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Severe acute respiratory syndrome (SARS) is caused by a new virus that appears to spread easily to others. It can cause serious symptoms and be difficult to treat.
SARS is a new illness that is causing concern among medical professionals worldwide because of its ease of spread, the possible severity of symptoms, and the rapid health deterioration seen in some infected patients. SARS has been fatal in about 4% to 6% of cases. Death may result from respiratory failure caused by damage to the air sacs (alveoli) of the lungs.
The first case of SARS was diagnosed in November 2002. The initial outbreaks happened in China and Hanoi, Vietnam.
Cases of SARS were reported in more than 25 countries by the end of April 2003. In most countries reporting SARS, the cases appear to have been limited to individuals who had recently traveled to an outbreak area, as well as to their close contacts and healthcare workers. There have been no new cases of SARS reported since 2003.
Causes

SARS is caused by a newly discovered virus.
There are many families and subtypes of viruses. Scientists have determined that a never-before-seen virus from the coronavirus family is the cause of SARS.
Other viruses in the coronavirus family are common throughout the world. Illnesses caused by coronaviruses are more prevalent in the winter months. Pneumonia and the common cold are examples of illnesses that can be caused by a coronavirus.
SARS is most likely spread when an infected person coughs or sneezes and another person breathes in the unseen droplets released in the air from the cough or sneeze.
How SARS is transmitted is not fully known at this time. Droplet transmission appears to be the primary way the illness is spread.
Touching an object that has been contaminated by someone with the SARS virus may also spread SARS.
Although it has not yet been proven, it is possible that you can get SARS by touching something contaminated with the virus and then touching your eyes, nose, or mouth. Surfaces that may be contaminated with the virus include doorknobs, elevator buttons, telephones, and used tissue.
Frequent and thorough hand washing with soap and water will decrease your chance of becoming ill from SARS, as well as a variety of other viruses and bacteria.
People with SARS are most likely to be infectious (able to give the germ to others) during the time they are having symptoms. Those who have been exposed to the virus but are not ill are not believed to be able to spread the virus.
Individuals who have symptoms of SARS are considered contagious until at least 10 days after symptoms of illness disappear. Those recovering from SARS should avoid contact with others until their clinician says they are no longer contagious.
There is no evidence that people exposed to the SARS virus who are not ill have the ability to pass it to others; however, scientists have not completely ruled out this possibility. The time between exposure to SARS and the onset of symptoms is usually 2 to 7 days, but it may be as long as 10 to 16 days. Therefore, health officials in some countries are encouraging those who have been in close contact with a SARS patient to avoid contact with others for 10 days after their last exposure to the ill person.

Symptoms

The first symptoms of SARS illness usually occur 2 to 7 days after exposure to the virus. The illness often begins with a temperature of 100.4ºF [38ºC] or higher. The temperature often increases and may be accompanied by chills. Later, a dry cough may develop.
Other early symptoms may include headache, body aches, and malaise (feeling generally unwell). A dry cough and mild difficulty breathing may occur soon after. Some SARS patients have also reported dizziness and diarrhea.
SARS patients may develop symptoms serious enough to require hospitalization. About 4% to 6% of SARS patients have died.
SARS can progress into serious respiratory illness. Ten percent to 20% of SARS patients develop respiratory failure severe enough to require a machine to help them breathe (ventilator). SARS pneumonia has been fatal in about 4% to 6% of cases. Death may result from respiratory failure caused by damage to the air sacs (alveoli) of the lungs.
Table 1. Possible Symptoms of SARS

Common early symptoms Temperature of 100.4ºF [38ºC] or higher Chills Body aches Malaise (feeling generally unwell) Headache Symptoms that may appear after the first day or two of the illness Dry cough Mild shortness of breath Dizziness Less common symptoms that may occur Nausea and vomiting Diarrhea Productive (mucus-producing) cough Sore throat Runny nose Risk Factors

You are at risk of contracting SARS if you have had direct close contact with an infected person. An example of this is living in the same house as a person infected with SARS.
“Close contact” includes having lived with or provided care for a SARS patient, or coming in direct contact with the respiratory secretions or body fluids of a SARS patient.
Your risk of contracting SARS is increased if you have recently traveled to an area that is experiencing a public outbreak of the illness. Having close contact with someone who has traveled to these outbreak areas also increases your risk of SARS virus exposure.

