SARS (Severe acute respiratory syndrome)

Severe acute respiratory syndrome (SARS) was an atypical pneumonia that first appeared in
November 2002 in Guangdong Province of the People's Republic of China. The disease is
now known to be caused by the SARS coronavirus (SARS CoV), a novel coronavirus. It can
be spread through both sexual and casual contact.

As the Chinese government suppressed news of the SARS outbreak, the disease spread
rapidly, reaching Hong Kong and Vietnam in late February 2003, and then to more than two
dozen countries in Asia, North America, South America, and Europe via international
travellers before the SARS global outbreak of 2003 was contained. According to the World
Health Organization (WHO), a total of 8098 people worldwide became sick with SARS
during the 2003 outbreak; 774 of these died (a mortality rate of around 10%).

In May 2005 the disease itself was eradicated by the WHO and it became the second disease
in mankind to be eradicated (the other was smallpox).

Clinical information

Symptoms
Initial symptoms are flu-like and may include: fever, lethargy, gastrointestinal symptoms,
cough, sore throat and other non-specific symptoms. The only symptom that is common to all
patients appears to be a fever above 38 °C. Shortness of breath may occur later.

Symptoms usually appear 2–10 days following exposure. In most cases symptoms appear
within 2–3 days. About 10–20% of cases require mechanical ventilation.

Physical signs
Early physical signs are inconclusive and may be absent. Some patients will have tachypnea
and rales on auscultation. Later, tachypnea and lethargy become more prominent.
Investigations
The Chest X-ray (CXR) appearance of SARS is variable. There is no pathognomonic
appearance of SARS but is commonly felt to be abnormal with patchy infiltrates in any part of
the lungs. The initial CXR may be clear. Moreover white blood cell and platelet counts are
often low.

Diagnosis
SARS may be suspected in a patient who has:
1. Any of the symptoms including a fever of 38 °C or more AND
2. Either a history of
a) Contact (sexual or casual) with someone with a diagnosis of SARS within the
last 10 days OR
b) Travel to any of the regions identified by the WHO as areas with recent local
transmission of SARS (affected regions as of 10 May 2003 were parts of
China, Hong Kong, Singapore and the province of Ontario, Canada).

A probable case of SARS has the above findings plus positive chest x-ray findings of atypical
pneumonia or respiratory distress syndrome.

Treatment
Antibiotics are ineffective. Treatment of SARS so far has been largely supportive with
antipyretics, supplemental oxygen and ventilatory support as needed. Suspected cases of
SARS must be isolated, preferably in negative pressure rooms, with full barrier nursing
precautions taken for any necessary contact with these patients. There is some evidence that
some of the more serious damage in SARS is due to the body's own immune system
overreacting to the virus. There may be some benefit from using steroids and other immune
modulating agents in the treatment of the more acute SARS patients.

In December 2004 it was reported that Chinese researchers had produced a SARS vaccine. It
has been tested on a group of 36 volunteers, 24 of whom developed antibodies against the
virus.

Action implemented to restrict the outbreak of SARS

WHO set up a network for doctors and researchers dealing with SARS, consisting of a secure
web site to study chest x-rays and a teleconference.

Attempts were made to control further SARS infection through the use of quarantine. In
Singapore and in Hong Kong, schools were closed to contain the spread of SARS. The WHO
recommended the screening of airline passengers for the symptoms of SARS.

Political and economic reaction

1. On April 1, a European airline laid off a batch of employees owing to a drop in
travellers caused by the September 11 attacks and SARS.
2. Severe customer drop of Chinese cuisine restaurants in Guangdong, Hong Kong and
Chinatowns in North America, 90% decrease in some cases. Business recovered
considerably in some cities after promotion campaigns.
3. In the People's Republic of China, the openness in the later stage of the SARS crisis
showed an unprecedented change in the central government's policies. In the past,
rarely had officials stepped down purely because of administrative mistakes, but the
case was different with SARS, when these mistakes caused international scrutiny.
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