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Question 1. What is SARS?

SARS is severe acute respiratory syndrome. This means that the disease is severe. The term acute indicates that the disease may start suddenly or develop rapidly.

Chinese travellers wear masks to ward off SARS as they line up to board trains at a railway station in Beijing April 23, 2003. An increasing number of people are leaving China’s capital after the disclosure by government of the outbreak of Severe Acute Respiratory Syndrome (SARS). SARS has killed 28 people and infected 588 in Beijing as of April 22. REUTERS

The main symptoms are related to the respiratory tract or the breathing passages and syndrome means that there are a similar group of signs and symptoms in patients suffering from the disease. (See Q 2).

Question 2: How can SARS be recognised?

The illness usually begins with fever (temperature is about 100.4 F or 38 C). The fever is often accompanied with chills, headache, discomfort and body aches (pain in the muscles). There may be mild signs related to breathing passages in the beginning.

After 2-7 days, the patient develops a dry cough that progresses to breathing difficulty. This breathing difficulty becomes severe in some of the patients. (See Q 13).

However as these symptoms, up to a point mimic flu, you should suspect SARS only if the patient has visited a country or an area where SARS is occurring or the patient has come in contact with someone suspected to be suffering from the disease.

X-ray chest in some of the patients with SARS indicates atypical pneumonia i.e. infection of the lung caused by germs or microorganisms other than the ones that usually cause pneumonia.

Question 3: How is SARS different from 'flu' (or sometimes known as common cold)?

'Flu' is a general term applied to many acute respiratory infections although influenza is blamed often as the cause of 'flu'. In contrast SARS is believed to be caused by a new corona virus. This virus is usually found in persons suffering from ordinary cold. Reasons why the corona virus causes severe acute respiratory infection (ARI) are not clear. SARS is not as contagious as 'flu'. Atypical pneumonia and breathing difficulty are more common in SARS than in 'flu'.

Question 4: Why is there so much concern about SARS?

There is worldwide concern about SARS because the disease has spread to many countries and several continents in a relatively short time, and continues to involve new areas. SARS is causing deaths in some of the affected patients. Many more need to be admitted to the hospitals and some require intensive care.

The disease at present has affected health care workers and people coming in close contact with those suspected to be suffering from SARS. There is concern that unless SARS is contained and rooted out urgently, this disease might become a continued problem.

Besides, at present, there is no cure (See Q 20) and no vaccine to prevent the disease (See Q 21).

Question 5: How severe is SARS? Can it lead to death?

SARS cannot be considered a mild disease. Fortunately, a majority, up to 90 per cent of SARS patients with proper healthcare, do recover without going into complications.

However, 10 per cent develop severe complications such as breathing difficulty or pneumonia. Of these, about 3-4 per cent of the SARS patients die.

Question 6: What is the cause of SARS?

Scientists in many laboratories around the world have been trying to find the cause of SARS. A new Coronavirus is the cause of the disease. It is believed to be a new coronavirus because the known corona virus infections cause only a mild ARI in human beings, while they also cause disease in animals - cats, dogs, pigs, mice and birds.

Question 7: Can the diagnosis of SARS be confirmed?

Some laboratory tests can be done on suspected cases and efforts are ongoing to develop diagnostic tests that can be widely used.

Question 8: How widespread is SARS, how many cases of the disease have been reported?

The figures are changing everyday. On 12th April, SARS has been reported from 19 countries in Asia, Australia, Europe, Latin America, USA and Canada. At present, except for very small countries, the disease has remained confined to areas in larger countries and not spread throughout the country. WHO has reported 2960 cases of SARS with 119 deaths up to 12th April, 2003. These numbers are going up.

Question 9: How does SARS spread and for how long does a person remain a risk to others?

When someone sick with SARS coughs or sneezes, the droplets of infection can infect others who are nearby. Many other illnesses like TB and smallpox have been known to spread in a similar way. It is believed that SARS virus can travel short distances. The virus can survive for some time after coming out from the patient. Whether infection can be spread through the objects contaminated by the infected persons, is not certain yet though it is being verified.

Most patients with SARS can spread infection to others as long as they have signs of the disease. It is therefore advised that a patient who is suspected to be suffering from the symptoms of SARS should be kept isolated for a period of 10 days after the cough and fever have subsided.

