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Severe Acute Respiratory Syndrome (SARS) like Covid-19 is a sudden respiratory tract infection that may present with a secondary infection like pneumonia.

Severe Acute Respiratory Syndrome (SARS)

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Ismail Munir

Overview

Severe acute respiratory syndrome is defined as an acute, meaning a sudden or severe infection of the respiratory tract, that may present with a secondary infection, such as pneumonia that causes breathing difficulty and sometimes death.

A rapidly progressive respiratory syndrome outbreak caused by a SARS-associated coronavirus was first identified by the World Health Organization in February 2003, in the Guangdong province of China. Cases were also reported earlier in 2002 but the infection rate was on a smaller scale. The virus quickly reached global proportions because of globalization and an increase in international travel. Over the following months after the first reported case of SARS, the respiratory infection spread globally to over 30 countries and was declared the first pandemic of the 21st century. In addition, a decade after the outbreak, the emergence of several novel pathogens including Avian flu, Nipah virus, Hantavirus, and H5N1 influenza were noted. Although, the SARS virus is unique compared to these other novel pathogens, because of its person-to-person transmission<a href="#accordion">[1]</a>.

By the end of the outbreak in July 2003, 8,098 cases and 774 deaths were reported globally, meaning that the virus killed 1 in 10 people<a href="#accordion">[2]</a>. People above the age of 65 were at a higher risk of infection and over half of those infected in this age group died from the infection<a href="#accordion">[2]</a>.&nbsp;The disease outbreaks between 2002 and 2004 were self-limiting. Similarly, since the 2009 H1N1 influenza pandemic, no known cases of SARS were reported anywhere in the world, until the recent COVID-19 pandemic. Blueprints from the SARS pandemic are, therefore, being used to fight COVID-19.&nbsp;

Researchers believe that SARS is a strain of the coronavirus that mutated in animals and enabled it to infect humans. The infection quickly spread from China to other Asian countries. A small number of cases were also reported in U.K. and Toronto (Canada). The pandemic was eventually brought under control by implementing a policy of isolating people and screening passengers traveling by air for signs of infection. Another case was reported in 2004 which was linked to a medical laboratory in China, because of someone coming in contact with the SARS virus. Initially, these illnesses were only found in animals. However, researchers believe that many global outbreaks of infectious illnesses or pandemics in recent history are caused because of viruses mutating and becoming capable of infecting humans. An example of a mutated virus includes SARS.

SARS is an airborne virus that spreads in a way similar to cold and flu. The virus spreads via airborne droplets or small droplets of saliva that spread in the air when an infected person coughs or sneezes into the air. If someone else breathes the droplets, they can get infected. SARS can also spread indirectly because of contact with surfaces such as door handles being touched by an infected person with unwashed hands. Anyone touching the surface may get infected. The SARS virus can also spread via feces, for example, if an infected person does not wash their hands properly after using the toilet, they can infect others. Evidence from the pandemic showed that those caring for and living with someone with SARS were at a higher risk of developing the infection themselves. The spread of the virus was largely through respiratory droplets. Treatment was primarily supportive as no specific antivirals were effective.&nbsp;

<div>&nbsp;</div>

Signs And Symptoms

The symptoms of SARS appear 2 to 7 days after a person is exposed to the virus. However, in some cases, it may take up to 10 days. The first symptom of SARS is a high fever &gt; 100.4&deg;F (38.0&deg;C). Whereas other symptoms include mild respiratory symptoms, such as those of flu. The early symptoms of SARS are listed below:&nbsp;

<ul>
	<li>High temperature</li>
	<li>Fatigue</li>
	<li>Headaches&nbsp;</li>
	<li>Chills</li>
	<li>Muscle pain&nbsp;</li>
	<li>Loss of appetite&nbsp;</li>
	<li>Diarrhoea in 10% to 20% of people&nbsp; 
	&nbsp;</li>
</ul>

Other symptoms that may develop over the course of 7 to 10 days include:&nbsp;

<ul>
	<li>Dry cough&nbsp;</li>
	<li>Shortness of breath&nbsp;</li>
	<li>Low levels of oxygen&nbsp;</li>
</ul>

&nbsp;

Most people with SARS also develop pneumonia, whereas others may develop long-term damage to the liver, kidneys, and lungs because of complications from the infection, which are more likely to be prevalent in patients over the age of 60 years. Most people with SARS make a full recovery.&nbsp; 
&nbsp;

