FEATURED BOOKS ON SARS FROM BARNES & NOBLE.COM

WHAT IS IT?

Severe acute respiratory syndrome (commonly abbreviated as SARS) is a potentially deadly and highly contagious virus.

WHAT ARE THE SYMPTOMS OF SARS?

The symptoms of SARS typically begin 2 to 7 days (or as many as 10 days) after the virus responsible for it has attacked a vulnerable individual. The first symptom of SARS is usually a fever over 100.4 degrees. Some patients report diarrhea associated with the fever. Diarrhea is loose watery feces (poop).

One or more of the following symptoms of a breathing illness must also occur for a diagnosis of SARS to be made: cough, difficulty breathing, shortness of breath, low oxygen in the blood, or x-ray findings of pneumonia. Pneumonia is inflammation of the lungs due to infection. The lungs are two organs in the body that help people breathe. The lungs can become firm and less elastic in SARS. Sore throat can also occur.

The breathing difficulties in SARS patients are usually mild. The fever is sometimes accompanied by chills, headache, body aches, or a feeling of discomfort. The cough usually develops in 2 to 7 days after symptom onset. The cough is usually dry, in which no mucus (a thick slippery fluid) comes up. The cough can get so bad that less oxygen gets to the blood. In 10 to 20% of the cases, patients will need mechanical devices to help them breathe.

To be diagnosed with SARS infection, one must have the symptoms above and must have either: (a) traveled to China, Vietnam, Taiwan, Hong Kong, or Singapore, or (b) cared for, lived with, or been exposed to the body fluids and/or sneezing and coughing of someone infected with SARS.

ARE THERE ANY LABORATORY FINDINGS CONSISTENT WITH SARS?

Yes. At the worst part of the illness, about 50% of SARS patients have been shown to have thrombocytopenia or leukopenia based on blood test results. Thrombocytopenia is a reduction of the number of platelets in the blood. Platelets are cells that help stop bleeding by changing the blood from a liquid to solid form. A cell is the smallest, most basic unit of life, that is capable of existing by itself. Leukopenia is an abnormal decrease in the number of white blood cells. White blood cells help protect the body against diseases and fight infections.

WHAT PUTS PEOPLE AT RISK FOR SARS?

Risk factors for getting SARS include being in close contact with someone that already has the disease, such as living with the person. Health care professionals, such as nurses and doctors, are also at risk when caring for patients with SARS symptoms if they do not follow the proper procedures to prevent infection. Recently (since March 2001) traveling to Hong Kong, Vietnam, China (especially southern China), or Singapore also puts one at risk for being infected with SARS because these are the places where SARS is found in the greatest numbers. For this reason, the Center for Disease Control and Prevention suggests that people may wish to postpone their travel to these countries if the trip is non-essential. It is believed that SARS may have originated in southern China.

WHAT CAUSES SARS?

On April 16, 2003 scientists from the World Health Organization announced that a type of coronavirus causes SARS based on experiments performed on monkeys at Erasmus University in Rotterdam, Netherlands. The coronavirus is a group of viruses that are named for their crown-like (corona) appearance when seen under a microscope.

Coronaviruses can survive in the environment for up to three hours. Coronaviruses usually cause infections of the upper respiratory tract. The upper respiratory tract includes the nose, throat, sinuses, and larynx. Sinuses are openings in the bones that often contain fluid. The larynx is an organ located at the upper part of the windpipe that produces voice.

The coronavirus has also been known to cause pneumonia, especially in patients with weak bodily defenses against infection. Pneumonia is inflammation of the lungs due to infection. The lungs are two organs in the body that help people breathe. The coronavirus can also cause the common cold. It can also cause severe diseases in other animals, such as birds, pigs, mice, cats, and dogs.

Scientists discovered that a type of coronavirus causes SARS because this virus was been found in the tissues of patients that have this disease. Blood tests then showed that these patients were recently infected with the coronavirus. The coronavirus has also been found in some patients after their nose and throat was swabbed. The coronavirus that is responsible for SARS is a new form of the virus that came from an animal. There is no chance that the virus that causes SARS is man-made.

