Frequently Asked Questions on Severe Acute Respiratory Syndrome (SARS)


Q: What is SARS?

Q: What is coronavirus?
Q: What is metapneumovirus?
Q: What are the symptoms of SARS?
Q: How contagious is SARS?
Q: How should SARS patients be managed?
Q: What is the treatment for SARS?
Q: When will this disease be identified?
Q: How fast does SARS spread?
Q: Does the drug Ribavirin cure SARS?
Q: How is SARS diagnosed?
Q: What is the difference between classical/typical pneumonia and atypical pneumonia?
Q: What is the difference between influenza and atypical pneumonia?
Q: Which countries have reported cases of SARS?
Q: What is the difference between a suspect and a probable case?
Q: Who is at risk of developing SARS?
Q: Is there anything that can be done to help prevent the spread of SARS?
Q: Is this disease spreading through or being spread by the Asian community only?
Q: Is there any evidence to suggest air-borne transmission?
Q: Is it safe to use public swimming pools?
Q: Is there a vaccine against the disease?
Q: How can I avoid contracting the disease in an office setting?
Q: How can I prevent contracting the disease in a lift?
Q: Should I take any precautions when visiting a health care facility?
Q: What precautions should be adopted if a family member or friend has contracted the disease?
Q: Should clothes be washed after visiting hospitals?
Q: What is the Department of Health advice about sharing food at home or in restaurants?
Q: Can the disease be prevented by wearing a face mask?
Q: Who should wear a face mask?
Q: What type of face mask should be used?
Q: Is the N95 face mask the only effective model to prevent atypical pneumonia?
Q: How often should a face mask be replaced?
Q: Is the outbreak in Guangdong Province, China linked?
Q: Could this result from bioterrorism?
Q: Should we be worried?
Q: Is it safe to travel?
Q: What is the purpose of a global travel advisory?
Q: Could this be the next flu pandemic?
Q: What does WHO recommend?
Q: How can the public keep apprised of the situation?
Q: What is WHO doing?
Q: What are the objectives of the international response to the multi-country SARS outbreak?
Q: Are there any positive developments?


Q: What is SARS?
A: Severe acute respiratory syndrome (SARS) is a highly contagious respiratory illness associated with coronavirus that has     recently been reported in Asia, North America, and Europe. SARS is an infection in which affected individuals develop a fever,     followed by respiratory symptoms such as cough, shortness of breath or difficulty breathing. In some cases, the respiratory     symptoms become increasingly severe, and people require oxygen support and mechanical ventilation. Other symptoms of     SARS include muscle aches, headaches, and sore throat. Currently, the cause of SARS is unknown, and no specific agents     have been identified.

Q: What is coronavirus?
A: Normally, coronaviruses cause mild to moderate upper-respiratory illness such as the common cold. When viewed under a     microscope, the coronavirus has a halo or crown-like appearance. Coronaviruses can also be found in animals.

Q: What is metapneumovirus?
A: Metapneumovirus is part of the paramyxovirus family. Viruses in the paramyxo family can be responsible for mumps, measles,     pneumonia and the common cold. The metapneumovirus was only recently identified in humans and has been proven to be very     common. It causes respiratory symptoms that are not usually as severe as those evidenced in the current outbreak.

Q: What are the symptoms of SARS?
A: The main symptoms of SARS are high fever ( 38?Celsius), dry cough, shortness of breath or breathing difficulties. Changes in     chest X-rays indicative of pneumonia also occur. SARS may be associated with other symptoms, including headache, muscular     stiffness, loss of appetite, malaise, confusion, rash and diarrhoea.

Q: How contagious is SARS?
A: Based on currently available evidence, close contact with an infected person is needed for the infective agent to spread from
    one person to another. Contact with aerosolized (exhaled) droplets and bodily secretions from an infected person appears to be     important. To date, the majority of cases have occurred in hospital workers who have cared for SARS patients and the close     family members of these patients. However, the amount of the infective agent needed to cause an infection has not yet been     determined.

Q: How should SARS patients be managed?
A: Patients should be placed in an isolation unit. Strict respiratory and mucusol barrier nursing is recommended. It is very     important that suspected cases are separated from other patients and placed in their own hospital room. Health care workers     and visitors should wear efficient filter masks, goggles, aprons, head covers, and gloves when in close contact with the patient.
    Hospital Infection Control Guidance.

Q: What is the treatment for SARS?
A: While some medicines have been tried with some success, no drug can, at this time, can cure the disease. Antibiotics do not     appear to be effective. Symptoms should be treated by adequately protected health professionals.

Q: When will this disease be identified?
A: An international multicenter research project to expedite identification of the causative agent was established on Monday 17     March. Eleven top labs in ten countries are consulting daily and are working together to identify the causative agent. Various     specimens have been collected from cases and post-mortem examinations. Laboratory tests are ongoing and a candidate     causative infectious agent is under investigation.

Q: How fast does SARS spread?
A: SARS appears to be less infectious than influenza. The incubation period is short, estimated to range from 2-7 days, with 3-5     days being more common. However, the speed of international travel creates a risk that cases can rapidly spread around the
    world.