Causes

SARS is a zoonotic disease, meaning that the virus originates in animals and is spread between animals and people. According to the Centers for Disease Control and Prevention (CDC), 75% of infectious diseases emerge from animals<a href="#accordion">[3]</a>. Similarly, most diseases emerge from wild animals and not from pets or domestic animals. Additionally, some animals may carry the virus but not show any signs of illness because their bodies have become acclimated to the virus. This means that the animals are immune to the virus.&nbsp;

Viruses mutate and evolve with time. Hence, when a new virus emerges, people don&rsquo;t have any immunity against it. However, in time the immune system develops antibodies against the new virus to fight off the disease. For example, when the swine flu (H1N1) first appeared in 2009, there were concerns that it may cause a pandemic, but now it is considered as a seasonal flu strain and people have developed immunity against it.&nbsp;

SARS spreads from one person to another because of close contact with someone who is infected with the virus. When a person with the virus coughs or sneezes without covering their mouth, the respiratory droplets that contain the virus can spread through the air and infect the mucous membrane of another person standing within 3 feet of the infected person. Also, people working in close contact with an infected person or having direct contact with an infected person are at a higher risk.&nbsp; Similarly, children can get infected by touching their mouth, nose, and eyes after contact with contaminated objects or surfaces.

Research further suggests that children are only infectious when they have symptoms, such as cough and fever. People are the most infectious during the second week of infection and hence, CDC recommends that as a precaution, people with SARS should stay in isolation to keep others from getting sick and should stay at home for 10 days till the symptoms have gone.

Interestingly, the virus may be able to live for months and even years below freezing-temperatures.&nbsp; 
&nbsp;

Measures To Limit Spread&nbsp;

SARS is infectious only after the symptoms have appeared and is most likely spread during the second week of infection. However, it is not known how long a person is infectious after the symptoms have appeared. As with any other infectious disease, a few simple steps can help prevent the spread of SARS:

<ul>
	<li>Avoid touching your eyes, mouth, and nose with unwashed hands.&nbsp;</li>
	<li>Cover the mouth and nose with a tissue, and throw the used tissue in the trash. If you don&rsquo;t have a tissue, cough, or sneeze in your elbow.&nbsp;&nbsp;</li>
	<li>Avoid sharing utensils, food, and drinks.&nbsp;</li>
	<li>Avoid crowds.&nbsp;</li>
	<li>Regularly clean surfaces with a disinfectant.&nbsp;</li>
	<li>If you have contracted the virus, limit interaction with people for 10 days or until symptoms improve.&nbsp; 
	&nbsp;</li>
</ul>

Diagnosis

According to the World Health Organization, for the diagnosis of SARS, a physical examination should show the following symptoms:&nbsp;

<ul>
	<li>100.4&deg;F (38&deg;C) fever&nbsp;</li>
	<li>Symptoms of lower respiratory tract infection, for example, shortness of breath, difficulty breathing, and cough</li>
	<li>Pneumonia&nbsp;</li>
	<li>All alternative diagnoses to explain the illness are ruled out 
	&nbsp;</li>
</ul>

When the SARS outbreak first began, it was a rare infection and the symptoms overlapped with flu and pneumonia. It is only possible for a person to be diagnosed with SARS if there is a current outbreak or if the person had been in an area where the illness is endemic. Laboratory tests for identifying SARS include:&nbsp;

<ul>
	<li>Blood tests&nbsp;</li>
	<li>Stool tests&nbsp;</li>
	<li>Nasal secretions tests&nbsp;</li>
	<li>Imaging tests for pneumonia&nbsp; 
	&nbsp;</li>
</ul>

However, in the early stages of the disease, the tests may not be reliable.&nbsp; 
&nbsp;

Treatment

Treatment of SARS includes immediate isolation of the patient in the hospital under close observation, in addition to barrier techniques such as wearing filter masks and goggles to prevent the spread of infection. Treatment is symptomatic and aids in easing the symptoms. Treatment may include:

<ul>
	<li>Breathing assistance with the use of a ventilator to deliver oxygen</li>
	<li>Antibiotics for treatment of secondary infections, for example, pneumonia; antibiotics, however, do not kill the SARS virus.&nbsp;</li>
	<li>Antiviral medication</li>
	<li>High dose of steroids for reducing swelling in the lungs 
	&nbsp;</li>
</ul>