On May 23, 2003, scientists in Hong Kong announced that SARS most likely came from the civet cat, although they are not 100% sure. Scientists say that they have found a type of coronavirus in the feces (poop) of the civet cat and in some of the liquids released from their bodies while breathing. Civet cats are cat-like creatures with long tails and weasel like bodies. Civet cats are a delicacy eaten in southern China, which is where the outbreak appears to have originated. Scientists believe that the coronavirus was transmitted from the civet cats to humans at some point when the civet cats are killed and/or eaten. Civet cats are usually killed in unsanitary conditions in China.

HOW IS SARS SPREAD?

SARS is spread when other people breathe in droplets in the air from the sneezing or coughing of someone that is infected with SARS. SARS may also be spread when people touch objects (such as door handles and water taps) that have been contaminated by someone else with this disease. The SARS virus has been found to be able to stay alive on cool surfaces for up to 4 days. It is not clear at this time how long somebody with SARS is capable of spreading it to someone else.

Scientists have discovered that the SARS virus can stay alive in diarrhea (loose poop) for up to 4 days. This means that the disease may also be spread through sewer pipes. The SARS virus can probably stay alive longer in diarrhea than in regular feces (poop) because diarrhea has less acid.

Scientists believe that there are some individuals known as "super spreaders" that are capable of spreading the disease to many people. It appears that super spreaders were people infected with SARS very early in the SARS outbreak, before health officials knew what kind of preventative measures to take. Since preventative measures have been used, no new super spreaders have emerged.

A top Hong Kong official has suggested that SARS may be spread through cockroaches and rats. That is, it is suggested that cockroaches and rats may transport the SARS virus and pass it on to humans.

HOW DANGEROUS IS SARS?

SARS is a disease that spread quickly around the world, although at present, it seems to be contained. As was mentioned earlier, SARS can kill people that are affected with it. Specifically, about 6% of people infected with SARS die from it. The World Health Organization has described SARS as a "worldwide health threat." On April 4, 2003, president Bush added SARS to the list of diseases that can lead Americans to be quarantined. In the medical sense, quarantine means to isolate from normal relations or communications to prevent the spread of a disease or illness.

HAS SARS HIT THE UNITED STATES?

It appears so. Specifically, there are 38 states in which there are suspected or probable SARS cases. California has the most suspected cases (29) followed by New York (28) and Washington (13). Overall, there are 175 suspected cases of SARS in the United States. Of these suspected cases, only 36 are considered probable cases of SARS. California has the most number of probable cases of SARS (23). Probable cases of SARS are those in which people have more severe breathing difficulties and pneumonia (inflammation of the lungs due to infection). People with probable cases of SARS have evidence of pneumonia on a chest x-ray. No one in the United States has died from SARS yet. This information was updated on 9/20/03.

WHAT OTHER COUNTRIES HAVE BEEN AFFECTED BY SARS?

Besides the United States, there are 31 countries that have been affected by SARS. The countries with the greatest number of suspected SARS cases are China (5327), Hong Kong (1755), Taiwan (671), Canada (250), and Singapore (206). As was mentioned above, the United States has 36 suspected cases. The most number of deaths from SARS have been in China (348) and Hong Kong (298). There are 8398 suspected cases of SARS in the world. This information was updated on 9/20/03.

HOW MANY PEOPLE HAVE DIED FROM SARS?

813 people have died from SARS as of 9/20/03.

WHERE AND WHEN DID SARS BEGIN SARS?

No one exactly knows for sure. But SARS was first identified in southern China in November of 2002. More specifically, it is thought to have begun in the province of Guandong in southern China. SARS began spreading to other countries in March of 2003.

IS THERE A TEST FOR SARS?

At this time there is no test for SARS, but scientists are working on developing one. The tests developed at this point in time have been inconsistent.

HOW IS SARS TREATED?

