SEVERE ACUTE RESPIRATORY SYNDROME (SARS)
What is the Severe Acute Respiratory Syndrome (SARS)?
SARS is a respiratory illness that has recently been reported worldwide. The countries that have been most severely affected are in Southeast Asia, specifically the People's Republic of China (including Hong Kong), Hanoi, Vietnam and Singapore.
When was SARS first recognized?
SARS was first reported among people in the Guandong Province of China, Hong Kong and Vietnam in March 2003. It has since spread to other countries.
What are the signs and symptoms of SARS?
People are suspected of having SARS if they have traveled to an affected area in Southeast Asia within ten days of symptom onset or had close contact with a SARS patient within ten days of symptom onset. The following are the usual symptoms:
- Fever greater than 100.4oF;
- One or more respiratory symptoms including cough, shortness of breath, difficulty breathing, hypoxia (low oxygen level), or a chest x-ray showing findings of pneumonia.
The illness usually starts with a fever and is sometimes associated with chills, headache, fatigue, body aches and an overall feeling of discomfort. After 3 to 7 days, the person may develop a dry cough and have trouble breathing.
What causes SARS?
SARS is a newly recognized disease. There is early evidence to suggest that SARS is caused by a virus, but the exact cause is still unknown. The Centers for Disease Control and Prevention has identified a new virus, a previously unknown type of coronavirus in some patients with SARS. More studies are being done to determine if this or other viruses cause SARS.
What are coronaviruses?
Coronaviruses are a group of viruses that have a crown-like (corona) appearance under a microscope. This family of viruses is a common cause of mild to moderate respiratory in humans. These viruses can survive in the environment for as long as 3 hours.
How is SARS spread?
As SARS is a new disease, we do not yet know for sure exactly how it is spread but it seems to require close contact with a SARS patient. Scientists believe that SARS is usually spread when someone with SARS coughs or sneezes droplets into the air and someone else breathes them in. This more often occurs when people are in close contact, like people who live in the same home as a SARS patient or a healthcare worker who is takes care of a SARS patient.
SARS may also be spread by touching something that has been contaminated with the secretions (from the nose or mouth) of a SARS patient. People with SARS should wear a mask if they are coughing and sneezing, wash their hands frequently and avoid sharing eating utensils (forks, spoons, glasses), towels and bedding with other people in the household. These items can be used by others after routine cleaning with soap and water. Patients with SARS should NOT share cigarettes or canned drinks.
Who is most at risk of getting sick with SARS?
SARS appears to spread most easily among close personal contacts - such as those who have cared for, lived with, or had direct contact with an infected person. Persons most at risk are those who live in the same home as a SARS patient or health care workers who do not use infection control procedures when providing medical care to a SARS patient. Those who have had only casual contact with an individual with SARS do not appear to be at risk of infection.
In the United States, almost all SARS patients have recently traveled to countries, such as Hong Kong and China, where large outbreaks of SARS are occurring. There has been no evidence to date of community spread in the United States.
How long does it take to get sick after being exposed to someone with SARS?
The incubation period (the period between when someone is first exposed to a SARS patent until he/she gets sick) is usually 2 to7 days but can be as long as 10 days. The illness usually begins with a fever greater than 100.4 oF.
How long is a person with SARS infectious (able to spread the disease to others)?
Evidence suggests that people are most likely to be infectious when they have symptoms, such as fever and cough. It is not yet known how long after symptoms begin that people with SARS might be able to spread the disease to others.
Is SARS dangerous?
Most people who have gotten SARS have recovered, but a small percentage (less than 5 per cent) of people have died. The disease may be more serious among older persons or those with other medical problems.
Are there any suspect cases of SARS in New York City?
To date, there have been seven New York City residents who are suspected to have SARS based on the Centers for Disease Control and Prevention's disease criteria for SARS. These individuals, ranging in age from 1 to 91 years old, had onset of symptoms during travel or shortly after return from either Hong Kong or China, countries with known community outbreaks of SARS. All of the New York City suspect cases have mild symptoms (typically just fever and cough) and are recovering. Because the initial symptoms of SARS are similar to the symptoms of many common illnesses seen this time of year (such as colds and flu), and because travel between New York City and Southeast Asia is common, it is expected that the number of suspect cases may increase. Many of these persons, however, will likely have unrelated illnesses.
The New York City Department of Health and Mental Hygiene (NYC DOHMH) has been monitoring cases and their household contacts until 10 days after the SARS patient has recovered. There has been no evidence to date of spread to health care workers or household members, nor evidence of community spread of SARS in New York City.