Currently, there is a lack of scientific evidence to show whether these treatments are effective. In addition, the antiviral medicine ribavirin is ineffective for the treatment of SARS.&nbsp; 
&nbsp;

Many people infected with SARS may develop pneumonia and severe breathing problems. SARS is fatal in some cases because of respiratory distress and may cause respiratory failure. People over the age of 60 and those with diabetes or HIV are at a higher risk of developing complications. Other possible complications of SARS include heart and liver failure.&nbsp; 
&nbsp;

In general, people who are in direct contact with infected individuals are at a higher risk of developing the infection, for example, healthcare workers and family members.&nbsp; 
&nbsp;

Below are some preventive measures for SARS infection:&nbsp;

<ul>
	<li>Wash your hands frequently with soap and water or use an alcohol-based rub with at least 60% alcohol.&nbsp;</li>
	<li>Cover your mouth and nose with a surgical mask if you&rsquo;re in the same room as a person with SARS. Wearing eyeglasses will also offer protection.&nbsp;</li>
	<li>Wash personal items, such as utensils, bedding, towels and clothing with soap and hot water.&nbsp;</li>
	<li>Disinfect surfaces that may have been contaminated with sweat, saliva, urine, stool, mucus, and vomit using a household disinfectant. Make sure that you are wearing disposable gloves when cleaning the surfaces. Throw away the gloves when you are done.&nbsp; 
	&nbsp;</li>
</ul>

Conclusion

Severe acute respiratory distress syndrome is a viral respiratory disease caused by a SARS-associated coronavirus and was first identified in February 2003, when an outbreak emerged in China and spread to other Asian countries. The virus belongs to the family of coronaviruses and spread from small mammals to people. In addition, SARS reached global proportions in 2003, but no new cases of the virus were reported since 2004, until the outbreak of the novel coronavirus SARS-CoV-2.

Researchers have postulated that when someone infected with SARS coughs or sneezes, the virus can spread via airborne droplets, in a similar way as the cold and flu and infect others. You can also catch the virus if you touch contaminated surfaces. The virus can survive on the hands, tissues, and other surfaces for hours, and may be able to live for months or even years below freezing temperatures.&nbsp;

While airborne transmission has a high possibility, the virus has also been found in the stool of people with SARS and can live in the stool for up to 4 days. Similarly, as with other coronaviruses, becoming infected and then getting reinfected is a possibility. The symptoms generally last for 2 to 10 days after being exposed to the virus. While it is not known for how long a person may be contagious after getting infected, people with active symptoms of SARS are contagious. Most patients identified with the infection were previously healthy adults between the ages of 25 and 70 years. Some cases have also been reported among children under the age of 15 years. Additionally, the fatality rate of the disease is around 3%.&nbsp; 
&nbsp;

Key Points

<ul>
	<li>Severe acute respiratory distress syndrome is a viral respiratory disease caused by a SARS-associated coronavirus and was first identified in February 2003, when an outbreak emerged in China and spread to other Asian countries.</li>
	<li>The virus belongs to the family of coronaviruses and spread from small mammals to people.</li>
	<li>In addition, SARS reached global proportions in 2003, but no new cases of the virus were reported since 2004, until the outbreak of the novel coronavirus SARS-CoV-2.</li>
	<li>Researchers have postulated that when someone infected with SARS coughs or sneezes, the virus can spread via airborne droplets, in a similar way as the cold and flu, and infect others. You can also catch the virus if you touch contaminated surfaces.</li>
	<li>The virus can survive on the hands, tissues, and other surfaces for hours and may be able to live for months or even years below freezing temperatures.&nbsp;</li>
	<li>While airborne transmission has a high possibility, the virus has also been found in the stool of people with SARS and can live in the stool for up to 4 days.</li>
	<li>Similarly, as with other coronaviruses, becoming infected and then getting reinfected is a possibility. The symptoms generally last for 2 to 10 days after being exposed to the virus.</li>
	<li>While it is not known for how long a person may be contagious after getting infected, people with active symptoms of SARS are contagious. Most patients identified with the infection were previously healthy adults between the ages of 25 and 70 years. Some cases have also been reported among children under the age of 15 years. Additionally, the fatality rate of the disease is around 3%.&nbsp; 
	&nbsp;</li>
</ul>

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