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| Vol. 25, No. 9 |
| May 15, 2003 |
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The “Scoop” on SARS Acute Severe Respiratory Syndrome, known as SARS, is one of the fastest spreading respiratory viruses in recent history. Not since the 1918 influenza epidemic, the largest public health event of the 20th century, which spread to every country in the world and affected about 20 percent of the world’s population, has a respiratory disease caused such widespread panic. To date, nearly 7,000 probable cases have been reported in 26 countries on five continents. However, as the numbers continue to steadily climb, new information is discovered on a daily basis. This information is being analyzed and put to use in medical communities worldwide to treat patients and keep the spread of SARS in check. Palmer Beasley, M.D., dean of The University of Texas School of Public Health at Houston, compared the spread of this “new” infection, to dropping lit matches in a dry field, scattering the flames in multiple directions. Until recently, the world – in this case the dry field – had never before experienced the magnitude of this virus’ potential. Current SARS “hot spots” include China, Taiwan and Hong Kong. It appears Vietnam has managed to control its cases of the SARS outbreak and Singapore is on the brink. Experts at the World Health Organization, the Centers for Disease Control and Prevention and other public health agencies are watching the United States for import cases that might “seed” the U.S. population. “This is a time for concern ... but not a time to panic,” Beasley said. Q: What causes SARS? A: SARS is caused by a coronavirus (related to the common cold). The virus was a known agent never previously documented in humans, but known to affect the animal kingdom. The human form is most likely a mutation from the animal variety. Q: How is the SARS virus transmitted? A: The most up-to-date information indicates that only respiratory secretions spread SARS. Person-to-person transmission is the most common way to spread the virus. When an infected person coughs or sneezes, saliva droplets are carried to those nearby. It can also be spread by touching a contaminated surface and then touching the eyes, nose or mouth. Q: What is the incubation period? A: Up to 10 days. Q: How is the spread stopped? A: It is crucial to break “bad habits that die hard,” and revert to “lessons your mother taught you.” Washing hands before and after eating and preparing food, keeping hands away from the face (and washing them if the face is touched), and keeping hands out of the mouth (for example, wetting fingers to make pages easier to turn) are the best ways to stop the spread of the SARS virus. If soap and water are unavailable, keep an alcohol-based hand gel within reach. These bottles are inexpensive and small enough to fit in pockets and purses. Prevention is the key, and education is half the job. Q: How has SARS affected Texas? A: There have been seven “suspect” cases in Texas, but not all were in the same geographic location – two were in Harris County and one was in Fort Bend County. Upon visual examination, SARS is not clinically distinguishable from other influenza or respiratory infections. Individuals suspected of having SARS display a wide variety of symptoms. Patients present with fever, cough or shortness of breath, AND have a recent travel history to a known SARS transmission area. The cases are reclassified as “probable” if chest X-ray or autopsy findings show respiratory infection. None of the Texas cases to date included enough symptoms in the “suspect” category to remain, and all classifications were dropped. Q: Are masks effective barriers to the germs? A: Masks are needed primarily in high-risk settings, such as hospitals. They don’t cause harm, but in a community setting with no history of the virus, such as Houston, they add very little value. People may wear them if it makes them feel safer, but there really is no need. Masks are intended to keep the wearer from spreading germs – they do little to protect the wearer from contracting most airborne illnesses. Mask wearers should change them often (viruses can survive for 24 hours), and moist masks are ineffective. In a hospital setting, health care workers should change masks after each patient contact. Q: Is it safe to travel? A: It is best to avoid travel to SARS-positive transmission areas. However, air travel to other destinations is not risky because airborne-spread numbers are low. It is a good idea to carry portable travel kits which include alcohol wipes and hand gel, a thermometer, household disinfectant, disposable gloves, and medical and evacuation insurance. Q: Should I change my daily routine to avoid the virus? A: Absolutely not. Continue normal, daily activities. These include outings to restaurants, ball games, and the theater, among others. Q: How does the SARS virus affect the blood supply? A:There have not yet been any cases of transfusion-transmitted SARS, but researchers have not ruled out the possibility. As with any virus, it’s possible for blood to contain SARS even if the donor shows no symptoms. The Food and Drug Administration has created some new safety guidelines. These include not accepting donations from people who have traveled overseas to SARS-positive transmission areas for 14 days after returning to the United States. Q: What are local hospitals and health care agencies doing to prepare? A: Hospitals worldwide are sharing information – the best source for comprehensive care. In addition to learning from these sources, each Texas Medical Center hospital is putting individualized contingency plans in place. Emergency rooms will rapidly triage and isolate suspect cases, and airborne/droplet precautions are under consideration for hospitalized patients. The Houston Department of Health and Human Services is under active SARS surveillance. Staff members regularly visit clinicians and review records to keep tabs on statistics. Q: What about local medical schools? A: The two Texas Medical Center medical schools, Baylor College of Medicine and The University of Texas Medical School at Houston, are preparing their faculty and staff members for a SARS outbreak. Baylor is keeping tabs on the current situation and will follow CDC guidelines, should there be an outbreak. UT-Houston Medical School is also taking a proactive approach. With 14 students and a faculty advisor on an annual elective trip to Beijing in April, L. Maximilian Buja, M.D., the school’s dean, asked the group to cut their trip short and return to the United States as the full extent of SARS was revealed by Chinese health officials. After consulting CDC policies and Herbert L. DuPont, M.D., professor in the medical school’s internal medicine division, Buja mandated all students on the trip not travel to the medical school, other UT-Houston facilities, or any patient-care facility for 10 days upon their return and undergo a health evaluation after that time period. UT-Houston physician offices have also formulated a plan for dealing with suspected SARS patients. This policy includes education for frontline health care providers. Q: What is the treatment for SARS? A: Suspect cases are treated similarly to other respiratory diseases, such as pneumonia. If necessary, supportive therapy, such as intubation or mechanical ventilation, will be administered. In China, an antiviral drug called Ribavirin is being tested in conjunction with steroids. In the United States, other antivirals are being considered, but none have been approved by the FDA. However, because of the urgency, approval may be expedited. Q: Is a vaccine in the works? A: The potential is good. If the epidemic is over by the time a vaccine is developed and approved, and SARS proves, like the flu, to be a cyclical virus, the public health community may be armed and ready the next time it comes around. Q: Are there cases of recurrence in those who appear to have recovered from SARS? A: There is not enough evidence available to support recent reports of SARS recurrence cases. Q: What does the SARS future hold? A: Nobody knows. Because this virus is difficult to understand, it is hard to predict. Q: Where can I find more SARS resources? A: Publications:
Internet:
– Texas Medical Center News with contributions from Baylor College of Medicine, The University of Texas Health Science Center at Houston and Gulf Coast Regional Blood Center
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