I am worried about this SARS epidemic that is developing in Asia and wonder if it is coming to the US and what I need to watch for. Thank you. KR. Salt Lake City, Utah

SARS- WHAT YOU SHOULD KNOW

Severe acute respiratory syndrome, or SARS, is a new virus that has emerged since March of this year.  It causes a severe influenza-like illness that in many patients progresses to severe viral pneumonia and even death.  There is currently no specific treatment to kill the virus.  Therefore, prevention is very important.

As of this week over 700 patients worldwide have died from SARS and over 5,000 have been infected.  In Toronto, Canada, new outbreaks this week have prompted the World Health Organizations to reinitiate a Travelers Advisory for that city. It sounds pretty scary doesn’t it?  Fortunately no cases have been seen in the United States yet and hopefully none will develop. However, it is best to be educated and aware of this disease and its symptoms so that one can take appropriate measures should one suspect clinical infection.

The highest incidence of this disease is still in Asia. Apparently new cases are continuing to be seen in Hong Kong, Mainland China, and Vietnam. It is reported that in Singapore new cases are abating. Travel to these areas is not recommended at this time. 

Clinical features:

In the past, patients who presented to their doctors with a low-grade fever and deep cough were almost always found to have viral bronchitis or influenza. Occasionally we see a case of viral or bacterial pneumonia but this is rare in a healthy community-based medical practice. Now, however, with SARS on the horizon, we must consider this new severe virus in any patient who has a fever greater than 100.4 degrees and a deep cough, shortness of breath, difficulty breathing and travel within ten days of onset of symptoms to an area with documented or suspected community transmission of SARS. Those areas once again are mainly in China, Hong Kong, and Vietnam; Singapore is still iffy.  

What does the patient look like who has SARS?  Initially it looks like influenza. A patient will run a fever greater than 100.4 degrees (oral temperature), and have a bad cough, shortness of breath or difficulty breathing. We also see diarrhea but this only occurs in about 10% of patients. It should be remembered, however, that about 90% of the patients who develop SARS only get a mild flu-like illness. It is only 10% who become severely ill with the pneumonia, which can then lead to death. 

Laboratory tests:

We do not have a specific test for SARS. It can only be detected in the blood several weeks afterwards through antibody testing and, as you may know, antibodies take several weeks to develop.  However, there are some key features which tend to indicate SARS. Examples:  1) the white blood count goes down, which is characteristic of many severe viral infections;  2) oxygen levels in the lungs are also very depressed in the patients who have a serious case of SARS; 3) a chest x-ray typically shows characteristecs consistent with viral pneumonia. 

Don’t forget, SARS has not been seen in the United States yet and so patients with fever greater than 100.4 and deep cough usually end up having influenza, walking pneumonia, bronchitis, etc. 

So don’t panic but do go to your doctor to be checked.

Treatment of SARS:

At this point there is no specific treatment other than supportive measures such as oxygen, assisted mechanical breathing, IV fluids, and, of course, strict airborne isolation so that the disease does not spread.

Conclusion:

SARS has certainly caught our attention and many people are fearful of it. However, it should be remembered that even though there have been 500 deaths, primarily in the Asian countries and Toronto Canada, this pales in comparison to the 30,000 to 40,000 people who die from influenza each year in the United States alone. I am not suggesting that we should let our guard down on SARS but we should keep in perspective the fact that this is still a disease that exists outside of our country and not worry too much about contracting it. However, it is always smart to be aware of the symptoms of any severe acute respiratory syndrome.