SARS

Definition
Severe acute respiratory syndrome (SARS) — a contagious and sometimes fatal
respiratory illness — first appeared in China in November 2002. Within six weeks,
SARS had spread worldwide, carried around the globe by unsuspecting travelers.
Eventually, 8,000 people were infected and 800 died of the disease.

The rapid and unexpected spread of SARS alarmed both health officials and the
public. SARS — the first newly emerged, serious and contagious illness of the 21st
century — illustrated just how quickly infection can spread in a highly mobile and
interconnected world. On the other hand, concerted international cooperation allowed
health experts to contain SARS just months after its emergence. What's more,
scientists now believe that some cases originally diagnosed as SARS may actually
have been avian influenza (bird flu), potentially a far more deadly disease.

Symptoms
SARS begins with a fever — a temperature of 100.4 F (38.0 C) or higher — that
usually occurs two to seven days after you've been infected, although it may not
appear for up to 10 days. Chills, muscle soreness, headache and a general feeling of
discomfort also are common. Two to seven days after the initial signs and symptoms,
you're likely to develop a dry cough. In some people, SARS may progress to severe
pneumonia, leading to an insufficient amount of oxygen in the blood (hypoxemia).

You're probably most contagious while you have active signs and symptoms. As a
precaution, the Centers for Disease Control and Prevention (CDC) recommends that
people who have recovered from SARS avoid going out in public for 10 days after
symptoms go away.

Causes
SARS is caused by a new strain of coronavirus, the same family of viruses that cause
the common cold. Until now, these viruses have never been particularly virulent in
humans, although they can cause severe disease in animals. For that reason, scientists
originally thought that the SARS virus might have crossed from animals to humans. It
now seems likely, however, that it evolved from one or more animal viruses into a
completely new strain.

How SARS spreads

Most respiratory illnesses, including SARS, spread through droplets that enter the air
when someone with the disease coughs, sneezes or talks. This type of transmission
can occur in two ways:
  Droplets. In droplet transmission, the infected particles are large and can
travel only about three feet. To inhale them, you must be face to face with
someone who's sick.
 Airborne particles. Because airborne particles are much smaller than
droplets, they travel farther and linger longer in the air. As a result, you can
become infected even after the person who coughed or sneezed has left the
room.

Most experts think SARS spreads mainly through face-to-face contact, but the virus
also may be spread on contaminated objects, including doorknobs, telephones and
elevator buttons.

Risk factors
In general, people at greatest risk of SARS have had direct, close contact with
someone who's infected, such as a roommate or family member. Doctors and hospital
workers who treated people with SARS before the disease was identified were some
of the first SARS casualties.

Researchers also have identified a variation in an immune system gene that may make
people with the variation much more vulnerable to the SARS virus. The genetic
variation is common among people of Southeast Asian descent but is rare in other
populations. This may help explain why most SARS cases have occurred in China and
Southeast Asia.

Tests and diagnosis

When SARS first surfaced, no specific tests were available to help doctors diagnose
the disease. Now several laboratory tests can help detect the virus, although all have
some limitations. These tests include:

 DNA test (reverse transcription polymerase chain reaction test). Using

secretions from your nose or a blood or stool sample, scientists look for the
DNA of a suspected pathogen.
 Blood test (serologic test). This checks a sample of your blood for the
presence of antibodies to SARS-associated coronavirus. Antibodies are
substances that your immune system produces to fight a specific infection.
 Virus test (viral culture). In this test, a small sample of tissue or fluid is
placed on a special medium (culture) that's incubated for a period of time and
then checked for the presence of the SARS virus.

Complications
Between 10 percent and 20 percent of people with SARS become progressively worse
and develop breathing problems so severe that they need the help of a mechanical
respirator. SARS is fatal in some cases, often due to respiratory failure. Other possible
complications include heart and liver failure.
Treatments and drugs
In spite of a concerted global effort, scientists have yet to find an effective treatment
for SARS. A combination of antiviral drugs normally used to treat AIDS — lopinavir-
ritonavir along with ribavirin — has been shown in clinical studies to prevent serious
complications and deaths from SARS. However, further testing is needed.

Prevention
Researchers are working on several types of vaccines for SARS, but until an effective
vaccine is developed, the World Health Organization (WHO) and the CDC have
established a number of guidelines aimed at stopping transmission of the disease.

Protecting yourself
If you're caring for someone at home with SARS, these measures can help you stay
healthy:

 Wash your hands frequently with soap and hot water or use an alcohol-based
hand rub containing at least 60 percent alcohol.
 Instead of touching your face with your hands, use a disposable tissue to rub
your eyes or nose.
 Wear disposable gloves if you have contact with the patient's body fluids or
feces. Throw the gloves away immediately after use and wash your hands
thoroughly.
 Wear a surgical mask when you're in the same room as a person with SARS.
Wearing glasses also may offer some protection.
 Use soap and hot water to wash the utensils, towels, bedding and clothing of
someone with SARS. Don't use these items yourself until they're clean.
 Use a household disinfectant to clean any surfaces that may have been
contaminated with sweat, saliva, mucus, vomit, stool or urine. Wear
disposable gloves while you clean and throw the gloves away when you're
done.
 Follow all precautions for at least 10 days after the person's signs and
symptoms have disappeared.
 Keep children home from school if they develop a fever or respiratory
symptoms within 10 days of being exposed to someone with SARS. They can
return to school if symptoms go away after three days.

Protecting others
If you've been diagnosed with SARS, the following measures can help prevent the
infection from spreading:

 Wash your hands carefully and frequently with soap and hot water or an
alcohol-based hand rub containing at least 60 percent alcohol.
 Cover your mouth and nose with a tissue when you cough or sneeze, and if
possible, wear a surgical mask when you're in close contact with other people.
 Don't share your silverware, towels or bedding with anyone in your home until
these items have been thoroughly washed with soap and hot water.
  Avoid going to school, work or other public places for 10 days after your signs
and symptoms disappear.

Traveling safely
Consider taking the following measures to help reduce your risk of SARS when
traveling:

 Buy or assemble a basic first-aid kit. Make sure the kit includes an alcohol-
based hand cleanser.
 Inform yourself. Learn as much as you can about the SARS status of the
countries you'll visit. You can find the latest information about SARS on the
WHO and CDC Web sites.
 Make sure you're current on all of your immunizations. It's best to have
any needed shots four to six weeks before your departure.
 Check your travel insurance. You may want to purchase coverage for
medical evacuation if you're traveling to a country that's having a SARS or
other infectious disease outbreak.
 Know where medical care will be available in the areas you visit. Take
with you a list of the names, addresses and phone numbers of recommended
doctors and hospitals at your destinations. Your doctor or local or state
medical society, the International Association for Medical Assistance to
Travellers or the U.S. State Department's Overseas Citizens Services can help
provide this information.
 Avoid "live" markets. In China, avoid visiting live food markets. Civet cats
sold in these markets have been found to carry viruses similar to the SARS
virus.

In transit
Some experts believe that infections spread on airplanes through the air vents located
directly above your seat. It's best to turn these vents off and to carry disposable
towelettes so that you can clean your hands frequently during the flight.