Closely monitor your health for 10 days following travel to a SARS-affected area. A clinician should evaluate any onset of fever, cough, or difficulty breathing that occurs within 2 weeks of your last exposure to a SARS-affected region.
Diagnosis

When seeking medical attention, it is important to notify your clinician that you have been exposed to the SARS virus.
Alert your clinician in advance if you may have been exposed to SARS. Exposure to the SARS virus is possible if you have recently traveled to an area known to have a SARS outbreak, or if you have had contact with a known SARS patient. Close contact with an ill person who recently traveled to an outbreak area might also increase your chance of exposure to SARS.
If your clinician suspects you may have an illness caused by the SARS virus, special precautions will be taken to prevent transmission of the virus to others. Precautions may include isolating you from other patients, having you wear a surgical mask, and having visitors and medical personnel wear special protective equipment.
Your clinician may ask questions about past illnesses, recent travel, and other things that may provide clues to the cause of your symptoms.

You should tell your clinician about any symptoms you have. Report any recent travel (or contact with someone who has traveled) to a SARS-affected area. Your clinician will use this information to determine if you fit the criteria for a suspected SARS case, as defined by the CDC.
A physical examination is necessary if you are having symptoms of SARS. An exam may help your clinician determine the extent and cause of your illness.

Your clinician will listen to your heart, lungs, and chest through a stethoscope. Your clinician will also check your temperature, pulse rate, blood pressure, and breathing speed. The information gathered during your physical examination may help your clinician determine if your illness is mild or serious.

Chest x-rays may be necessary.
Some people with mild symptoms can be effectively treated without having a chest x-ray taken. However, a chest x-ray is often needed to determine the extent of your illness and to look for other abnormalities.
Chest x-rays may show a specific type of pneumonia, which may help clinicians diagnose SARS as the cause of your illness. Chest x-rays can also show complications of SARS, such as acute respiratory distress syndrome (ARDS).

It is possible to have SARS even if you have a normal chest x-ray, especially early in the course of the illness.
Laboratory tests may help determine the cause of your illness, how your body is tolerating it, and what medications may effectively treat it.
Your clinician may draw your blood for laboratory testing. A sputum sample (mucus coughed from the lungs) may be taken to help identify possible medications to treat your infection. Swabs may also be taken from your nose and throat for testing. These tests can help your clinician determine the cause of your illness. Tests can also help in evaluating how your body is tolerating the illness.

If you are having breathing difficulties, you may be given tests that assess your lungs' ability to move oxygen into the blood. These tests include pulse oximetry and an arterial blood gas test.

Table 2. Could Your Illness Be SARS?

You may be ill with SARS if you meet the following criteria: You have a respiratory illness of unknown cause that started after February 1, 2003. You have a temperature of 100.4ºF [38ºC] or greater. You have symptoms of respiratory illness, or a chest x-ray that shows lung changes characteristic of a SARS illness. You have been exposed to the SARS virus. Exposure could happen in the following ways:

• You traveled to an area with an active SARS outbreak within 10 days of the onset of your symptoms (including an airport layover in an affected area).You've had close contact within 10 days of the onset of your symptoms with a person with suspected or confirmed SARS.You've had close contact within 10 days of the onset of your symptoms with a person who has a respiratory illness and who recently traveled to an area with a SARS outbreak.

Adapted from: Updated Interim U.S. Case Definition of Severe Acute Respiratory Syndrome (SARS), Department of Health and Human Services, Centers for Disease Control and Prevention.

Prevention and Screening

The CDC recommends avoiding travel to areas that are experiencing SARS illness in their community.
Daily updates of the number of SARS cases and regions affected can be found at the CDC website. The site includes recommendations for travel to foreign countries. Consult your clinician to discuss the most current risks of international travel.
Table 3. CDC Travel Recommendations

Recommendation Comments Postpone nonessential travel to countries with reported SARS outbreaks. Check the CDC website for the most up-to-date travel warnings available. Do your homework before you travel. Check your health insurance to ensure you would be covered if you fell ill and needed medical transport back to the U.S. Check with the U.S. Department of State (DOS) to find out about healthcare services in the areas you will be visiting.

