong); Hanoi, Vietnam; Singapore; and Toronto.
2. The CDC case definition fora probable case:
Radiographic evidence of pneumonia ci respiratory distress
syndrome
b. Autopsy findings consistent with respiratory distress syndromewithout an identifiable cause.
C. Mignon::
I..Patients with respiratory symptoms and the above criteria should be
evaluated for SARS.
0051.i/8

Severe Acute Respiratory Syndrome (SARB) .
SOP: 042 Pap 3 off
2. Initial diagnostic testing should Include pulse oximetry. chest radiograph (may show patchy interstitial infiltrates), blood cultures, sputum Ono* stain and culture. An ABO should be considered with a
pulse =inlet, of 95%.
3.
Basic labanarey values should be obtained including a cbc with a diffaential, chem. 7, liver function tests and CK. Blood counts mayMeld normal at decreased white blood count and platelet count. Some
Patients have developed elevated CK levels and tramardnises.
4.
Tem for viral reseitasoty pathogens such as influenza A and B and respiratory syncytial virus should be obtained. A specimen (urine) forLegit:India and pneumococcal should mho be considered.
S. Ile Rename of.this new coronavirus has re:ondy been sequenced
• making &gas& testing feasible. Middies should save any availableclinical specimens (respinnoey, serum, whole blood, and stool) foradditional testing until a specific diagnosis is made.
6.
Inpsdeots should have nssopheryngeid swab. lower respiratory sample(BAL•'pleural fluid, tracheal aspirate), whole blood, sem, and stool sent for evaluation in 'Inspected came Ouqratiamt should have the same amtples collected excluding the lower respiratory sample.Autopsy specimens may the be submitted.
7.
-Acute and conadacent (greater than 21 days afar onset of symptoms) serum samples should be collected from each patient who meets theSARS case definition. Paired sera and other clinical IPOCIIIMIS can beforwarded through Sate mid local health departments for teeing at
CDC or thready to the Naval.Research Center in San .la(p)
D. Protection:
1. The exact route of transmission has not been confirmed; infection isMately spread by airborne droplets, however. contact transmission has
not been excluded.
2.. Stupected cases in the clinic or ED should be identified early andimmediately provided with a surgical mask to cover the patient's mouthand nose. He.she should be smarmed horn other patients into a
motive praisure or gime room.
3..
Health care providers are advised to use standard precautions (hand hygiene) as well as airborne precautions using a N-95 respirator (allpersonnel must have a qualitative fit test) and contact precautions with
gowns and gloves, Eye protection should also be worn for patient
0051u9
NOV00267
Severe Acute Respiratory Syndrome (SARS) SOP: 042
• Page406
contact Patients should be isolated in a negative pressure room: if thisis not possible, a private room is advisable.
4. Cases should avoid interactions outside their hospital room (inpatients) or home (outpatients) and not go to work, school, or other public Irma until 10 doge after symptom resolution. The duration of infectivity hasnot yd been defined; therefore, precautions are advised for 10 days afterreminder), symptoms and fever have resolved.
S. Health care workers vitro have unprotected exposes to a EARS patient should watch for feversfrespiratory symptoms for 10 days after exposure. An mom= should be reported to Panintive Medicine.
6.
Exposed and syalpsoindia hatithcws workers with fever or aspiratory

syrnptoms should tisk medical atinstion and should not go to work.

7.
Exposed hatithcom workers who remain asymptormdic om per

..
their norms! work..
8.
Reconenendstione may dense with nether data concerning the
etiologic Ogees and its trannniesion: check the CDC website for the
mcww404ftWftmadom
9. Further guidelines are located on the CDC vabsite.
a. "basin: domestic guide= for Milleganent of exposures to
EARS for hatitb:are and other institutional settings" atbilliftedmighggyarjdollantsg maggiashowsin
b.
"Interim guidance on infection control precautions for patientssuspected EARS end dose contacts in households" at bgplIwww.cdc.govineidocVewsfic-closecn•orrm hug

c.
"Updated interim domestic infection cordrol guidance in the healthcare and oonummity setting far patients with suspectedEARS" at laglAvww.cdc.govincidocl/sesfintketioncontrol.hug

d.
"Information for close contact of MRS patients" at:bripJ/www.odc.eovhucidod/san/factsl

E. Treatment
No specific treatment is currently available. Some patients have been treated with antiviral agents and/or steroids, but the benefits of such
tbeespies cwrentiy unknown.
2.
Until a bacterialcease of the infection is excluded, broad-spectrumantibiotics we recommended for those with pneumonia to cover conummity-ecquired pneumonia as well as atypical organism Examples of witibioties include Cethiaxone 2 grams iv qd and levaquin
500 rng 1V/po qd OR Ceftriaxone 2 grams iv qd and Axithromycin 500
me.Po gi
3.
Internal Medicine and infectious diseases consultation is recommended.
F. Prognosis:
005110

Severe Aerie Respiratory Syndrome (BARS) SOP: 042 Page S of 6
1.
The severity of illness is variable rasing flom a mild viral illnessto death.

2.
To date. the case frailty rate is 3.5% with most deaths attributed to respiratory failure.

G. Case Reportinip
I. AU care should be reported to the chitin of command, Preventive Medicine and to the IMIID specialist.
2.
State or local health departments in the U.S.. an be notified for U.S. cases (not !pliable)

3.
CDC at 770-4811-7100

00S1.1.1
Severs Ante Respirsem Syndrome (BARS) SOP: 1142 Paged off
STANDARD OPERATING PROCEDURES 011101131111230 Bay, Cvls REVIEWED ANDAPPROVED BY:
Officer In Charge Dda
IMPLEMENTED BY:
Director for Administration • Date
Senior Enlisted Advisor Dale
ANNUAL REVIEW LOG:
By: Date:
By: By: Date: Date:
By Dale:
By: Data
By Date:
SOP REVISION LOG:
Revision to Page: Dale:
Revision to Page: Doe:
Revision to Paw Date:
Revision to Page:Revision to Page Dale: Date:
Revision to Page: Date:
ENTIRE SOP SUPERSEDED BY:
Title:
SOP NO: Date:

0051_12
NOV00270
DODDON-000672

Doc_nid: 
2917
Doc_type_num: 
63