The illness is mysterious but worrying. SARS, or Severe Acute Respiratory Syndrome is making headlines around the world. As we learn more about it, two things jump out. First, that while we should take it very seriously — it has killed more than 54 people to date — there is no need to panic because its spread since being identified has been very limited.
The World Health Organization (WHO) defines SARS as persons with a respiratory illness of unknown etiology (cause) with an onset after 1 February 2003. They add that the person would have one or more of these signs: cough, shortness of breath, difficulty breathing, and fever over 38C. In addition, the person would have had either close contact with someone suspected of being infected and/or have travelled to one of the high-risk areas. If you meet this case definition please call your family doctor and arrange to be seen. If you go to your local hospital please call first so that hospital staff will be ready to greet you.
The last two characteristics, being in close contact or having travelled to a high-SARS region are perhaps the most important points for us to consider. If one thing is clear it is that the spread of this illness requires close contact with an infected person. In particular, it appears to be transmitted by respiratory droplets released through coughing or sneezing. Still, health authorities have not ruled out transmission in more casual settings, though that seems unlikely.
The World Health Organization is tracking the spread of SARS around the world. They report that (as of March 29) there have been 1550 cases, including 54 deaths. There are two cases in B.C. While the initial spread of SARS was quick, once the method of transmission was identified and precautions put into place, no cases have been reported that did not include close contact with an infected person. Since global surveillance was put into place and rapid isolation of cases undertaken, there have been no secondary outbreaks of the illness.
SARS has spread to 13 countries, but its greatest effects have been felt in only a few locales. The WHO identifies Hong Kong, Singapore, China (Beijing, Shanxi, Guangdong), Taiwan and Hanoi, Viet Nam as being of greatest concern. In Canada, there have been 37 reported cases: 35 in Ontario, and one each in British Columbia and Manitoba. There have been three deaths. All of these cases occurred in people who had either travelled to Asia, or had contact with SARS cases in the household or in a health care setting.
Mobilizing resources against health threats such as SARS is in part the responsibility of the Global Outbreak Alert and Response Network. This group is a technical collaboration of institutions and networks who pool their resources for the rapid identification, confirmation and response to outbreaks of international importance.
Identifying SARS and mobilizing worldwide effort is a wonderful example of epidemiological detective work. On March 17, an international multi-centre project was set up to work on identification of the source of the illness. Initial efforts identified the first case as originating at a hotel in Hong Kong. Later, a link was made to an outbreak of an unusual pneumonia in Guangdong, China. It seems that a visitor from mainland China became sick a week before staying in the hotel. This was probably the source of the outbreak. Working in many centres around the world, epidemiologists soon identified coronavirus as the conclusive cause of SARS.
Today, SARS seems to be under control as a result of the speedy action by health authorities around the world. That is not to say the situation cannot change, nor that a cure has been found — it has not. But we can all feel safer because of the measures that have been put into place as a result of international cooperation.
VCHA SARS Hotline 604.708.5300, Provincial SARS Hotline; 800.454.8302 and BC Nurseline 866.215.4700
As an addendum to this article, we note that the first WHO officer to identify the outbreak, Dr. Carlo Urbani, died on March 29 of SARS. He was an expert on communicable diseases based in Hanoi, Viet Nam. It is because of his early detection of the disease that global surveillance was heightened and many new cases identified and isolated before they infected others.
— 30 — Call-out: “If one thing is clear it is that the spread of this illness requires close contact with an infected person”