SARS (Healthcare Providers)

Severe acute respiratory syndrome (SARS) is a viral respiratory illness. The illness usually begins with a high fever (measured temperature greater than 100.4·F [>38.0·C]). The fever is sometimes associated with chills or other symptoms, including headache, general feeling of discomfort, and body aches. Some people also experience mild respiratory symptoms at the outset. Diarrhea is seen in approximately 10 percent to 20 percent of patients.
After two to seven days, SARS patients may develop a dry, nonproductive cough that might be accompanied by or progress to a condition (hypoxia) in which the person does not have sufficient oxygen. In 10 percent to 20 percent of cases, patients require mechanical ventilation. Most patients develop pneumonia.

SARS is caused by a previously unrecognized coronavirus, called SARS-associated coronavirus (SARS-CoV). Coronaviruses are a group of viruses that have a halo or crown-like (corona) appearance when viewed under an electron microscope. These viruses are a common cause of mild to moderate upper-respiratory illness in humans and are associated with respiratory, gastrointestinal, liver and neurologic disease in animals.

The incubation period for SARS is typically two to seven days, although in some cases it may be as long as 10 days.

The primary way that SARS appears to spread is by close person-to-person contact. The virus that causes SARS is thought to be transmitted most readily by respiratory droplets (droplet spread) produced when an infected person coughs or sneezes. Droplet spread can happen when droplets from the cough or sneeze of an infected person are propelled a short distance (generally up to 3 feet) through the air and deposited on the mucous membranes of the mouth, nose or eyes of persons who are nearby. The virus also can spread when a person touches a surface or object contaminated with infectious droplets and then touches his or her mouth, nose or eye(s). In addition, it is possible that SARS-CoV might be spread more broadly through the air (airborne spread) or by other ways that are not now known.

Close contact is defined as having cared for or lived with a person known to have SARS or having a high likelihood of direct contact with respiratory secretions and/or body fluids of a patient known to have SARS. Examples include kissing or embracing, sharing eating or drinking utensils, close conversation (within 3 feet), nursing care, and any other direct physical contact. Close contact does not include activities such as walking by a person or sitting across a waiting room or office for a brief time.

Available information suggests that people with SARS are most likely to be infectious only when they have symptoms, such as fever or cough. However, as a precaution against spreading the disease, people with SARS should stay at home until 10 days after their symptoms are no longer present. Patients are most infectious during the second week of illness.

All members of a household with a SARS patient should carefully follow recommendations for hand hygiene (e.g., frequent hand washing with soap and warm water or use of alcohol-based hand rubs), particularly after contact with body fluids (e.g., respiratory secretions, urine, or feces). Use of disposable gloves should be considered for any direct contact with body fluids of a SARS patient. However, gloves are not intended to replace proper hand hygiene. Immediately after activities involving contact with body fluids, gloves should be removed and discarded and hands should be cleaned. Gloves must never be washed or reused.

Each patient with SARS should be advised to cover his or her mouth and nose with a facial tissue when coughing or sneezing. If possible, a SARS patient should wear a surgical mask during close contact with uninfected persons to prevent spread of infectious droplets. When a SARS patient is unable to wear a surgical mask, household members should wear surgical masks when in close contact with the patient.

Sharing of eating utensils, towels, and bedding between SARS patients and others should be avoided, although such items can be used by others after routine cleaning (e.g., washing with soap and hot water). Environmental surfaces soiled by body fluids should be cleaned with a household disinfectant according to manufacturer's instructions; gloves should be worn during this activity.
Household members and other close contacts of SARS patients should be actively monitored by the local health department for illness. Household members or other close contacts of SARS patients should watch for fever (i.e., measure temperature twice daily) or respiratory symptoms and, if these develop, should immediately seek healthcare evaluation. In advance of evaluation, healthcare providers should be informed that the individual is a close contact of a SARS patient so arrangements can be made, as necessary, to prevent transmission to others in the healthcare setting. Household members or other close contacts with symptoms of SARS should follow the same precautions recommended for SARS patients. Household members or other close contacts of SARS patients need not limit their activities outside the home if they do not have fever or respiratory symptoms.

Several laboratory tests can be used to detect SARS-CoV. A reverse transcription polymerase chain reaction (RT-PCR) test can detect SARS-CoV in clinical specimens, including blood, stool, and nasal secretions. Serologic testing also can be performed to detect SARS-CoV antibodies produced after infection. Serologic testing does require both an acute and convalescent serum. Finally, viral culture has been used to detect SARS-CoV. The state public health laboratory and the Center for Disease Control laboratory can perform the necessary tests if criteria for testing are met.

Health care providers should consult their local health departments for laboratory testing information when SARS is suspected.

CDC recommends that patients with SARS receive the same treatment that would be used for any patient with serious community-acquired atypical pneumonia. Various antiviral drugs are being tested against SARS-CoV to see if an effective treatment can be found.

There are some precautions that can prevent the spread of many infectious diseases. The most important is frequent hand washing with soap and warm water or use of alcohol-based hand rubs. Avoid touching the eyes, nose and mouth with unclean hands. Encourage others to cover their nose and mouth with a tissue when coughing or sneezing and to dispose of tissues after use. Finally, avoid sharing drinks, cigarettes, eating utensils or other items that may come in contact with respiratory secretions or body fluids.

Right now, there are no disinfectant products registered by the U.S. Environmental Protection Agency for use on environmental surfaces that are specifically listed as having the ability to kill SARS-CoV. However, related viruses that have similar physical and biochemical properties can be killed with bleach, ammonia or alcohol, or cleaning agents containing any of these disinfectants. Cleaning agents should be used according to the manufacturer's instructions.

To contain the spread of a contagious illness, such as SARS, public health authorities rely on many strategies. Two of these strategies are isolation and quarantine. Both are practices in public health which control exposure to infected or potentially infected individuals. Both may be undertaken voluntarily or compelled by public health authorities.

Isolation of people who have a specific illness separates them from healthy people and restricts their movement to stop the spread of that illness. Isolation allows for the focused delivery of specialized health care to people who are ill, and it protects healthy people from getting sick. People in isolation may be cared for in their homes, in hospitals, or at designated health care facilities.
Quarantine, in contrast, applies to people who have been exposed and may be infected but are not yet ill. Separating exposed people and restricting their movements is intended to stop the spread of that illness. Quarantine is very effective in protecting the public from disease.

SARS was first reported in Asia in February 2003. In early March 2003, the World Health Organization (WHO) issued a global alert about SARS. Over the next few months, the illness spread to more than two dozen countries in North America, South America, Europe, and Asia. By late July, however, no new cases were being reported and the illness was considered contained. According to WHO, more than 8,000 people worldwide became ill with SARS during the outbreak of 2003, of these, 813 died. The United States had eight laboratory confirmed cases. Illinois had no laboratory confirmed cases during the outbreak. SARS cases reported in the United States occurred primarily among people who traveled to SARS-affected areas; a small number of other people became ill after being in close contact with a SARS patient while in the United States. There was no evidence that SARS spread more widely in the community in the United States.