At present, there is no cure for SARS. SARS is such a new medical problem that it is not currently known how best to treat it. There is presently no cure for SARS. Some doctors have used antibiotics (medications that kill bacteria) to treat SARS, since these medications have been used to treat conditions with similar symptoms. Antiviral medications (drugs that fight against a virus), such as ribavirin and oseltamivir, have been used to treat SARS as well. Different antiviral drugs are being used to see how well they can fight against the coronavirus, which is suspected of being the cause of SARS, as discussed above.

Sometimes, steroids have been given in combination with antiviral and antibiotic medication to treat SARS. Steroids are any of a large number of hormone substances with a similar and basic chemical structure. Hormones are natural chemicals produced by the body and released into the blood that have a specific effect on tissues in the body. So far, global health officials have not seen good results with steroids and ribavirin (see last paragraph). Only some patients have responded to steroids and some doctors have questioned whether ribavirin actually harms patients.

If you have symptoms of SARS, you should consult a health care provider. It would be helpful to tell the health care provider if you were near anyone with similar symptoms and where you have recently traveled.

IN WHAT WAYS ARE OFFICIALS TRYING TO PREVENT AND CONTROL SARS?

In the United States, people returning by plane from China, Singapore, and Vietnam are being issued health alert cards. The cards ask the returning travelers to monitor their health for 10 days and to see a doctor if they get a fever with a cough or have breathing difficulties. Approximately 15,000 health alert cards are distributed a day. The World Health Organization has recommended that travelers not leave countries if they are suspected of having symptoms of SARS or breathing illnesses. The Center for Disease Control and Prevention is trying to monitor people for 14 days who have been on flights with people suspected of having SARS. The Center for Disease Control and Prevention suggests that people may wish to postpone their travel to Hong Kong, China, Vietnam, and Singapore if the trip is non-essential.

For people that travel by boat, the health cards mentioned above are also provided to people traveling on ships. Health inspectors also board airplanes or boats if a traveler is reported to have SARS symptoms. Patients suspected of having SARS are being isolated in the hospital and kept from the general public in order to control the spread of the disease. Thus, these individuals do not go to school, work, restaurants, or other public places. The isolation continues for 10 days after breathing difficulties and fever have gone.

People with SARS are encouraged to cover their nose and mouth when sneezing or coughing. They are also asked to wear a surgical mask when they come in contact with others who are not infected. Alternatively, people (such as family members) that come in close contact with a suspected SARS patient can wear a surgical mask if the patient is unable to do so. People (such as health care workers) that come in close contact with a suspected SARS patient are also recommended to use surgical gloves if ay contact is made with bodily fluids. Afterwards, the gloves should be thrown out and the hands should be washed.

Doctors recommend that people who come in contact with suspected SARS patients should maintain proper hygiene, such as frequently washing the hands. They are advised against sharing eating utensils, bedding, and towels. However, these items can be used again after routine cleaning with soap and hot water. Sinks, toilets, and other surfaces can be disinfected with common household cleaners, but the cleaners must be used often. Scientists discovered on 5/4/03 that the SARS virus can be killed with disinfectants.

WHAT IS THE PROGNOSIS FOR PEOPLE WITH SARS?

On 5/8/03, the World Health Organization announced that the death rate from SARS had risen from 6% to 14-15%. In people over the age of 60, the death rate may be over 55%. However, many people recover quickly and do not seem to infect many others. Scientists are unsure why some people die quickly and others recover quickly.

IS THE SARS OUTBREAK OVER?

The World Health Organization announced on 5/17/03 that that the majority of the world's SARS outbreaks are coming to an end. The main difficulty remains to control the spread of disease in mainland China.

WHAT IS THE ORIGIN OF THE TERM, "SEVERE ACUTE RESPIRATORY SYNDROME?"

Severe acute respiratory syndrome comes from the Latin word "severus" meaning "serious," the Latin word "acutus" meaning "sharp," the Latin word "respiraratorius" meaning "having to do with breathing," and the Greek word "syn" meaning "together," and the Greek word "dromos" meaning "course." Put the two words together and you get "serious sharp (sudden) coursing together of breathing (difficulties)."