Question 10: Is it safe to travel by air or by other means of public transportation during the SARS epidemic?

International travellers should follow the travel advisory that is issued and updated regularly by WHO. This travel advisory provides guidelines for international travel. It states clearly which geographical areas are suspect for transmission of disease, and therefore, people should avoid visiting.

It also gives guidelines for actions by passengers travelling from infected areas and for airline and airport staff. Such an advisory is prepared after due consultation with the countries affected. For national travel, the guidance issued by national authorities should be followed. In areas from where the SARS epidemic is reported, the advice would be to avoid crowded areas, including public transportation.

However, if you need to travel on the public transport system e.g. bus, train and other shared vehicles, it is advisable to keep your mouth and nose covered to avoid possible exposure to the infection.

Question 11: What is the advice on children going to school if SARS is occurring in the area?

The decision to close down the schools and educational institutions is made by the local authorities and it is based on the advice from health department. If SARS is a problem and schools have been closed, then children should stay at home. They should avoid going to crowded public places to prevent getting infected from a patient with SARS. This will help to prevent infection from SARS patients to others.

Question 12: What is the advice about visiting crowded public places to prevent SARS?

Crowded public places e.g. shopping malls (bazaars, cinema halls, stadiums) should be avoided during the epidemic of SARS. If they have to be visited, then precaution of covering the mouth and nose completely should be observed. (See Q 11).

Question 13: If exposed to SARS how long does it take for a person to develop the illness?

After exposure to the disease, it takes about 2-7 days for the exposed patient to develop the first symptoms of the disease. In some cases this period, may be as long as 10 days. As mentioned already the first symptom is fever with temperatures above 100.4 F or 38 C. (See Q 2).

Question 14: When was SARS first reported? From where did the outbreak start? On 26th February, 2003, a man was admitted to a hospital in Hanoi, Vietnam with symptoms of SARS. It is believed that the epidemic originated in Guangdong province in China in November 2002. (See Q 17).

Question 15: Are there any travel restrictions relating to SARS?

The travel advice is announced regularly by WHO in consultation with the countries involved. The new travel advice is intended to limit further international spread of the epidemic of SARS by restricting travel to areas where the reasons for the pattern of spread of the disease are not well understood.

This advice is proposed to be reviewed regularly by the experts and will change as more information becomes available. Local health authorities should be contacted to get up to date details about the affected areas. (See Q 10).

Question 16: Is SARS related to bioterrorism?

According to currently available information, SARS does not seem to be related to bioterrorism.

Question 17: What may be the origin of SARS?

It is very difficult to be certain how this new disease originated. What we understand though not conclusively is that it probably started in November in Guangdong province of China. How it originated there is difficult to state. The first acquisition of the disease may have come from an animal or a bird that are in close proximity to the humans. (See Q 14).

Questions 18: Who are the people at the risk of getting SARS?

* Travellers and businessmen who have travelled to countries that are reporting SARS.

* Health care workers who are responsible for providing care to patients suspected of SARS. Those who do not observe the recommended infection control measures are at risk.

* Household members of patients suspected to be suffering from SARS. 

Q 19. How should these people, who must deal with a SARS patient, protect themselves? In the household, measures to control the spread of SARS should be continued for 10 days after the symptoms of fever, cough and respiratory system are gone. Patients suspected to be suffering from SARS should not go to work, school and other public places especially crowded places. Since the disease spreads mainly by coughing or sneezing, patients suspected of SARS should wear a specially designed mask.

People who are in close contact with a patient suffering from SARS should also wear such a mask. If this is not available use a surgical mask to get at least some protection from the disease. Use disposable gloves while handling the body fluids of the patients suffering from SARS. The gloves should be discarded after use and the hands should be cleaned thoroughly with soap and hot water.

Sharing of utensils, towels, bedding of a SARS patient with other members of family should be avoided. The above items should be washed thoroughly with soap and hot water before reuse. Toilets, sinks, and other surfaces should be cleaned several times in the day with ordinary household cleaners. Hand hygiene is important. Hands should be thoroughly cleaned frequently with soap and hot water to prevent the spread of SARS. Used masks and gloves should be burnt promptly and not reused.

Question 20. Is there a cure for SARS?