What should I do, if I or someone in my family has recently traveled in Southeast Asia?
You should monitor your own health for ten days following your return. If you become ill with a high fever (> 100.4 oF) and a cough or difficulty breathing, you should notify your doctor or visit a hospital emergency department and be sure to tell your doctor that you have have recently traveled in Southeast Asia. If you are not sick, it is not necessary to stay at home or limit your activities in any way. It is okay to go to work or school, or for young children to go to daycare or other child care programs. You do not need to use a mask or see a doctor as long as you are feeling well.
Is it safe to travel to Southeast Asia?
At this time, there are no travel restrictions in place directly related to SARS. However, a travel advisory from the Centers for Disease Control and Prevention recommends that persons planning nonessential or elective travel to the People's Republic of China, Hong Kong, Hanoi, Vietnam or Singapore may wish to postpone their trip until further notice. This temporary recommendation will be re-evaluated daily as this outbreak evolves. The recommendation does not apply to passengers simply passing through the airports in these areas, if they are not spending any time in the affected countries.
Persons who travel to Southeast Asia should be aware of the symptoms of SARS. If they develop high fever and cough or difficulty breathing, they should see a doctor immediately and be sure to mention their recent travel to Southeast Asia. There is no recommendation at this time to wear masks while traveling. Updates on SARS, recommendations, and travel advisories can be found on the World Health Organization website at www.who.int/en and the Centers for Disease Control and Prevention's website at www.cdc.gov.
How can I help prevent SARS?
The Centers for Disease Control and Prevention has issued guidelines for how to prevent SARS from spreading to family contacts of SARS patients and in the hospital setting. In medical care settings, it is important that health care providers follow special precautions when caring for a patient who may have SARS. For others, the best way to prevent SARS is by not traveling to places where there are known outbreaks of SARS, unless absolutely necessary.
If I am traveling to Southeast Asia, is there a medicine I can take to prevent SARS?
No, there is no known medicine you can take to prevent SARS. However, if you do become ill in Southeast Asia, or after you get back, you should see a doctor and mention that you have recently traveled to that region.
What is being done to prevent SARS patients from coming into the United States?
For people traveling by plane, federal quarantine inspectors stationed at the airports are screening travelers from Southeast Asia for symptoms of SARS. In addition, health alert cards are being distributed to air passengers asking travelers to monitor their health for ten days and to see a doctor if they become sick with a fever and cough or difficulty breathing. These health alert cards are also being provided by the major shipping associations to people traveling on cargo ships and cruise ships into ports in the United States. Inspectors are also boarding ships if a passenger or crew member is suspected of having SARS.
What if I have been on board an airplane or ship with someone who is suspected of having SARS?
All passengers and crew members will be advised by port authorities to seek medical attention if they develop symptoms of SARS (see above).
Is there a treatment for SARS?
Because the exact cause of the illness is still being investigated, there is currently no known treatment for SARS. Different types of treatment regimens have been used for severely ill hospitalized patients with SARS, including antibiotics, anti-virus medications and steroids, but it is too soon to tell if any of these will be effective. Supportive treatment, such as intravenous fluids and medicines to control fever or pain, is critical.
Is there any reason to believe that SARS is linked to bioterrorism?
The pattern of spread as far as is known is what would typically be expected in a contagious respiratory or flu-like illness. People most at risk are either health care workers taking care of sick people or family members or household contacts of people infected with SARS. There is no evidence to suggest bioterrorism.
What is being done about SARS overseas?
The World Health Organization and the Centers for Disease Control and Prevention are aggressively responding to cases of SARS and working to identify a cause of the illness.
What is being done about SARS in New York City?
The New York City Department of Health and Mental Hygiene is working closely with hospitals and medical providers to increase their awareness of SARS and to help them rapidly identify any cases that arrive in the City. As a precautionary measure, the Department has issued several alerts to hospitals asking them to immediately report any illnesses suspected of being SARS. All suspect SARS patients and their close contacts are followed on a daily basis until 10 days after their illness ends.
Why has the New York City Department of Health and Mental Hygiene asked hospitals to be on the alert for SARS?
Identifying possible cases early will allow special precautions to be taken in the hospital to prevent its spread. In addition, the Department will assist hospitals in sending laboratory specimens to the Centers for Disease Control and Prevention to help identify the cause of the disease.
Who can I call if I have questions or concerns?
The public can call the New York City Department of Health and Mental Hygiene at 311.
For additional information, see the World Health Organization's website at www.who.int/en or the Centers for Disease Control and Prevention's website at www.cdc.gov/ncidod/sars.
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