Global Alert and Response (GAR)

Frequently Asked Questions on Severe Acute Respiratory Syndrome (SARS)

24 March 2003

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, no drug can, at this time, be recommended for prophylaxis or treatment. Antibiotics do not appear to be effective. Symptoms should be treated by adequately protected health professionals. As a result of good supportive care, some patients in Hanoi have been transferred from critical care wards to regular wards.

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 : Where and when was the first case of SARS reported ?

A : On 26 February, a man was admitted to hospital in Hanoi with high fever, dry cough, myalgia (muscle soreness) and mild sore throat. Over the next four days he developed increasing breathing difficulties, severe thrombocytopenia (low platelet count) and signs of adult respiratory distress syndrome requiring ventilator support.

Q : How many cases of SARS have been reported to date ?

A : From 1 February to 24 March, 456 cases including seventeen deaths have been reported. In the early stages the symptoms are similar to those of many diseases including influenza. Heightened awareness about the disease, and the vigilance of health authorities around the world, have resulted in a close watch for suspected cases and rapid and thorough reporting. Not all of these suspected cases may prove to be SARS. There are many reports and rumours coming in from around the world, but quite a few of these will turn out to be normal wintertime activity of diseases like influenza whose early symptoms are similar. The cumulative number of cases and deaths is continuously updated on the WHO web site .

Q : How many countries report cases of SARS ?

A . As of 24 March, cases had been reported from thirteen countries. Of these, four countries have only imported cases with no documented local transmission, indicating that the disease is not spreading in these countries and residents are not at risk.

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 several 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 low. Since the WHO global alert issued on 15 March, only isolated cases have been identified and no secondary outbreaks have occurred.

Q : Is it safe to travel ?

A : WHO has not recommended restricting travel to any destination in the world. However, all travellers should be aware of the main symptoms and signs of SARS, as given above. 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 Marchis 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: 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) Many national authorities have also established web sites with excellent information for both the general public and the medical profession.

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.

A WHO/Global Outbreak Alert and Response Network team of epidemiologists, case management, infection control and laboratory experts is assisting national health authorities particularly in Vietnam. The Hanoi team has received personnel and supplies from a number of organizations throughout the world. WHO epidemiologists are also supporting investigations in Hong Kong and China.

Q : What are the objectives of the international response to the multi-country SARS outbreak ?

A : The overarching 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.

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