"When a new disease such as SARS emerges and poses a threat to the global population, it is important to learn the facts as they become available, to follow all recommended precautions, and to remain calm."
By Alexander Ackley, Jr., M.D.
SARS (Severe Acute Respiratory Syndrome) is a serious, contagious disease that can be deadly. It also has the potential to cause costly disruptions of daily life in any place in which it gains a foothold.
In my opinion, it is not prudent to attempt to minimize or soften the facts. The SARS mortality rate in Toronto is 10 percent despite first-rate medical facilities and care. In Hong Kong, the populace is mostly masked and fearful; schools have been closed; hotel occupancy is 5 percent, and many businesses are threatened with bankruptcy.
Therefore it is incumbent upon all citizens not just our civic officials, university administrators and business leaders, but all of us to take attentive personal responsibility and follow all pertinent recommendations from public health authorities to try and assure that this infection does not even enter our communities.
When a new disease such as SARS emerges and poses a threat to the global population, it is important to learn the facts as they become available, to follow all recommended precautions, and to remain calm.
The Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) continue to intensively investigate the epidemiology of SARS and have made a number of recommendations to the public. Their recommendations and those from state, local and school district officials have been essential for those living and working in Mercer County, which has several colleges and universities, a seminary and dozens of international companies each with possible international travelers.
The disease, which first surfaced in China in November, has now spread to 27 countries around the world, including countries in Europe and North America. At least 5,000 cases are reported worldwide, with a 6 percent mortality rate.
As of April 26, there have been approximately 50 probable and 220 suspected SARS cases reported in the United States, including five in New Jersey, but there have been no deaths. Mortality is highest among the elderly and those with chronic diseases, but even young, healthy adults have succumbed. Fortunately, children under 15 years old who have contracted SARS have recovered.
At this time, there is no indication that the United States is experiencing any community spread of SARS.
In a collaborative international effort, scientists at the CDC and other laboratories have identified and sequenced the genome of a previously unrecognized coronavirus as the prime suspect cause of SARS. Coronaviruses, of which there are a number of known human and animal species, are best known as a cause of the common cold.
The identification of a new coronavirus as the most likely cause of SARS means that scientists can now concentrate on developing specific diagnostic tests, antiviral treatments and perhaps a preventive vaccine, although historically it has taken years to produce an effective vaccine for any infection.
In most cases, SARS is spread by close person-to-person contact.
The majority of SARS cases have involved people who cared for or lived with someone with SARS, or those who have had direct contact with infectious material, such as respiratory secretions, from a person who has it. If someone who has SARS coughs or sneezes droplets onto themselves, others, or surface areas, this poses a contagious threat. If you touch the skin or other objects that are contaminated with infectious droplets and then touch your eyes, nose or mouth, you run the risk of developing SARS.
It is also possible that in some instances highly "super-infectious" individuals spread SARS more broadly through the air or by other means that are not yet identified.
The symptoms of SARS are very similar to those associated with the flu. SARS begins with a fever greater than 100.4 degrees. In addition, headache, an overall feeling of malaise and body aches are common. Some people also experience mild respiratory and gastrointestinal symptoms. After two to seven days, they may develop a dry cough and have trouble breathing. Some patients advance into a severe and unusually protracted course of pneumonia from which they eventually recover or occasionally die.
If you think you may have SARS, call your doctor before you visit the office or call in advance before going to an emergency room. To help your doctor make the diagnosis, report if you have recently traveled to China, Hong Kong, Singapore or Toronto, or if you have been in contact with someone who has the symptoms (fever accompanied by a cough and/or difficulty breathing), especially if that person has traveled anywhere recently.
To help contain the spread of SARS, those who may be infected must severely limit outside interactions and should not go to work, school or other public areas until told to do so by a doctor or public health authority.
Information currently available indicates that people are most likely to be infectious when they have symptoms, such as fever or cough. However, the length of time before or after symptoms appear that SARS patients might be able to transmit the disease to others is unknown. For the duration of the illness, be vigilant about taking the recommended infection control precautions, which are described below.
If you are a family member living with someone suspected of or possibly exposed to SARS, the CDC recommends that you contact your local health department and take the following infection control procedures:
Wash your hands frequently with soap and water or use alcohol-based hand rubs, particularly after contact with body fluids (e.g., respiratory secretions, urine, or feces).
Use disposable gloves when coming into direct contact with the patient or objects that the patient has come in contact with. Immediately after use, dispose of these gloves and wash hands thoroughly.
Use surgical masks to limit the spread of infectious droplets (this applies both to patients and those coming in contact with patients).
Avoid sharing eating utensils, towels and bedding.
Clean possibly contaminated surfaces frequently with a household disinfectant.
At the present time, the CDC advises that people planning any nonessential travel to mainland China and Hong Kong, Singapore, and Hanoi, Vietnam, should postpone their trips until further notice. The CDC also has a separate travel alert with specific recommendations for travel to Toronto and elsewhere in Ontario, Canada. The WHO has advised the public not to go to Toronto; it is on the same list as Hong Kong.
For more SARS information, visit the CDC Web site at www.cdc.gov/ncidod/sars/or call the CDC public response hotline at (888) 246-2675 (English), (888) 246-2857 (Español).
The newspapers and TV news stations have also been reporting very up-to-date and accurate information, but you need to check the news almost every day as the situation has been evolving rapidly. Share your knowledge with family and friends.
Dr. Alexander Ackley, Jr., is the hospital epidemiologist and chairman of the Infection Control Committee at The Medical Center at Princeton. This article was prepared in collaboration with Lorraine Seabrook.