Be sure your vaccinations are current before traveling outside of the country. See your caregiver at least 4 to 6 weeks before you travel outside of the country. Although there is no vaccine that prevents SARS infection, it is still important to tell your caregiver where you plan to travel so they can ensure you receive the appropriate vaccinations. Pack first-aid supplies and take them with you. Take a first-aid kit that contains basic medical supplies. Include a thermometer, disinfectant, and surgical gloves. Take measures to help prevent contracting the SARS virus while traveling. Wash your hands as much as possible while traveling. Use an alcohol-based antimicrobial hand rub solution for hand cleansing when soap and water are not available.

Avoid close contact with large groups of people whenever possible. Know what to do if you become ill while visiting a SARS-affected area. Seek medical care. Call the U.S. Embassy or Consulate if you do not know of any healthcare provider in the area. Notify the medical staff that you may have SARS before you go to the clinic so that they can take precautions to protect others. Cancel or postpone any further travel. Limit contact with other people as much as possible. Wear a surgical mask when around others. If a surgical mask isn't available, cover your mouth and nose with tissue when coughing and sneezing.

Adapted from: Advice for Travelers about SARS. Department of Health and Human Services, Centers for Disease Control and Prevention.

Accessed April 10, 2003.
People who suspect a household member may have SARS should take special precautions to protect themselves and the public.

It is important to protect yourself when caring for or living with a person who has SARS. It is also the responsibility of all household members to protect the public from the spread of SARS.
Frequent and thorough hand washing is the first step in preventing the spread of any contagious illness. Because of the highly contagious nature of SARS, isolation of the SARS patient is necessary during the illness and for at least 10 days after the symptoms have disappeared.

Table 4. Precautions to Take When Caring For a Household Member With SARS

The following precautions should continue until a clinician has determined that the SARS patient is no longer contagious. Anyone ill with SARS should limit interactions outside of the home. SARS patients should not go to work, school, day care, or other public areas until everyone in the household has been symptom-free for at least 10 days. Other members of the household do not need to stay home unless they develop symptoms of illness. Anyone who may have been exposed to SARS should monitor their health closely. Seek medical attention if fever or respiratory symptoms develop.

Inform caregivers that you may have been exposed to SARS. Protect caregivers and visitors from exposure to infectious airborne droplets. These droplets cannot be seen. They are released into the air when a SARS patient coughs or sneezes.

The SARS patient should wear a surgical mask when others are in the room. If the patient cannot wear a mask, then anyone coming into contact with that person should wear a mask. The patient should cover their mouth and nose with tissue when coughing and sneezing. All household members and visitors should practice good hand hygiene. Wash hands thoroughly with soap and water before and after contact with a SARS patient or any object that has come in contact with the patient. Disposable gloves can reduce hand contamination by 70% to 80%. However, gloves DO NOT replace good hand washing. Use disposable gloves when coming in contact with any body fluids of a SARS patient. Discard the gloves immediately after use (don't reuse), and wash your hands right away. When soap and water is not available, use an alcohol-based antibacterial hand rub to clean your hands.

SARS patients should not share eating utensils, towels, or bedding. Others can use these items after the items are washed or laundered with soap and hot water. Surfaces touched by SARS patients should be frequently disinfected. Frequently disinfect doorknobs, phones, toilets, sinks, and other surfaces touched by patients with SARS. Wear disposable gloves when cleaning. Common household cleansers are sufficient to achieve disinfection. Follow directions on the label, and disinfect often. Soiled household waste, such as tissues or used surgical masks, can be disposed of like normal trash. Use gloves when gathering and bagging household waste. Always wash your hands after removing and disposing of the gloves. Treatment

Urgent Care

Any significant trouble with breathing requires immediate medical attention.
It is important to seek medical attention immediately if signs of serious breathing difficulty occur. These signs may include shortness of breath; lips or nail beds that are turning dusky, gray or blue; and breathing that is so difficult that you become tired. Confusion, dizziness, and fainting are also signs that hospitalization may be necessary. Oxygen, intravenous medications, and close monitoring may be required. Approximately 10% to 20% of individuals with SARS require help breathing from a machine (ventilator) for a period of time.

