Severe Acute Respiratory Distress Syndrome - cont'd

SARS appears to require direct contact with respiratory secretions or other body fluids for transmission. "Direct contact" would include inhaling respiratory droplets from the cough or sneeze of an infected person near you.

The possibility that contaminated objects might serve as source of infection also is under investigation. Coronaviruses can survive for two to three hours in the environment and if, as the U.S. CDC suspects, the cause of SARS is a corona virus, this method of disease transmission is possible.

Severity of the Disease

* All patients develop pneumonia or shortness of breath.

* Ten to 20 percent of patients require treatment in the intensive care unit and/or mechanical ventilation (respirator).

* Most affected patients were healthy before infection; many were in the prime of life.

* Of the cases reported to the WHO as of March 31, approximately 3 to 4 percent of the patients have died and 15 percent have recovered; the rest remain hospitalized.

Prevention

Because the causative agent has not been identified, healthcare professionals have not recommended a reliable treatment or prophylaxis. At present, there is no evidence that influenza vaccine, antibiotics or antiviral medications will prevent this disease.

Avoid situations in which you could be exposed to patients with SARS. Avoid close contact with suspected SARS patients by refraining from direct care of patients or direct contact with respiratory secretions and body fluids of those suspected to be infected. Wash your hands frequently and thoroughly.

Treatment

At present, there is no treatment for the disease. Doctors at the U.S. CDC state that no specific antiviral therapy has been shown to be of benefit, although doctors in Hong Kong have reported some success with the antiviral agent ribavirin.

In its advanced stage, SARS is often fatal. Health officials say they have no immediate hope for an effective treatment, making symptomatic and supportive care essential. Countries with poorly developed healthcare infrastructures will not be able to provide this care.

Persons who become infected overseas may have trouble finding transportation home. Commercial airlines refuse to transport persons known to be infected with SARS. Crew and medical personnel willing to transport a SARS patient by private aircraft will be difficult to find. Only a limited number of countries will accept a SARS patient. By definition, these patients have pneumonia and/or shortness of breath, an additional risk for transportation by aircraft where the oxygen pressure is less than optimal.

If treatment must be obtained in an affected country, less-developed countries like Vietnam are ill-equipped to deal with a SARS outbreak. In Vietnam, hospitals have been closed, and clinics screen patients by telephone. Quality medical care is unavailable nationwide. Even in more developed regions such as Hong Kong, medical facilities could quickly be overwhelmed if SARS continues to spread rapidly. Although transmission to medical personnel has been curtailed in Hong Kong, there is ongoing evidence of transmission of the disease within the community, and no sight of an immediate end to the outbreak. The burden on the public health sector is enormous.

Travel Delays

Persons with respiratory symptoms may be prohibited from boarding flights or checking into hotels in southeast Asia. Check with your airline or hotel about specific precautions or requirements.

Travelers flying to or from locations that have reported SARS cases should anticipate delays at airports. In accordance with the WHO guidelines, airlines and medical personnel from the affected country, will screen air passengers prior to departure from Hanoi, Vietnam; Mainland China, Taiwan, Hong Kong, Singapore, and Toronto, Canada for symptoms of SARS. After landing, customs and health officials will again question all travelers from these locations for the presence of respiratory symptoms. Travelers exhibiting respiratory symptoms may be quarantined.

**As of March 31, countries/areas affected by SARS, according to the CDC, include: Hong Kong; Mainland China; Hanoi, Vietnam; and Singapore. These are areas where community transmission of SARS has been documented or suspected, and are areas at risk of an expanding outbreak. This list is subject to change daily and can be monitored at the following sites: www.cdc.gov/ncidod/sars/index.htm or www.cdc.gov/ncidod/sars/casedefinition.htm.