SARS
Severe acute respiratory syndrome (SARS) | |
---|---|
Other names | Sudden acute respiratory syndrome Severe acute respiratory syndrome coronavirus (SARS-CoV-1) |
Prevention | N95 or FFP2 respirators, ventilation, UVGI, avoiding travel to affected areas[2] |
Prognosis | 9.5% chance of death (all countries) |
Frequency | 8,096 cases total [when?] |
Deaths | 783 known |
Severe acute respiratory syndrome (SARS) is a viral
SARS was a relatively rare disease; at the end of the epidemic in June 2003, the incidence was 8,469 cases with a case fatality rate (CFR) of 11%.[5] No cases of SARS-CoV-1 have been reported worldwide since 2004.[6]
In December 2019, a second strain of SARS-CoV was identified: SARS-CoV-2.[7] This strain causes coronavirus disease 2019 (COVID-19), the disease behind the COVID-19 pandemic.[8]
Signs and symptoms
SARS produces
The average incubation period for SARS is 4–6 days, although it is rarely as short as 1 day or as long as 14 days.[10]
Transmission
The primary
Diagnosis
SARS-CoV may be suspected in a patient who has:[citation needed]
- Any of the symptoms, including a fever of 38 °C (100 °F) or higher, and
- Either a history of:
- Contact (sexual or casual) with someone with a diagnosis of SARS within the last 10 days or
- Travel to any of the regions identified by the World Health Organization (WHO) as areas with recent local transmission of SARS.
- Clinical criteria of Sars-CoV diagnosis[12]
- Early illness: equal to or more than 2 of the following: chills, rigors, myalgia, diarrhea, sore throat (self-reported or observed)
- Mild-to-moderate illness: temperature of >38 °C (100 °F) plus indications of lower respiratory tract infection (cough, dyspnea)
- Severe illness: ≥1 of radiographic evidence, presence of ARDS, autopsy findings in late patients.
For a case to be considered probable, a chest X-ray must be indicative for atypical pneumonia or acute respiratory distress syndrome.[citation needed]
The WHO has added the category of "laboratory confirmed SARS" which means patients who would otherwise be considered "probable" and have tested positive for SARS based on one of the approved tests (ELISA, immunofluorescence or PCR) but whose chest X-ray findings do not show SARS-CoV infection (e.g. ground glass opacities, patchy consolidations unilateral).[12][13]
The appearance of SARS-CoV in chest X-rays is not always uniform but generally appears as an abnormality with patchy infiltrates.[14]
Prevention
There is a vaccine for SARS, although in March 2020
- Hand-washing with soap and water, or use of alcohol-based hand sanitizer[17]
- Disinfection of surfaces of fomites to remove viruses
- Avoiding contact with bodily fluids
- Washing the personal items of someone with SARS in hot, soapy water (eating utensils, dishes, bedding, etc.)[18]
- Avoiding travel to affected areas
- Wearing masks and gloves[19]
- Keeping people with symptoms home from school
- Simple hygiene measures
- Distancing oneself at least 6 feet if possible to minimize the chances of transmission of the virus
Many public health interventions were made to try to control the spread of the disease, which is mainly spread through
SARS-CoV is most infectious in severely ill patients, which usually occurs during the second week of illness. This delayed infectious period meant that quarantine was highly effective; people who were isolated before day five of their illness rarely transmitted the disease to others.[10]
As of 2017, the CDC was still working to make federal and local rapid-response guidelines and recommendations in the event of a reappearance of the virus.[22]
Treatment
As SARS is a viral disease, antibiotics do not have direct effect but may be used against bacterial secondary infection. Treatment of SARS is mainly supportive with antipyretics, supplemental oxygen and mechanical ventilation as needed. While ribavirin is commonly used to treat SARS, there seems to have little to no effect on SARS-CoV, and no impact on patient's outcomes.[23] There is currently no proven antiviral therapy. Tested substances, include ribavirin, lopinavir, ritonavir, type I interferon, that have thus far shown no conclusive contribution to the disease's course.[24] Administration of corticosteroids, is recommended by the British Thoracic Society/British Infection Society/Health Protection Agency in patients with severe disease and O2 saturation of <90%.[25]
People with SARS-CoV must be isolated, preferably in
Some of the more serious damage caused by SARS may be due to the body's own immune system reacting in what is known as cytokine storm.[27]
Vaccine
Vaccines can help the immune system to create enough antibodies and decrease a risk of side effects like arm pain, fever, and headache.[28][29] According to research papers published in 2005 and 2006, the identification and development of novel vaccines and medicines to treat SARS was a priority for governments and public health agencies around the world.[30][31][32] In early 2004, an early clinical trial on volunteers was planned.[33] A major researcher's 2016 request, however, demonstrated that no field-ready SARS vaccine had been completed because likely market-driven priorities had ended funding.[16]
Prognosis
Several consequent reports from China on some recovered SARS patients showed severe long-time sequelae. The most typical diseases include, among other things, pulmonary fibrosis, osteoporosis, and femoral necrosis, which have led in some cases to the complete loss of working ability or even self-care ability of people who have recovered from SARS. As a result of quarantine procedures, some of the post-SARS patients have been diagnosed with post-traumatic stress disorder (PTSD) and major depressive disorder.[34][35]
Epidemiology
SARS was a relatively rare disease; at the end of the epidemic in June 2003, the incidence was 8,422 cases with a case fatality rate (CFR) of 11%.[5]
The case fatality rate (CFR) ranges from 0% to 50% depending on the age group of the patient.[10] Patients under 24 were least likely to die (less than 1%); those 65 and older were most likely to die (over 55%).[36]
As with MERS and COVID-19, SARS resulted in significantly more deaths of males than females.
