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SARS - June 2003
By Brian L Tiep, MD
Respiratory Disease Management Institute, Pomona, CA

Definition and epidemiology

SARS stands for Severe Acute Respiratory Syndrome. The title of this article includes a date, which emphasizes the newness of this disease and that our understanding of it is rapidly evolving. SARS was first identified in Hong Kong and Mainland China with the first cases probably occurring in November 2002. In March 2003, the World Health Organization (WHO) issued a warning about a flu-like illness that progresses to severe shortness of breath and pneumonia. Several people died but most recovered. SARS is highly contagious and some of its victims included medical personnel who treated these patients.


Symptoms of SARS

SARS begins with a fever greater than 100.4°F. It also includes headache, muscle aches and pains, generalized weakness and mild respiratory symptoms initially. Some people have had diarrhea. After 2 to 7 days, they may develop a dry cough and become short of breath; it may progress to pneumonia. Those with severe cases may require mechanical ventilation.


SARS Worldwide

From November 2002 to June 5 2003, there have been 7,478 cases worldwide in 28 countries. 779 people have died bringing the mortality rate to 10.4%. The risk of death appears to be higher if the person has coexisting health conditions including diabetes and COPD. In the USA 379 SARS cases have been identified in 40 states. 311 (82%) of these cases have been classified as suspected SARS and 68 (18%) (in 24 states) were confirmed. There have been no reported deaths from SARS in the USA.

Originally, the SARS virus probably came from animal reservoirs, perhaps around the Guangdong Province of China. People at greatest risk for the development of SARS in the USA have been traveling in epidemic areas of the world. These areas include: China, Hong Kong, Vietnam, Singapore, Taiwan and Toronto, Canada.


Treatment of SARS

There is not yet any specific treatment to kill the infection. SARS is believed to be caused by a corona virus, which is a first cousin to viruses that cause the common cold. No antibiotic, antiviral or protease inhibitor seems to help. Most people get better with generalized supportive care. It is important to begin treatment at the earliest stage of the disease both for the patient, and to prevent spread of the disease.


Preventing the Spread of SARS

Respiratory droplets spread the virus, just as they do for the common cold. Two strategies have been utilized to protect against the spread of infectious and contagious diseases: quarantine and isolation. Quarantine is for people who have been exposed but are not yet ill. Separating exposed individuals from the rest of the public is very effective at preventing the spread of SARS. Generally the patient remains at home with measures in place to protect other members of the family.

Isolation is for patients who already have SARS. Isolation is a stricter measure to protect healthy people including health care workers. People in isolation may be cared for in their homes, in hospitals, or at designated health care facilities. In most cases, isolation is voluntary; however, many levels of government (federal, state, and local) have the basic authority to compel isolation of sick people to protect the public. Those whose illness is mild may be cared for at home with measures to protect other family members. Masks, gloves and good hand washing are essential. Do not share linen or eating utensils. SARS patients are asked to remain isolated until 10 days after the resolution of the fever, provided their respiratory symptoms have also resolved. Other household members must be monitored for the development of SARS.


SARS Research

Fortunately, some of the world's best scientists have been working hard to understand the illness and develop a treatment for it. Some scientists believe that a vaccine is possible, although such a vaccine will be a challenge to develop. Both the CDC and WHO are working "feverishly" to protect against the spread of SARS.


Protecting yourself against SARS.

It is best to avoid travel to infected areas of the world. You and your companions should wash your hands frequently and well. Universal precautions are recommended by the CDC for health care facilities to avoid the spread of SARS. These include hand washing, gloves, masks, gowns, and foot covering. Masks have not been recommended for public areas. If you or someone you know begins to develop SARS symptoms and you have traveled to infected areas, or have been in close contact with a person infected with SARS, seek help immediately! Do not wait! This approach will protect you and others around you.


Best Strategy

At this point, our best advice is to stay informed, live healthy with good nutrition and adequate exercise and practice effective hand washing both at home and when you are out in public. Check the CDC Website for the latest information at www.cdc.gov. Also, you may call the CDC at (888) 246-2675 (English), (888) 246-2857 (Español).

The article appears in PERF's June 2003 Newsletter

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