Severe Acute Respiratory Syndrome
SARS - FAQ
Severe Acute Respiratory Syndrome Projected Cases
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New Links Updated Charts - June 27, 2003
The increase in the total number of cases has flattened out.  Had no intervention taken place to halt the progression of the disease, SARS would probably have infected the majority of the human race within a year and the death toll would have been in the tens of millions.  

One of the factors that enabled SARS to be contained is that virtually everyone who gets the disease became deathly ill.  Our statistical study of the disease showed that the death rate from SARS was much higher than was initially being reported.

As can be seen, by comparing the two charts, death from the virus follows on average about 14 days after the onset of the symptoms of the disease. The spread of SARS was stopped because governments made fighting the spread of the disease a national priority.  The lessons that were learned, we all need to learn.  If not for SARS then for the next outbreak.

 Recently Prof Roy Anderson, of Imperial College London, confirmed that our earler estimate that one in ten people who are infected with the disease will die.
ONE IN 10 AT RISK OF DEATH
Sars death rate running at twice WHO estimate
SARS death rate doubles: expert

The story of the spread of the disease and the people who fought to prevent it from spreading is both a tradegy and a story of about every day heros.  Many of the victims of the disease were doctors and nurses who were exposed to the virus before they knew what they were fighting. 

The atypical pneumonia outbreak is now believed to have started around Nov. 1, 2002 in Guangdong Province, China. The suspected source of the virus is a catlike animal, the masked palm
civet.  The live virus has been found in the saliva and feces of these animals, which were sold in a live animal market in Guangdong Province, China.  Five percent of the first nine hundred victims worked with these animals as food handlers or chefs.

In February 03, it was reported that about 300 cases of atypical pneumonia, with 5 deaths, had occurred in Guangdong province in China.  The magnitude of the danger of the disease was learned after Liu Jianlun, 64, a doctor from Zhongshan University in China's Guangdong province, who had been treating victims in the province traveled to Hong Kong.  Liu was assigned room 911 at Hong Kong's Metropole Hotel.  On Feb. 21, Liu went sightseeing with his brother-in-law.

On the night of Feb. 21, Liu felt ill. He called ahead to the hospital he warned them in advance that he had a communicable disease, and precautions were taken to place him in a pressurized room.  Meanwhile Johnny Chen, an Chinese-American, was staying on the same floor of the hotel as Liu Jianlun. He came to  from Hanoi.
checking himself into the Kwong Wah Hospital, Liu inadvertantly infected a dozen people at the Metrople Hotel.

Liu died March 4 2003.   His brother-in-law died soon after.  The outbreak had begun.

Only one of the people infected by the doctor was a resident of Hong Kong.  That 26 year old young man repeatably sought treatment at the Prince of Wales Hospital, and was finally admitted on March 4, 2003.  On March 11, 2003, 50 people working in the ward called in sick. SARS in Hong Kong.  This was an event that sent shock waves through the Communicable Disease Surveillance & Response (CSR) System.  WHO issued a global alert on 12 Mar 2003.  National authorities began implemented heightened surveillance for cases of SARS. Where cases have been identified their prompt isolation has slowed the further spread of the disease in virtually all countries.

In Singapore the Ministry of Health was notified on the 13th of March that three persons who had travelled to Hong Kong at the end of February had been admitted to hospital for pneumonia after they returned to Singapore. Two of them had recovered and been discharged from hospital. The remaining case was recovering in hospital.Singapore Ministry of Health  By March 21st, Thirty-nine people had been identified as having SARS  : Singapore Ministry of Health SARS Home

Explanation of so-called SARS “super-spreaders”
“Super-spreader” is a term that has been used to describe certain individuals with atypical pneumonia, now recognized as cases of SARS, who have been implicated in spreading the disease to numerous other individuals.

The phenomenon of a “super-spreader”, which is not a recognized medical condition, dates back to the early days of the outbreak. At that time, when SARS was just becoming known as a severe new disease, many patients were thought to be suffering from atypical pneumonia having another cause, and were therefore not treated as special cases requiring special precautions of isolation and infection control.  Several of early cases were super spreaders "walking biological weapons."

Stringent infection control measures were not in place.  In the absence of protective measures, many health care workers, relatives, and hospital visitors were exposed to the SARS virus and subsequently developed SARS.
 


SARS is a respiratory illness with body temperature measured over 100.5 Degrees Fahrenheit. SARS is spread by close contact with an individual who has the disease.  Close contact is defined as having cared for, having lived with, or having direct contact with respiratory secretions and/or body fluids of a person known to be a suspect SARS case.
On April 16, 2003, WHO announced that the cause of the SARS virus has been positively identified. The pathogen, a member of the coronaries family [the family _Coronaviridae_], has never before seen in humans. .  The speed with which the cause of Severe Acute Respiratory Syndrome (SARS) has been identified is a tribute to an extraordinary collaboration among laboratories from countries around the world.   "Now we can move away from methods like isolation and quarantines and move aggressively towards modern intervention strategies including specific treatments and eventually vaccination. With the establishment of the causative agent, we are a crucial step closer," according to Dr. David Heymann, Executive Director, WHO Communicable Diseases programmes.