Q: Does the drug Ribavirin cure SARS?
A: Health Canada's Special Access Programme (SAP) provides access to drugs that are not approved for sale in Canada for     patients suffering from serious and life-threatening conditions when other marketed therapies have either failed or are unsuitable.
    SAP is currently providing access to intravenous and oral Ribavirin for use in SARS. These products are not approved for sale in     Canada. The efficacy of Ribavirin in treating SARS is unknown, although it has been used to treat a variety of viral illnesses     including Respiratory Syncytial virus, Lassa fever, and Hanta virus. SAP is working closely with health care professionals at     each of the hospitals involved to gather information on the use of Ribavirin for SARS, and potential adverse effects.

Q: How is SARS diagnosed?
A: In the absence of a laboratory test, doctors are using the following criteria to diagnose SARS:
    people who have recently travelled to affected countries in Asia or who have had close contact with persons diagnosed with
    SARS; and develop a fever (over 38.0 degrees Celsius); and have one or more of the following respiratory symptoms: cough,     shortness of breath or difficulty breathing.

Q: What is the difference between classical/typical pneumonia and atypical pneumonia?
A: Classical/typical pneumonia is mainly caused by bacteria such as streptococcus.
    Atypical pneumonia is mainly caused by viruses such as influenza and adenovirus, bacteria such as chlamydia and
   mycoplasma, and other unknown agents.

Q: What is the difference between influenza and atypical pneumonia?
A: Influenza symptoms such as fever, cough and headache usually subside within a few days without any serious
    complications or signs of pneumonia.

Q: Which countries have reported cases of SARS?
A: Click here for SARS Locator.

Q: What is the difference between a "suspect" and a "probable" case?
A: A "suspect" case of SARS is a person who fits into one of the following two categories:
    a person who develops fever and one or more respiratory symptoms, including cough, shortness of breath or difficulty breathing,     within 10 days of returning from travel to areas in Asia where SARS cases are being reported; or a person who develops fever     and one or more respiratory symptoms, including cough, shortness of breath or difficulty breathing, within 10 days of having
    had close contact with a "probable" case of SARS.
   "Probable" cases of SARS are similar to suspect cases, but often they have a more severe illness, with progressive shortness
    of breath and difficulty breathing, and in some cases, chest x-rays show signs of atypical pneumonia.

Q: Who is at risk of developing SARS?
A: At this time, the only risk factors identified are recent travel to affected countries in Asia, or close contact with a person who
    has SARS. Close contact includes living in the same household, providing health care to someone with SARS, or having direct     contact with respiratory secretions and body fluids of a person with SARS.

Q: Is there anything that can be done to help prevent the spread of SARS?
A: Practising good personal hygiene is a key to stopping the spread of this disease. Thorough hand-washing - using hot, soapy     water and lathering for at least 20 seconds - is the single most important procedure for preventing infections. This is because     disease-causing micro-organisms can frequently be found on the hands.

Q: Is this disease spreading through or being spread by the Asian community only?
A: While identifying the cause of the disease has been difficult, time has shown that its spread is not limited to any one geographic     region, nor is it linked to a particular ethnic group. SARS can be contracted and passed on by any individual, regardless of their     cultural identity or background. The only requirement to becoming infected is by direct, close contact with a SARS affected     individual.

Q: Is there any evidence to suggest air-borne transmission?
A: Based on available information, and the results of scientific analysis, transmission is most consistent with droplets and direct     contact with a patient's secretions.

Q: Is it safe to use public swimming pools?
A: There is no evidence of transmission through swimming. In any case, people feeling unwell should not go swimming.

Q: Is there a vaccine against the disease?
A: A vaccine is not yet available.

Q: How can I avoid contracting the disease in an office setting?
A: If feeling unwell, employees should seek early medical advice and not go to work. All staff should maintain good personal     hygiene and a healthy lifestyle. The office should be well ventilated, and windows opened from time to time. Air conditioners     should be well maintained and cleaned regularly. Office furniture and equipment should be kept clean.

Q: How can I prevent contracting the disease in a lift?
A: Maintain good personal hygiene. Wash hands frequently. Cover your nose and mouth with a tissue when sneezing or coughing.     Wear a face mask if you have symptoms of a respiratory tract infection. Building management should ensure lifts and public     access areas are kept clean - lift control panels and door handles should be thoroughly and frequently cleaned with disinfectant     or a diluted bleach.

Q: Should I take any precautions when visiting a health care facility?
A: People seeking medical consultation should maintain good personal hygiene. Wash hands frequently. Wear a face mask.

Q: What precautions should be adopted if a family member or friend has contracted the disease?
A: People should avoid visiting patients with atypical pneumonia. People who have close contact with patients suffering from the     disease should:
  - Observe quarantine regulations. You will be required to stop work, stay at home and report daily to surveillance centres for 10     days.
  - If you must leave your home, wear a face mask and observe good personal hygiene.
  - If you think you may have had contact with an infected person, wear a face mask for at least 10 days and seek medical advice.
  - At home, clean toys and furniture properly (using a solution of 1 part bleach : 49 parts water).
  - Pay special attention to your health and hygiene. Wash hands frequently.
  - Seek early medical advice if feeling unwell.

