SARS: New “Deadly” Virus

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What is SARS?

SARS stands for Severe Acute Respiratory Syndrome, an illness suspected to be viral, that has been reported in Asia, North America and Europe. Worldwide, as of May 13, 2003, there have been 7548 cases and 573 deaths. The following are cases by country: China, 5086, 262 deaths; Hong Kong Area, 1686, 225 deaths; Taiwan, 207, 24 deaths; Singapore, 205, 28 deaths; United States, 64, no deaths; Viet Nam 63, 5 deaths; Philippines, 10, 2 deaths. CDC keeps daily updates on these cases. The number of cases and deaths are expected to rise until the virus is definitely identified, containment strategies formulated and implemented, and treatment discovered.

What causes SARS?

That is the million-dollar question on the minds of scientists all over the world, who are still trying to identify the etiologic agent of this mysterious flu-like illness. The Center for Disease Control and Prevention in the United States announced on March 25, 2003 that its scientists “had detected a previously unrecognized coronavirus in 2 patients with SARS.” Coronavirus was found in the nose and throat swabs of these two patients, whose serum test also indicated a recent infection with coronavirus. There are now conclusive proof that coronavirus is the cause of SARS. Studies are ongoing in at least “13 laboratories worldwide pulled together by the World Health Organization in an unprecedented collaboration to hunt down the disease.”

Where did it start?

Experts theorized it could be linked to an earlier outbreak of an unidentified disease in Foshan City, Guangdong Province, China, on November 16, 2002, where 305 people developed the illness and five have died. Hong Kong, who had its SARS patients a little more than a month after Foshan City, is said to be the most seriously affected area, with more than 50% of the cases, followed by Vietnam and Singapore. To avoid exposure, many scheduled visitors to these countries have cancelled their trips.

What are the symptoms of SARS?

Fever greater than 38.0 C (100.4 F) ushers in the illness, sometimes associated with chills, malaise, headache, and body aches. Some patients also had mild breathing difficulty. The initial picture somewhat mimics that of influenza. After 3 to 7 days, the patient may have dry non-productive cough that might be accompanied by more breathing distress. In 10%-20% of cases, the patients may require a ventilator to help them breathe.

How is SARS transmitted?

It appears that the spread is by droplet infection: direct contact with immediate family members, friends, healthcare providers, and others in direct contact with respiratory secretions and body fluids.

What is the Incubation Period?

From the time of exposure to a patient with SARS, the individual may develop the illness between 2 to 7 days, although some isolated reports have indicated an incubation period as long as 10 days. Therefore, those who do not come down with SARS after two weeks of exposure would most likely not develop SARS from that incident.

Is there a test for SARS?

The progress of the collaborative studies on SARS is so dynamic that a definitive test (and possibly treatment) for the illness may, hopefully, be forthcoming soon, or may have been developed by the time you read this article. At the present, CDC and its partners around the world are crafting a new test to look for evidence of coronavirus infection among patients with SARS.

What are coronaviruses?

Coronarviruses are a group of viruses that have a halo or crown-like appearance under the microscope. They are a common cause of mild to moderate upper respiratory tract infection in humans; usually associated with respiratory, gastrointestinal, liver and neurologic disease in animals like cats, dogs, pigs, mice and birds.

Is SARS due to a coronavirus?

At this time, a coronavirus is the major suspect but studies are still underway to ascertain 100% what the etiology of SARS is. It is fundamental to find the real culprit agent in order to develop a strategy of management.

Is it Flu or SARS?

In view of this new illness, it is important for patients to know if the symptoms are due to a bout of influenza or to SARS. While the initial symptoms may be similar, the progression (beyond 3 days) or worsening of fever, malaise, cough, body aches, and the development of breathing difficulty (shortness of breath) makes it prudent for the patient to seek immediate medical attention.

What should recent travelers do?

Those travelers returning home from countries where cases of SARS have been reported should monitor their own health for at least 10 days. If any of those symptoms described above develop, or if in doubt, immediate medical attention should be sought. The physician must be informed of the travel history.

What is the current management for SARS?

Until the final and definitive recommendations are officially adopted and announced by the scientific community, CDC currently suggests that patients with SARS get the same treatment that would be used for any person with serious community acquired atypical pneumonia of unknown cause. This includes antiobiotics, antiviral agents, such as oseltamivir or ribavirin, and steroids. The possibility that coronavirus is the cause of SARS has not changed the treatment recommendations above.

Are there travel restrictions related to SARS?

No, at this time, there are no travel restrictions in place directly related to this illness. However, a CDC travel advisory recommends postponement of any nonessential travel to China (Hong Kong, Guangdong Province) and Hanoi, Vietnam, Canada, Singapore until further notice. Onward travel of healthy passengers on the same plane as a SARS suspect (who would be removed from the plane or boat by port authorities) will be allowed to continue to their destination.

Could SARS be due to a terrorist act?

There is no evidence that SARS could be due to a terrorist act. The obvious mode of spread appears to be to family members and healthcare givers exposed to by direct and close contact with the patient infected with SARS.

Can a SARS suspect refuse isolation?

A person suspected to have SARS on board a plane or a ship, or any public domain, cannot refuse to be isolated and examined for confirmation (or clearance). The governments (Federal, State and local) have basic authority to compel isolation of suspects and persons ill with SARS to protect the general public from a serious epidemic.

©2003Raoul R. Diez, M.A.O.D.