DISEASES : SARS - Questions and Answers

SARS stands for Severe Acute Respiratory Syndrome and is a severe form of pneumonia, accompanied by a fever. It is believed the illness is spread from coughing and sneezing or from direct face-to-face contact with an ill person.
The virus is also present in other body fluids such as saliva, urine, and faeces. It is believed that the virus can survive in faecal matter for 1.5 to 2 days. Therefore, if someone touches infected objects and then touches their mouth, nose, or eyes there is a possibility of infection. In some cases it is still not certain how SARS spreads.

The symptoms of SARS begin within 10 days after direct contact with a SARS patient. They include any of the following :

• Fever of more than 38 degrees Celsius or 100.4 degrees Fahrenheit
• Muscle aches and pains
• Severe fatigue
• A severe headache
• Dry cough
• Shortness of breath
• Vomiting
• Diarrhea

You should be assessed for SARS, if you have developed symptoms within the last 10 days, your symptoms are worse than you normally experience and you have been :

• In contact with anyone who has SARS or is under investigation for SARS or
• To a SARS - affected country and have symptoms

Call your local public health unit or your local Emergency Department

Refer to the following websites :

• Health Canada
• Center for Disease Control
• World Health Organization

Patients with SARS are treated in hospital with antibiotics and antiviral agents and receive supportive care. Cases are kept in isolation rooms with hospital staff using appropriate precautions during patient contact.

You should seek medical attention. Cover your nose and mouth with a clean mask or towel immediately and proceed to your nearest hospital as soon as possible. Anyone who meets any of the risk criteria must call their local public health unit.
If you think that you are getting sick, make sure to wear a mask and seek advice from a qualified health professional in your community. If you must leave home to go to a hospital, make sure to wear a mask to prevent the possible spreading of the disease to others. It is a good idea to call ahead to inform the hospital of your arrival. If you don't have a mask you may consider calling an ambulance to get you safely to the hospital.

Anyone who has been exposed to SARS in the past 10 days should be quarantined at home, for a 10-day period, even if they are not displaying symptoms.

The incubation period for SARS is estimated to be 10 days. If you and the other members in your household do not develop symptoms within 10 days from your last exposure to a person with SARS, you can end your quarantine.

To protect your health, and the health of others, the following precautions are necessary :

• Remain at home, do not leave your house and do not have anyone visit you at home. Family members do not have to be quarantined, unless a member of the household is diagnosed with SARS.
• Wear a mask when you are in the same room with another member of your household.
• Change your mask twice a day. Family members do not have to wear a mask.
• Do not share personal items, such as towels, drinking cups or cutlery.
• Wash your hands frequently.
• Sleep in separate rooms.
• Measure your temperature with your own thermometer twice a day over the 10-day period.
• If anyone in the household develops fever (over 38 C / 100.4 F), respiratory symptoms (cough, shortness of breath, difficulty breathing), headache, or is feeling unwell, call Telehealth Ontario at 1-866-797-0000.

No, family members of healthy people who are in isolation do not need to stay home because there is no risk they can transmit SARS. If the person in isolation develops signs of SARS, their entire household will be placed in isolation.

SUSPECT CASE is a person presenting with :

Fever (over 38 degrees Celsius)

AND

Cough or breathing difficulty

AND

One or more of the following exposures during the 10 days prior to the onset of symptoms :

Close contact with a person who is a suspect or probable case

Recent travel to an "Area with recent local transmission" of SARS outside of Canada

Recent travel or visit to an identified setting in Canada where exposure to SARS may have occurred (e.g., hospital – including any hospital with an occupied SARS unit – household, workplace, school, etc.). This includes inpatients, employees or visitors to an institution if the exposure setting is an institution.

OR

A person with unexplained acute respiratory illness resulting in death after November 1, 2002, but on whom no autopsy has been performed

AND

One or more of the following exposures during the 10 days prior to the onset of symptoms :

Close contact with a person who is a suspect or probable case. Close contact means having cared for, lived with or had face-to-face (within one metre) contact with, or having had direct contact with respiratory secretions and/or body fluids of a person with SARS.

Recent travel to an "Area with recent local transmission" of SARS outside of Canada

Recent travel or visit to an identified setting in Canada where exposure to SARS may have occurred (e.g., hospital – including any hospital with an occupied SARS unit – household, workplace, school, etc.). This includes inpatients, employees or visitors to an institution if the exposure setting is an institution.

PROBABLE CASE is a person presenting with :

A suspect case with radiographic evidence of infiltrates consistent with pneumonia or respiratory distress syndrome (RDS) on chest x-ray (CXR).

OR

A suspect case with autopsy findings consistent with the pathology of respiratory distress syndrome (RDS) without an identifiable cause.

Exclusion Criteria
A suspect or probable case should be excluded if an alternate diagnosis can fully explain their illness.

Comments
In addition to fever and cough or breathing difficulty, SARS may be associated with other symptoms including: headache, myalgia, loss of appetite, malaise, confusion, rash and diarrhea.

This is a clinical decision between doctor and patient.

People can call Telehealth Ontario at 1-866-797-0000 to speak to a registered nurse who will have full information about the symptoms. Alternatively call the ministry INFOline toll-free in Ontario at 1-866-532-3161 or in Toronto call 416-314-5518 / TTY 1-800-387-5559. Hours of operation are 8:30am - 5:00pm

WHO reports 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.

According to the WHO, on February 26, 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.

WHO indicates that a cumulative total of 8,098 cases of SARS, with 774 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.

WHO reports that cases have been reported from 31 countries.

See also :

• Severe Acute Respiratory Syndrome (SARS)

October 2003