SARS Update to Date

Medical Author: Frederick Hecht, M.D.
Medical Editor: Barbara K. Hecht, Ph.D.

April 1, 2003 -- The New England Journal of Medicine has released two articles and an editorial about SARS (severe acute respiratory syndrome), well before they were scheduled to appear in the Journal, because of their important public health implications. The articles and editorial are designed to help physicians caring for patients who may have SARS . They are as follows:

"A Cluster of Cases of Severe Acute Respiratory Syndrome in Hong Kong" by K.W. Tsang and Others. This article outlines the clinical features of SARS based on the cases of 5 men and 5 women in whom SARS was diagnosed between February 22 and March 22, 2003 in Hong Kong. Exposure between the source patient and subsequent patients with SARS ranged from minimal to close. The incubation period was 2 to 11 days. All patients had fever (temperature over 38°C or 100.4°F for over 24 hours), and most of them had dry cough, dyspnea (difficulty breathing), malaise, headache, and hypoxemia (low blood oxygen). Nine of the 10 patients also had lymphopenia (low lymphocyte count) . Chest films showed progressive air-space disease. Two of the 10 patients died of progressive respiratory failure. Fever followed by rapidly progressive respiratory compromise is the key complex of signs and symptoms from which the syndrome derives its name.

"Identification of Severe Acute Respiratory Syndrome in Canada" by S.M. Poutanen and Others. SARS was first identified in Canada in early March 2003. This report is based on the first 10 cases identified in Canada. The patients ranged from 24 to 78 years old. Transmission occurred only after close contact. The most common symptoms were likewise fever, malaise followed by nonproductive cough and trouble breathing. Lymphopenia and elevated liver enzymes were common. Mechanical ventilation was required in 5 cases. Three patients died. The human metapneumovirus and a novel coronavirus were each found in the respiratory secretions from 5 of 6 patients. In 4 cases both viruses were isolated. In conclusion, SARS is associated with substantial morbidity (death) and mortality (death). It appears to be transmitted by droplet or contact.

Editorial: Case Clusters of the Severe Acute Respiratory Syndrome by J.M. Drazen, the Editor-in-Chief of the Journal. Dr. Drazen addresses physicians and other health personnel:" We all hope that this disease will burn itself out soon, but it is foolish to rely on hope alone. The key word now for medical personnel around the world is caution but not panic...if you encounter a suspected case." Dr. Drazen suggests. "Take the isolation precautions for known cases very seriously...keep a high index of suspicion, since the epidemiologic link to known cases may be blurred. I would err on the side of obtaining oxygen saturation values and obtaining chest radiographs for patients with equivocal or abnormal findings on physical examination."


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