Country or region | Cases | Deaths | Fatality (%) | |
---|---|---|---|---|
China[a] | 5,327 | 349 | 6.6 | |
Hong Kong | 1,755 | 299 | 17.0 | |
Taiwan[b] | 346 | 81 | 23.4[38] | |
Canada | 251 | 43 | 17.1 | |
Singapore | 238 | 33 | 13.9 | |
Vietnam | 63 | 5 | 7.9 | |
United States | 27 | 0 | 0 | |
Philippines | 14 | 2 | 14.3 | |
Thailand | 9 | 2 | 22.2 | |
Germany | 9 | 0 | 0 | |
Mongolia | 9 | 0 | 0 | |
France | 7 | 1 | 14.3 | |
Australia | 6 | 0 | 0 | |
Malaysia | 5 | 2 | 40.0 | |
Sweden | 5 | 0 | 0 | |
United Kingdom | 4 | 0 | 0 | |
Italy | 4 | 0 | 0 | |
Brazil | 3 | 0 | 0 | |
India | 3 | 0 | 0 | |
South Korea | 3 | 0 | 0 | |
Indonesia | 2 | 0 | 0 | |
South Africa | 1 | 1 | 100.0 | |
Colombia | 1 | 0 | 0 | |
Kuwait | 1 | 0 | 0 | |
Ireland | 1 | 0 | 0 | |
Macao | 1 | 0 | 0 | |
New Zealand | 1 | 0 | 0 | |
Romania | 1 | 0 | 0 | |
Russia | 1 | 0 | 0 | |
Spain | 1 | 0 | 0 | |
Switzerland | 1 | 0 | 0 | |
Total excluding China[a] | 2,769 | 454 | 16.4 | |
Total (29 territories) | 8,096 | 782 | 9.6 | |
|
Outbreak in South China
The SARS epidemic began in the
The viral outbreak was subsequently genetically traced to a colony of cave-dwelling horseshoe bats in Xiyang Yi Ethnic Township, Yunnan.[4]
The outbreak first came to the attention of the international medical community on 27 November 2002, when Canada's
In early April 2003, after a prominent physician,
Many healthcare workers in the affected nations risked their lives and died by treating patients, and trying to contain the infection before ways to prevent infection were known.[48]
Spread to other regions
The epidemic reached the public spotlight in February 2003, when an American businessman traveling from China, Johnny Chen, became affected by pneumonia-like symptoms while on a flight to Singapore. The plane stopped in
The severity of the symptoms and the infection among hospital staff alarmed global health authorities, who were fearful of another emergent pneumonia epidemic. On 12 March 2003, the WHO issued a global alert, followed by a health alert by the United States Centers for Disease Control and Prevention (CDC). Local transmission of SARS took place in Toronto, Ottawa, San Francisco, Ulaanbaatar, Manila, Singapore, Taiwan, Hanoi and Hong Kong whereas within China it spread to Guangdong, Jilin, Hebei, Hubei, Shaanxi, Jiangsu, Shanxi, Tianjin, and Inner Mongolia.[citation needed]
Hong Kong
The disease spread in Hong Kong from Liu Jianlun, a Guangdong doctor who was treating patients at Sun Yat-Sen Memorial Hospital.[50] He arrived in February and stayed on the ninth floor of the Metropole Hotel in Kowloon, infecting 16 of the hotel visitors. Those visitors traveled to Canada, Singapore, Taiwan, and Vietnam, spreading SARS to those locations.[51]
Another larger cluster of cases in Hong Kong centred on the Amoy Gardens housing estate. Its spread is suspected to have been facilitated by defects in its bathroom drainage system that allowed sewer gases including virus particles to vent into the room. Bathroom fans exhausted the gases and wind carried the contagion to adjacent downwind complexes. Concerned citizens in Hong Kong worried that information was not reaching people quickly enough and created a website called sosick.org, which eventually forced the Hong Kong government to provide information related to SARS in a timely manner.[52] The first cohort of affected people were discharged from hospital on 29 March 2003.[53]
Canada
The first case of SARS in
The official response by the Ontario provincial government and Canadian federal government has been widely criticized in the years following the outbreak. Brian Schwartz, vice-chair of Ontario's SARS Scientific Advisory Committee, described public health officials' preparedness and emergency response at the time of the outbreak as "very, very basic and minimal at best".[56] Critics of the response often cite poorly outlined and enforced protocol for protecting healthcare workers and identifying infected patients as a major contributing factor to the continued spread of the virus. The atmosphere of fear and uncertainty surrounding the outbreak resulted in staffing issues in area hospitals when healthcare workers elected to resign rather than risk exposure to SARS.[citation needed]
Identification of virus
In late February 2003, Italian doctor
Origin and animal vectors
In late May 2003, a study was conducted using samples of wild animals sold as food in the local market in Guangdong, China.
