SARS (Severe Acute Respiratory Syndrome) is a relatively new illness that has been reported in Asia, North America, and Europe in recent months. As of March 21, 2003, the majority of patients identified as having SARS have been adults aged 25--70 years who were previously healthy. Few suspected cases of SARS have been reported among children aged <15 years. It is a highly contagious illness that is spread by person-to-person contact (e.g. touching surfaces that have been contaminated with infectious droplet secretions, and then making contact with your eye(s), nose, or mouth). These droplets are emitted by people who cough, sneeze, or blow their noses. Since SARS is a relatively new illness, many of its actions are still a mystery. It also may be possible that SARS spreads through the air or some other unknown method. Although scientists are still not completely sure of the cause of SARS, the most popular hypothesis is that it is caused by the coronavirus. This virus is the common cause of mild to moderate upper-respiratory illness in humans and is associated with respiratory, gastrointestinal, liver and neurologic disease in animals. Scientists have not yet determined why a virus that can cause merely a mild respiratory illness, can also cause something as severe as SARS.

Symptoms and Diagnosis

     The incubation period for SARS is two to seven days. People who have been exposed and infected with the virus, then begin to exhibit symptoms. In its early stages, SARS manifests itself through one or more of the following symptoms: A fever of greater than 100.4 F (>38.0 C), headache, an overall feeling of discomfort, and achiness. Some people may have mild respiratory symptoms. Within a span of two to seven days, a person may start to develop a dry cough and have difficulty breathing. This begins to cause a marked decrease of much needed oxygen getting to the body’s organs and tissues, which, may, in turn, require the person to be put on a ventilator to aid in delivering enough oxygen to the body. Mechanical ventilation has been needed for about 10-20 percent of the cases diagnosed. There has been a broad range of the severity of the manifestation of this disease from person to person, with no potential trends. In other words, a person could come into contact with someone who was fatally sick with SARS, and show only a low grade fever, or not even show any symptoms at all. The fatality rate for people who meet the definition of SARS as provided by the World Health Organization (WHO) is 3%.

      SARS is primarily diagnosed through a variety of tests including a chest X-ray (although evidence may not show up in the beginning stages of the illness), blood cultures, sputum cultures, testing for various viral pathogens, and urine cultures. Several new blood tests have been developed to check for the presence of specific factors that help to pinpoint SARS. These tests should be done initially and again about 21 days after the onset of the symptoms. All specimens collected from patients suspected to have SARS should be forwarded to the CDC (Centers for Disease Control) for confirmation.

Treatment

      Treatment of SARS depends on the severity of the disease. Currently SARS is being treated like other moderate to severe community acquired atypical pneumonia's. There has been no preferred course of action determined specifically for SARS. Many locations are treating SARS patients with a combination of anti-viral and antibiotic drugs, and steroids (to aid in opening up breathing passages).

Protection & Isolation

     SARS is highly contagious and protective measures should be taken to stop the spread of the illness. Hand washing is extremely important for both health care workers and the general public alike. Since SARS is spread through respiratory secretions that may have come into contact with the surfaces of objects, frequent hand washing with anti-bacterial soap or alcohol based hand solutions greatly reduces chances of indirectly spreading the illness. Also do not let soiled hands come into contact with your mouth, eyes, or nasal passages. Surfaces should be frequently scrubbed with anti-bacterial agents (chlorine based), and soiled linens should be properly laundered using hot settings and bleach based detergents. Be faithful in disposing of soiled tissues that may contain respiratory secretions. Disposable gloves should be used when anyone may come into direct contact with contaminated objects and the infected person’s respiratory fluids, and should be properly disposed of after each usage. Other members of the household need not restrict their outside activities unless they develop symptoms of SARS, such as a fever or respiratory illness. Although it is not recommended that the general public wear masks to help prevent the spread of SARS, health care workers who will come into direct contact with patients who have been diagnosed with SARS are required to wear masks, gloves, protective gowns, and eye protection.

     If a person is suspected of having SARS, measures should be taken to protecting others from becoming infected, until the individual arrives at the hospital. They should be encouraged to cover their nose and mouth with a tissue when coughing and sneezing, then discard it immediately while proceeding to cleanse hands. If at all possible, the individual should wear a mask. If the individual cannot wear a mask, all people that come into contact with that person should wear a mask. It is very important that the mask fits properly for maximum safety from exposure. Surgical masks should fit snugly around the mouth and nose. Masks should not be shared between people. They should be discarded at least daily, or when they are moist or soiled. One should remember to wash hands after coming into contact with a soiled mask.