So far, there is no specific cure for SARS. The disease should be treated like an atypical pneumonia of unknown cause. Nor is there any specific treatment for SARS. Regular consultations are going on amongst doctors to discuss the best treatment of the disease. Antibiotics are given but they are of doubtful value.

Antibiotics may be useful in tackling secondary infections. In the patients who are admitted, antivirals and steroids are given but their role is not established. Supportive treatments for the symptoms and care have helped to a large extent eg. medicines like Paracetamol to bring down the fever, and provision of ventilators to be 20% of the patients with breathing difficulty who may require them. Remember that 96% of all SARS patients have fully recovered with proper care and treatment.

Question 21. Can SARS be prevented by a medicine or a vaccine?

There are no medicines or vaccines that are known to prevent SARS (See Q 20 for treatment).

Question 22. What is the advice on the masks and gloves in the prevention of SARS? Persons who are in close contact with a SARS patient should use an appropriate mask.

Those who handle the body fluids of patient with SARS should also wear disposable gloves that should be discarded after use. Health workers should observe special care to protect themselves since they are at greater risk of getting the disease.

Ordinary masks do not protect against SARS, but there are masks that provide about 95% protection. WHO recommends the N95 or the N100 masks. These are disposable and can be used for a period up to 8 hours after which they must be replaced with a fresh mask. Health-care workers must wear a mask when in contact with a SARS patient or while handling the body fluids of the patient. Masks need to be worn only by those who are in close contact with a patient suspected of SARS. Others who are concerned about getting the disease because their work is likely to expose them to risk of getting the disease should seek guidance from their employer on how to protect themselves. In other situations when the contact is not close, cover your nose and mouth with a tissue or clean handkerchief making sure that the mouth and nose are completely covered.

Priority for using masks is for health care workers attending SARS cases. Next are household contacts who are care-givers for the SARS patient.

Question 23 What should a person suspected to be suffering from SARS do?

SARS should be suspected if the patient has fever and other signs suggestive of the disease and has been in close contact with SARS patients or visited areas of countries with known cases of SARS (See Q 2).

A health care worker should be contacted or a hospital facility visited and the patient suspected of the disease should inform the health care provider of any recent visit to a country/area where SARS is being reported or provide the history of contact with a patient suspected to be suffering from SARS. When the patient complains of breathing difficultly or shortness of breath, hospitalization is advised (See Q 20).

Question 24 What is your advice to the health care workers regarding prevention of SARS?

As mentioned already, health care workers have a greater risk of getting SARS since they come into contact with them than the people in the general population. They are at greater risk since they come in close contact and are exposed to the body secretions that are infected. Health care workers should be vigilant and they should carefully screen those who have fever, cough or other symptoms of SARS.

Health care workers who have symptoms of SARS and have a history of exposure to patients with SARS should not report for duty until 10 days after the relief from fever, cough and other respiratory symptoms. During this period they should stay away from the other health care workers, hospital staff and the community.

Infection control measures that are recommended by the hospital/ health facility should be strictly followed. They must wear masks of proper specifications, gloves, goggles and aprons while handling patients suspected of suffering from SARS or while handling their body fluids (See Q 22).

Question 25 What are the positive developments in the control of SARS?

As a result of the global alert and response network, assistance to national authorities, probably the rapid spread of SARS has been checked. There is heightened awareness about the disease in the public, the media and the national governments. There is now improved understanding of the cause of SARS and how it may be spreading in many countries who are reporting the disease. Recommendations on supplies and various control measures to check the spread of the disease are being made.

This epidemic is likely to convince the national authorities to strengthen infection control measures in hospitals and health facilities.

Question 26 What was WHO done to control SARS?

Who through its global alert and response network is working with its partners to track the epidemic. It is coordinating the effort through the various laboratories and WHO collaborating centres to identify the cause of the disease.

WHO is helping to improve the understanding on how the disease is spreading. In consultation with the national governments and partners WHO has issued travel advisories and this continues to be updated. It has established web for information sharing. Technical and logistic support is being provided to countries on request. Initial essential supplies kits to control the disease are being made available to the countries.

For any further information, please contact: Mrs. Harsaran Bir Kaur Pandey, Information Officer, WHO South-EASt Asia Region Office, New Delhi, Contract details: Mobile: 98-110-21001 and land line # 23370971 (Direct) and 23370804 (Extension: 26401/26424)

(World Health Organisation Regional Office for South East Asian Region)

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