In 2005, two studies identified a number of SARS-like coronaviruses in Chinese bats.
It took 14 years to find the original bat population likely responsible for the SARS pandemic.[72] In December 2017, "after years of searching across China, where the disease first emerged, researchers reported ... that they had found a remote cave in Xiyang Yi Ethnic Township, Yunnan province, which is home to horseshoe bats that carry a strain of a particular virus known as a coronavirus. This strain has all the genetic building blocks of the type that triggered the global outbreak of SARS in 2002."[4] The research was performed by Shi Zhengli, Cui Jie, and co-workers at the Wuhan Institute of Virology, China, and published in PLOS Pathogens. The authors are quoted as stating that "another deadly outbreak of SARS could emerge at any time. The cave where they discovered their strain is only a kilometre from the nearest village."[4][73] The virus was ephemeral and seasonal in bats.[74] In 2019, a similar virus to SARS caused a cluster of infections in Wuhan, eventually leading to the COVID-19 pandemic.
A small number of cats and dogs tested positive for the virus during the outbreak. However, these animals did not transmit the virus to other animals of the same species or to humans.[75][76]
Containment
The World Health Organization declared severe acute respiratory syndrome contained on 5 July 2003. The containment was achieved through successful public health measures.[77] In the following months, four SARS cases were reported in China between December 2003 and January 2004.[78][79]
While SARS-CoV-1 probably persists as a potential zoonotic threat in its original animal reservoir, human-to-human transmission of this virus may be considered eradicated[citation needed] because no human case has been documented since four minor, brief, subsequent outbreaks in 2004.[77]
Laboratory accidents
After containment, there were four laboratory accidents that resulted in infections.
- One postdoctoral student at the National University of Singapore in Singapore in August 2003[80]
- A 44-year-old senior scientist at the National Defense University in Taipei in December 2003. He was confirmed to have the SARS virus after working on a SARS study in Taiwan's only BSL-4 lab. The Taiwan CDC later stated the infection occurred due to laboratory misconduct.[81][82]
- Two researchers at the Chinese Institute of Virology in Beijing, China around April 2004, who spread it to around six other people. The two researchers contracted it 2 weeks apart.[83]
Study of live SARS specimens requires a
Society and culture
Fear of contracting the virus from consuming infected wild animals resulted in public bans and reduced business for meat markets in southern China and Hong Kong. The WHO declared the end of the pandemic on March 24 2004. [85]
See also
- 2009 swine flu pandemic
- Aerosol
- Avian influenza
- Bat-borne virus
- Severe acute respiratory syndrome coronavirus 2
- Health crisis
- Health in China
- Healthy building
- Indoor air quality
- List of medical professionals who died during the SARS outbreak
- Middle East respiratory syndrome– a coronavirus discovered in June 2012 in Saudi Arabia
- SARS conspiracy theory
- Sick building syndrome
- Zhong Nanshan
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Further reading
- Sihoe AD, Wong RH, Lee AT, Lau LS, Leung NY, Law KI, Yim AP (June 2004). "Severe acute respiratory syndrome complicated by spontaneous pneumothorax". Chest. 125 (6): 2345–51. PMID 15189961.
- Enserink M (March 2013). "War stories". Science. 339 (6125): 1264–8. PMID 23493690.
- Enserink M (March 2013). "SARS: chronology of the epidemic". Science. 339 (6125): 1266–71. PMID 23493691.
- Normile D (March 2013). "Understanding the enemy". Science. 339 (6125): 1269–73. PMID 23493692.
External links
- MedlinePlus: Severe Acute Respiratory Syndrome News, links and information from The United States National Library of Medicine
- Severe Acute Respiratory Syndrome (SARS) Symptoms and treatment guidelines, travel advisory, and daily outbreak updates, from the World Health Organization (WHO)
- Severe Acute Respiratory Syndrome (SARS): information on the international outbreak of the illness known as a severe acute respiratory syndrome (SARS), provided by the US Centers for Disease Control