Severe Acute Respiratory Syndrome
SARS - FAQ
Severe Acute Respiratory Syndrome
Projected Cases
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