High-risk performance Many HCWs became more susceptible to contracting the disease due to their operations and high-risk interactions with SARS patients.
Direct contact by patient Direct contact and resulting transmission of the disease "occurs when there is physical contact between an infected person and a susceptible person". The most plausible cases of transmission through indirect contact are when an HCW or healthy person touches a surface contaminated with droplets from an infected patient's sneeze or cough or inhales those droplets themselves. At the same time, if the droplets come in contact with the healthy person's mouth, eye, or nose, the healthy person also risks becoming ill. Less intentionally but also important, these masks discourage patients and HCWs from putting their fingers or hands in contact with the nose and mouth, which could usually allow bacteria to spread from the hand to these areas. They are also helpful for HCWs to attempt to avoid contamination, as the gowns can be removed and disposed of easily after an operation or interaction with a patient. While seemingly less critical than masks, gowns were worn nearly the same amount by HCWs as masks. HCWs can again, like gowns, easily dispose of and change gloves in order to help improve and maintain good sanitary conditions. Compared to all of the other pieces of equipment, gloves were worn the most often by HCWs who contracted the disease. Because there was no known cure for SARS, the pressure and stress was especially prominent among HCWs. With this challenge came many psychological effects—most notably stress.
Stress was a psychological effect experienced by many HCWs during the outbreak. As a result, HCWs are more prone to actually getting the disease when they encounter certain causes of transmission, like the high-risk performance causes above. These factors collectively allowed the disease to spread much quicker at first, infecting HCWs who knew little about the method of transmission of the disease. They were therefore unable to adequately protect themselves from the disease, and communication surrounding disease treatment and prevention was inhibited by their lack of knowledge.
Inadequate training for HCWs In addition to the POC's release of its set of SARS-specific directives in 2003, there was also training that was to be completed by HCWs planning to deal with and care for SARS patients. This training included video sessions and other lessons equipping HCWs for safe interactions with SARS patients. Unfortunately, not all of this training was done—if at all—before HCWs began to interact with SARS patients. Over a third of HCWs never received any type of formal training, and half of those receiving any formal training received it after they had begun to interact with and care for SARS patients. At the same time, many of the HCWs receiving training received it from another HCW, allowing for the possibility of some error in the training. Aside from this type of training, many HCWs complained that most efforts—which included only posting informational posters in the wards—were inadequate. == Prevention and treatment in the future ==