As of yet no deaths of SARS have been reported in the United States.

On April 20, 2003, the CDC changed the way that SARS cases are being counted.  Prior to that date the CDC counted SARS cases based on the suspect category, after the 20th it counted these cases based on the probable category.  This is the reason for the drop in the number of cases being reported in the United States.

Our neighbors to the north, Canada, as of June 27, 2003, had reported 251 cases and 37 individuals who have died.  All Canadian cases have occurred in persons who have traveled to Asia or had contact with SARS cases in the household or in a health-care setting. Of those nations, which have been identified as having individuals who have contracted the disease, Canada's death rate at over 10% is the highest in the world.  Canada uses two categories probable cases and suspect cases.  Canada reports probable cases to WHO.  SARS in Canada.   By March 16, 2003, Health Canada had received reports of seven individuals who have become ill with severe acute respiratory syndrome (SARS) in Ontario and British Columbia.

Of the 8,450 people who are reported to have contracted SARS by June 27, 2003, the majority, 7,401 have recovered and 810 to have died.
 

The CDC has a travel advisory, and health alert notices, which are being distributed at ports of entry to people returning from three affected regions. CDC advises that people planning elective or nonessential travel to mainland China and Hong Kong; Singapore; and Hanoi, Vietnam may wish to postpone their trips until further notice. Because the epidemiology of SARS in Canada is significantly different with regards to community transmission, CDC is not issuing a specific travel advisory for Canada at this time. (See also CDC Advice for Travelers about SARS.)

The Genome Sciences Centre has generated the genomic sequence of the Toronto isolate, TOR2, of the Coronavirus which may be associated with the condition known as Severe Acute Respiratory Syndrome (SARS). The Centre has created a test for the virus that provides results within two hours.  The current Genome Shotgun Data is available for download. The format is raw sequence reads in fasta format, not vector or quality clipped.  The draft whole genome assembly is available for download. The fasta file contains the first draft genome assembly totalling 29,736 base pairs. This assembly may contain errors. Primers, which are the key pieces for a PCR test, were made publicly available by network laboratories on the open WHO web site (http://www.who.int/csr/sars/primers/en/ ) on 4 April. The primers have since been used by numerous countries around the world.

SARS diagnostic test kit made available to members of WHO network
Scientists participating in the WHO collaborative network of laboratories have developed several diagnostic tests for SARS. These include a so-called “PCR” test, which allows detection of the distinctive genetic information of a virus.
Since infection control measures have been put in place, the number of new cases of SARS arising from a single SARS source case has been significantly reduced.

Eventually as the disease spreads it will not be safe to travel to an affected area.

Those greatest at risk remain relatives of victims and hospital care workers.

Much of the information related to SARS on this site is from ProMED. The global electronic reporting system for outbreaks of emerging infectious diseases & toxins, open to all sources. ProMED-mail, the Program for Monitoring Emerging Diseases, is a program of the International Society for Infectious Diseases.
 

·    MMWR Update: Severe Acute Respiratory Syndrome-United States,2003
 

There have been a number of updates and new postings to the CDC website regarding SARS. Below is a list of current postings. Please periodically check the CDC website for the most current information at: http://www.cdc.gov

Severe Acute Respiratory Syndrome (SARS)

New Postings

Disease progression:
Following presentation, chest x-rays continue to worsen and most patients demonstrate bilateral changes with interstitial infiltrations (fluid build-up between cells in the lungs). These infiltrations produce x-rays with a characteristic cloudy appearance. Patients then fall into one of two groups. The majority, 80 to 90% of patients at day six or seven, show improvement in signs and symptoms. A second smaller group, progress to a more severe form of SARS, many of whom develop acute respiratory distress syndrome and require mechanical ventilator support. Mortality associated with the more severe group is high, however, a number of patients have remained on ventilator support for prolonged periods of time. Mortality in the severe group appears to be linked to a patient’s other illnesses (co-morbid factors).

Prognostic indicators:
Generally, patients over 40 with other illnesses are more likely to progress to the severe form of the disease.

Therapy:
Numerous antibiotic therapies have been tried to date with little clear effect

World Health Orginization (WHO) - Communicable Disease Surveillance and Response

WHO - Situation Updates - Severe Acute Respiratory Syndrome (SARS)

CDC - Severe Acute Respiratory Syndrome (SARS)

CDC - Frequently Asked Questions

CDC - Fact Sheet

CDC - Isolation and Quarantine

CDC- Travel Advisory

CDC - Information for Airline, Airport, and Air Travel Personnel

CDC - Interim Guidance for State and Local Health Departments

CDC - SARS Report of Suspected Cases Under Investigation in the United States

WHO - Cumulative Number of Reported Cases (SARS)

Executive Order - Revised List of Quarantinable Communicable Diseases

Infection Control Guidance for Quarantine Officers

The Disaster Center

SARS - FAQ
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