SARS Update: Tears, Fears and Hope


By Robert Scally, NurseZone assistant editor

At least five American health care workers have come down with probable cases of severe acute respiratory syndrome, SARS, while the worldwide death toll from the disease continues to grow. But health officials have positively identified the virus that causes SARS and a test for the disease is reportedly in the works.

The Centers for Disease Control and Prevention (CDC) confirmed in an April 14 press briefing that at least five American health care workers have suspected cases of SARS. Nationally, there are 208 suspected cases of SARS in the United States, but no deaths have been reported.

However, on April 17, the CDC announced it was changing its definition of SARS to match the definition used internationally by the World Health Organization.

“We are now going to include information about probable patients with SARS, which are those patients who have pneumonia and would be consistent with the case definition that the WHO is using internationally,” Julie Gerberding, M.D., CDC director, said during an April 17 press briefing. “So when we use that definition, we end up out of the 208 suspected cases, 35 of them meet the case definition for probable SARS.”

“In the United States, a total of 19 people who are contacts of travelers have been identified with suspected or probably SARS so far,” Gerberding said. “Of these, five are health care workers and the other 14 are host household contacts.”

Despite the change, the CDC will still use the more broad definition of SARS.

“We will continue to use the broad case definition for epidemiologic purposes in this country because we want to cast the widest possible net and make sure that we are providing the best medical care and also the best isolation for people who are suspected of having this condition,” Gerberding explained.

Stopping the spread of SARS in the United Sates and protecting health care workers has been a top priority for the CDC, Gerberding said.

“In terms of what we’re doing to protect health care workers throughout the entire delivery system, the principle is that patients suspected of SARS are put in isolation,” Gerberding said during a press briefing. “They’re put in rooms that have the appropriate air exchange, so that if there is any tendency for airborne transmission, that we are minimizing it. In addition, the health care personnel and visitors wear masks, not just surgical masks under these conditions, but the N95 respirator mask, which is the appropriate mask for hospital environments where you’re worried about airborne transmission.”

Worldwide, especially in Asia, news about the spread of the disease has not been good.

Since SARS was first reported on March 12, 3,293 probable cases of SARS have been reported in 21 nations. There have been 58 deaths worldwide related to SARS, as of April 16, according to the World Health Organization.

The majority of the reported cases, 2,700 as of April 16, and deaths, 50, have been reported in China and Hong Kong.

The New York Times reported April 16 that Chinese authorities have greatly underreported the number of SARS cases. The number of SARS cases in Beijing, China is between 100 and 200 and as many as 1,000 people are being held in quarantine, mostly in military hospitals, a WHO official told the Times.

SARS has spread fear throughout Asia. In Hong Kong and Singapore people have taken to wearing surgical masks and gloves in public; ridership on Hong Kong’s public transit system has plunged 20 percent and officials in several nations are afraid that the disease will have a negative effect on the region’s already troubled economy.

However, the SARS picture is far from hopeless.

In a major breakthrough for understanding the disease, a worldwide coalition of scientists in 13 laboratories in 10 nations identified the virus that causes SARS. The cause of SARS was positively identified as a strain of coronavirous—a member of the same family of virus that causes the common cold—that has never before been seen in humans.

Although SARS can be fatal, its mortality rate is about 4 percent and many of the people known to have contracted the disease, about 1,548 people, have recovered, according to the WHO.

Gerberding of the CDC noted that spread of SARS in the United States appears to have been contained.

A test to identify persons infected with SARS is under development by Swiss pharmaceutical firm Roche and test kit could be ready in about six weeks. Work on a vaccine for SARS is also underway, but is expected to take a few years to develop.

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