Q: Should clothes be washed after visiting hospitals?
A: Yes. Wash them immediately you get home.

Q: What is the Department of Health advice about sharing food at home or in restaurants?
A: Do not share eating utensils. Adopt the good practice of using serving spoons and chopsticks.

Q: Can the disease be prevented by wearing a face mask?
A: Wearing a proper face mask can help lower the risk of infecting the disease. Make sure hands are washed before putting on a     mask.

Q: Who should wear a face mask?
A: The following people should wear a face mask:
   - People with respiratory infection symptoms
   - People who care for patients with respiratory infection symptoms
   - People who have been in close contact with confirmed cases of atypical pneumonia should wear a face mask for at least 10      days from the last contact
   - Health care workers
   - When travelling to places with SARS cases

Q: What type of face mask should be used?
A: An ordinary surgical face mask is effective in preventing the spread of droplet infections.

Q: Is the N95 face mask the only effective model to prevent atypical pneumonia?
A: Surgical face masks and the N95 face mask are both effective in preventing the spread of droplet infections. Wear N95 face      masks, which is recommended by WHO for health care workers, if you are in direct contact with people with SARS symptoms      and are travelling to places with severe SARS outbreak like China and Hong Kong.

Q: How often should a face mask be replaced?
A: In general, a surgical face mask needs to be changed daily. However, replace the face mask immediately if it becomes worn or     damaged.

Q: Is the outbreak in Guangdong Province, China linked?
A: Extensive investigation is under way to better understand the outbreak of atypical (unusual) pneumonia that began in
    Guangdong province in November 2002. Findings from this investigation should help clarify possible links with cases of SARS.

Q: Could this result from bioterrorism?
A: There is no indication that SARS is linked to bioterrorism.

Q: Should we be worried?
A: This illness can be severe and, due to global travel, has spread to many countries in a relatively short period of time. However,     SARS is not highly contagious when protective measures are used, and the percentage of cases that have been fatal is about     5%.

Q: Is it safe to travel?
A: Observe good personal hygiene. Wash hands frequently. Avoid visiting overly crowded places that are poorly ventilated. Wear     face mask. Travellers should be aware of the main symptoms and signs of SARS. People who have these symptoms and have     been in close contact with a person who has been diagnosed with SARS, or have a recent history of travel to areas where cases     of SARS have been spreading, should seek medical attention and inform health care staff of recent travel. Travellers who develop     these symptoms are advised not to undertake further travel until fully recovered.

Q: What is the purpose of a global travel advisory?
A: The purpose of the advisory WHO issued on 15 March </entity/csr/don/2003_03_15/en> is to tell people what SARS looks like     and what they need to report to a physician. The WHO alert does not recommend cancellation of, or change in, travel plans.     Trade and tourism should not be restricted. The purpose of the alert is to heighten the awareness of travellers, health authorities,     and physicians, not to restrict travel.

Q: Could this be the next flu pandemic?
A: Tests have not yet conclusively identified the causative agent of SARS. The possible involvement of an influenza virus was an     initial concern.

Q: What does WHO recommend?
A: WHO recommends that global surveillance continue and that suspected cases are reported to national health authorities. WHO     urges national health authorities to remain on the alert for suspected cases and followed recommended protective measures.     SARS patients should be isolated and cared for using barrier nursing techniques and provided with symptomatic treatment.

Q: How can the public keep apprised of the situation?
A: The public is advised to consult the home page of the WHO website <http://www.who.int> : for daily updates on the outbreak     and relevant press releases. More information is available on the WHO SARS web page which is easily accessed through the     WHO home page or through: Severe Acute Respiratory Syndrome (SARS) <http://www.who.int/csr/sars>. This website will also     provide daily updates on SARS news.  

Q: What is WHO doing?
A: WHO, through the Global Outbreak Alert and Response Network, is working with its partners to track the global dimensions of     this outbreak and coordinate efforts to quickly identify the causative agent, improve diagnostic precision, and provide advice on     recommended treatment. WHO works closely with health authorities in the affected countries to provide epidemiological, clinical     and logistic support as needed.

Q: What are the objectives of the international response to the multi-country SARS outbreak?
A: The aims of the international response, coordinated by WHO, are to:
   - Contain and control the outbreak
   - Identify the causative agent
   - Identify effective treatment regimes
   - Support health care infrastructure in affected countries by coordinating supplies and additional health care workers if needed
   - Provide information to health officials and address public concerns

Q: Are there any positive developments?
A: A significant number of cases in Viet Nam, as a result of good supportive care, have improved. In addition, the global
    surveillance system has proven to be a very sensitive and rapid means of reporting of suspected cases. Health authorities     around the world are now alert to the risk of SARS. Information on cases compiled over the last three weeks is expected to
    shed new light on the behaviour of this disease. Secondary outbreaks have to date been avoided since global surveillance was     put in place and rapid isolation of cases undertaken.

Source from CDC Atlanta, Ministry of Health Hong Kong, Ministry of Health Canada.

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