Seek immediate medical attention if you are concerned that your symptoms are getting worse. Dial 9-1-1 or 0 for an ambulance if you develop breathing problems or have dizziness or fainting. Do not try to drive yourself to the hospital. Warn medical personnel that you may have the SARS virus so that they can take appropriate infection control measures to protect themselves and others.

Table 5. Warning Signs That Your Illness Is Serious

If you experience any of the following signs, seek medical attention immediately. Trouble getting your breath Difficulty breathing that is so severe you become worn out Nail beds and lips that are turning gray or blue Dizziness, confusion, or fainting Scientists are still researching the best drug therapy to treat SARS. Currently, clinicians are treating seriously ill SARS patients with antibiotics, steroids, inhaled medications to help breathing, and antiviral medications.

Your clinician is the best source of information on the most up-to-date drug treatment choices available for SARS. Ask your clinician or pharmacist for more information on any medications prescribed or recommended.
Self Care

If your SARS symptoms are mild, you may recover at home.
The SARS virus can cause symptoms that range from mild to severe. Some people are able to recover at home. It is important that individuals recovering from SARS minimize their contact with others until all signs of illness have been gone for at least 10 days.

Drink plenty of liquids (preferably water), eat healthy foods, and get plenty of rest. Over-the-counter medications such as aspirin or acetaminophen may help with fever and muscle aches.

Table 6. Ways to Take Care of Yourself While Recovering From SARS

Drink plenty of water (at least 6 to 8 large glasses a day). This can help you cough up any extra secretions in your lungs that may make it hard for you to breathe. Take ibuprofen, or acetaminophen for fever, aches, and pains. Ask your clinician or pharmacist which medicine is right for you.
Always follow the directions on the label unless otherwise instructed by your clinician. Avoid alcohol, since it can reduce the coughing and sneezing reflexes needed to clear your lungs. Drinking alcohol can interfere with the effectiveness of many other medications and can increase your risk of serious side effects when you are taking certain medicines.

Do not smoke. Wash your hands frequently. This can help minimize your chance of becoming ill with another germ while your body is recovering from SARS. Eat a well-balanced diet. Ask your clinician about any vitamins or supplements that may be right for you. Do not take a cough suppressant unless your clinician recommends it. You may need to take a cough suppressant at night if your cough makes it difficult for you to get enough rest. Use cough suppressants sparingly, and only if directed by your clinician. Be sure to get at least 8 hours of rest a night, preferably in a warm room. You may need extra rest, such as naps, while recovering from SARS. Keep your clinician informed should your symptoms worsen. Contact your clinician if your medication causes any unpleasant side effects. Smoking when ill with SARS can make your illness worse and delay your recovery.

Smoking reduces the ability of the cilia in the lungs to function effectively. Cilia are small, hair-like cells that move to propel secretions, germs, and foreign particles out of the lungs. Having trouble coughing up the extra secretions in your lungs may cause you to feel worse or to feel sick longer. Your clinician can inform you of a number of medications and programs available to help you quit smoking.

Drug Therapy

Your doctor is the best source of information on the drug treatment choices available to you.
Prognosis

SARS pneumonia can be serious, even life-threatening.
Approximately 10% to 20% of SARS patients develop serious breathing problems that require intensive care and respiratory support (ventilator). SARS has been fatal in about 4% to 6% of cases. Those who are elderly or who have a weakened immune system because of other health problems are more likely to develop serious complications from SARS.
The course of SARS can vary widely. Some may be only mildly ill; others may require hospitalization.

Some people who came in close contact with a SARS patient later developed a fever but did not develop respiratory symptoms. This may mean that illness from the SARS virus does not always progress to breathing problems.

How long it takes people to recover from SARS depends on their age, their general health, and the severity of their illness.
Middle-aged or elderly people may take longer to regain their strength. It is important for those recovering from SARS to continue to take care of themselves, avoid sick people, and get plenty of rest.