      In the hospital, isolating patients suspected to have SARS is extremely important. Although, it has already been proven that SARS is contagious in those that are actively showing symptoms, it is not known if or how long a person is contagious before symptoms occur. Currently, there is no evidence that shows that asymptomatic individuals are contagious.

     The cases that have been reported in the United States have been reported among those who have traveled internationally (see “Travel and Quarantine” below), or those who have come into close contact of exposed individuals because of living arrangements or when providing unprotected health care. There is currently no evidence that SARS is spreading through the United States.

Exposures to Health Care Workers

      Health care workers have positively been shown to be a positive mode of transmission for SARS within and between health care facilities. If a health care worker comes into direct unprotected contact with someone actively exhibiting SARS, they should be given a 10 day leave from work. They should minimize all person-to-person contact, by staying in their house and isolating themselves as much as possible from others in the house. They should only go outside for emergency purposes. The protection precautions mentioned above should be implemented. They should also be monitored for SARS symptoms in that 10 day period. Once the worker returns to work, should other unprotected exposures occur, the worker need not take another leave. Body temperature checks and interviews regarding symptoms are to be done daily for 10 days by someone from the employee health staff. For those health care workers who have had protected exposure to a SARS patient, they need to monitor themselves for any possible symptoms for 10 days following the exposure.

      If the health care worker begins to show signs of SARS, they should not report to work. They should monitor symptoms for 72 hours. If the symptoms resolve after 72 hours, they are allowed to return to work after cleared with infectious disease and public health personnel. If the illness progresses to meet all SARS criteria, they must remain off work for 10 days AFTER THE FEVER BREAKS. If a fever persists, but the criteria for SARS is not met, they should be monitored for another 72 hours. If, after these 72 hours, the worker does not meet the SARS criteria after a clinical evaluation, then infection control measures can be stopped with the permission of public health personnel.

Travel & Quarantine

      One of the most current issues with the spread of SARS is travel, more specifically international travel (especially those people traveling to and from China; Hong Kong; Taiwan; Singapore; Vietnam; and Toronto, Canada where the highest number of cases have been found, and where people coming into the United States departed from). People traveling internationally are asked to monitor themselves closely for SARS-like symptoms, and seek medical attention should they start to exhibit them. CDC (Centers for Disease Control) Health inspectors are on hand for those people traveling by ship and plane should a case of SARS be suspected (i.e. someone showing symptoms of SARS). If a suspected SARS case is reported on a plane or ship while en route, a Quarantine Inspector will be there to meet the plane or ship, and take the appropriate health precautions to ensure the safety of the people of the United States. If possible, the crew of the airplane or ship will try to relocate the ill passenger or crew member away from others. If the passenger is only passing through a port of entry on his/her way to another destination, port health authorities may refer the passenger to a local health authority for assessment and care. Quarantine inspectors also provide isolation precautions until appropriate medical treatment can be provided or until they are no longer infectious. Should someone resist isolation precautions, inspectors have the authority to involve local, state, and federal government and law enforcement personnel to ensure the safety of the United States citizens.

     People that have been on a plane or ship where a case of SARS has been suspected, should monitor themselves for symptoms, but there are currently no recommendations to stop the travel of those people that have shared a plane or ship with someone who has shown SARS-like symptoms. The CDC is currently developing a way to track travelers who have had a possible exposure to SARS from another passenger, through a 14 day follow-up program to check for symptoms.

What Prevention Measures are Being Taken on a National Level

     “CDC is working closely with WHO and other partners as part of a global collaboration to address the SARS outbreak. For its part in this international effort, CDC has taken the following actions:
• Activated its Emergency Operations Center to provide round-the-clock coordination and response.
• Committed more than 300 infectious disease experts and support staff to work on the SARS response.
• Deployed medical officers, epidemiologists, and other specialists to assist with on-site investigations around the world.
• Provided ongoing assistance to state and local health departments in investigating possible cases of SARS in the United States.
• Issued multiple notices providing guidance on ways to minimize the risk for SARS in health-care facilities, in the household, when traveling, and in other settings.
• Conducted extensive laboratory testing of clinical specimens from SARS patients to identify the cause of the disease.
• Initiated a system for distributing health alert notices to travelers who may have been exposed to cases of SARS.
As always, CDC is committed to communicating regularly and effectively with public health professionals, elected leaders, clinicians, and the general public.” (from the Centers for Disease Control)


             Sources: The Center For Disease Control (CDC) & The World Health Organization (WHO)