SARS: The New Latest Public Health Concern
For the past few months, it has become increasingly difficult to open a newspaper or turn on the television without being deluged by stories about SARS. We learn of travel advisories to Toronto, Hong Kong, China, and other countries. There is talk of major economic ramifications. And when we are in a crowded, public place, we probably all become a little uncomfortable if someone coughs or sneezes.
What exactly is this tiny organism that has created such a stir? SARS, or Severe Acute Respiratory Syndrome, is a recently recognized respiratory illness that appears to be caused by a virus. It is classified as an atypical form of pneumonia, and is related to the family of viruses that causes the common cold --corona viruses, which are named for their halo-like appearance when viewed under a microscope. Epidemiological investigations suggest that SARS is spread via face-to-face contact or through the transmission of infected droplets. However, the possibility of contracting this illness as a result of handling a contaminated object has not been ruled out.
According to the World Health Organization, the death rate from this disease is running about 5.9-6%. The majority of cases have occurred in Asia, with China leading in the number of deaths (and still increasing), followed by Hong Kong (where the number of cases have leveled off). Canada ranks third in the number of cases, and to date is the only country outside of Asia where people have died from SARS. It should be noted, however, that the cases in Canada generally have been confined to health care workers caring for people with known cases of SARS in hospital settings. The position taken by the Centers for Disease Control so far has been that U.S. citizens traveling to Canada “are not at risk for SARS if they stay out of hospitals and follow some common sense precautions.” To date, the transmission of SARS in the United States has not been a major public health problem. Cases have been identified in 38 states, with California, New York, and Washington leading the way. In Connecticut, as of 4/24/03, there have been 5 confirmed cases, 4 suspected cases, and 1 probable case.
Usually, the first symptom of SARS is the presence of a fever greater than 100.40 F., which is sometimes associated with chills. Headache, muscle aches, and a general feeling of discomfort usually follow. In the beginning, there may be mild respiratory symptoms. Occasionally people experience dizziness, nausea, vomiting, diarrhea, sore throat, and runny nose. After 2 to 7 days, a dry cough usually develops, and breathing may become so difficult that a respirator is required. Typically, the incubation period for SARS is 2 to 7 days, but it may take as long as 10 days to develop.
Knowing the symptoms of SARS is especially useful during this time of the year when so many people suffer from colds and allergies. One difference between a cold and SARS is that most colds develop in the upper respiratory system, affecting the nose, throat, and sinuses. SARS begins in the lower respiratory system, involving the lungs. It resembles the flu more than a cold, with a fever, headache, and body aches. With regard to allergies, many allergic reactions involve a clear nasal discharge, sneezing, itchy or watery eyes, and wheezing, or mild difficulty breathing. If allergy medications relieve these symptoms, the cause of the discomfort is not SARS. If breathing difficulty is the result of asthma (often triggered by colds and allergies), it is very important to follow a treatment regimen prescribed by the physician to control the asthma. If asthma is not adequately managed, the linings of the airways can become inflamed and cause additional lung problems. Further, if an asthmatic person does acquire SARS, the condition can be made worse. While SARS is considered to be a form of pneumonia, in which the lungs become inflamed and retain fluid, severe respiratory symptoms occur fairly quickly in most forms of viral pneumonia. In cases of SARS, these severe symptoms take longer to develop.
If you or someone you live with develops SARS, it is important to see your doctor and follow all instructions closely. If the person with SARS remains in the home, make sure all occupants, including the affected person cover the mouth and nose with tissue when coughing or sneezing. Everyone should wash thei9r hands frequently and thoroughly with soap and hot water. The ill person and those residing with him or her should wear a surgical mask whenever in close contact with other people. Do not share towels, bedding, clothing, or silverware, and be sure to wash these items with soap and hot water. The person with SARS should limit contact with the public, and not go to school, work, church, theaters, stores, etc. for a 10-day period. Any surfaces that have been contaminated by bodily fluids (sweat, saliva, vomit, urine, mucous), such as counters, tables, door knobs, and bathroom fixtures should be cleaned with a household disinfectant according to the directions on the product. Cleaning should be done wearing disposable gloves that are discarded after use; do not reuse them. These precautions should be practiced for 10 days after the fever and other symptoms have disappeared. While the person SARS should be isolated, members of the same household do not have to restrict their outside activities unless they develop symptoms as well.
For the latest information about SARS, contact the Connecticut State Department of Public Health at (860) 509-8000 or on line at www.dph.state.ct.us. The web site for the Centers for Disease Control is www.cdc.gov. Additional information is available by contacting the Central Connecticut Health District at (860) 721-2822.