Global Alert: Severe Acute Respiratory Syndrome (SARS)

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Updated March 25, 2003

A deadly respiratory infection, provisionally called "severe acute respiratory syndrome (SARS)," is spreading quickly around the world. Reports have come in from Canada, China, Hong Kong, Taiwan, Indonesia, Philippines, Singapore, Thailand, and Vietnam, prompting the World Health Organization to issue a global alert for the first time in more than a decade. To answer questions about diagnosis, infection control, and treatment, Medscape's editors have developed this collection of reports and resources to inform and assist medical professionals.

Epidemiology: The U.S. Centers for Disease Control and Prevention (CDC) announced yesterday that a new coronavirus is the prime suspect in the search for the cause of SARS.

"You've heard reports from other laboratories internationally that are also concerned that coronavirus may be an etiology," said Julie Gerberding, MD, director of the CDC, during a teleconference today. "Coronavirus is not a paramyxovirus, it is not a metapneumovirus. It is a family of viruses that traditionally have caused common illnesses like colds and upper-respiratory tract infections and can be quite contagious."

On Saturday, the World Health Organization (WHO) announced that scientists in Hong Kong had strong evidence supporting their hypothesis that a paramyxovirus, possibly metapneumovirus, was the cause of SARS.

The CDC report is based on the isolation of coronavirus from tissue samples from two patients, and the detection of coronavirus DNA in several others. Dr. Gerberding also stated that it did not appear to be a known coronavirus. "We know from sequencing pieces of the virus DNA that it is not identical to the coronaviruses that we have seen in the past. This may very well be a new or emerging coronavirus infection, but it is very premature to assign a cause."

In separate remarks made during a WHO press briefing this morning, Drs. David Heymann and Klaus Stohr mentioned a total of four valid etiologic hypotheses, each deserving of equal attention at this time. According to Dr. Stohr, "There is consistent finding of both pathogens in individual patients or of either of the pathogens in other patients." In addition to these two single-agent hypotheses, he added, "the third hypothesis is, very obviously, that these two pathogens have to come together to cause this very severe outbreak."

"There could be a fourth," said Dr. Heymann, following up his colleague's statements. "It is possible that both are common viruses: one found in all the patients, even though it's not causing disease, and the other will be the disease-causing agent, so they could both be found but not be related in any way, just there by chance."

Epidemiology: The number of suspected SARS cases reported by WHO has increased to 487, up from 456 yesterday. Cumulative SARS deaths remains at 17. (These tallies do not include 305 cases and 5 deaths reported in China's Guangdong province between November and February.) WHO officials expressed concern that the growing number of infections in Hong Kong, Singapore and Vietnam points to problems with control measures in those countries, and that the growing number of cases will complicate efforts to contain further spread of the disease.

The CDC is now reporting a total of 39 suspected U.S. cases in 18 states, up from 37 yesterday.

Health officials continue to stress that transmission of SARS appears to require close and prolonged contact, as among case patients and healthcare workers and case patients and family members.

Diagnosis, Treatment, Outcomes: Lionel Mandell, MD, Professor of Medicine and Chief of the Division of Infectious Diseases at McMaster University in Hamilton, Ontario, and a leading authority on viral diseases and infectious pneumonia, told Medscape Infectious Diseases that SARS cases range in severity from a mild febrile illness to life-threatening pneumonia. When asked about optimal treatment approaches, Dr. Mandell said that top experts attending a CDC teleconference agreed that treatment should include broad-spectrum antibiotic coverage and also the administration of ribavirin, a broad-spectrum antiviral drug that has shown varying degrees of clinical efficacy in a variety of human diseases, including several caused by paramyxoviruses. There is no evidence that ribavirin is active against coronaviruses.

While many patients have responded well to therapy, Dr. Mandell said there is no way to know what component of therapy is responsible. "It could be the antibacterials or the antivirals, or simply good supportive care while the infection runs its course."

What this tells me is that we should be taking every precaution possible (only with the guidance of your current health practitioner or doctor) to prevent the transmission of this unidentified outbreak regardless of your local or current well-being. My suggestion therefore would be the following:

·          Avoid large crowds, such as crowded subways, busses, etc., where people may cough and/or sneeze in your airspace.

·          If the aforementioned situations cannot be avoided, try breathing through a handkerchief.

·          DO NOT take antibiotics as a precautionary measure since many strains of bacteria are becoming resistant to antibiotics. You do not want to expose any bacteria or virus to an antibiotic on entry; this will increase the probability of resiliency for the microbes.

·          This is a weapon against mankind, and they shall come together, but not by God. Pray and stand on Isaiah 54:17  No weapon that is formed against thee shall prosper; and every tongue that shall rise against thee in judgment thou shalt condemn. This is the heritage of the servants of the LORD, and their righteousness is of me, saith the LORD.

Summary of Events to Date

On March 15, 2003, the WHO issued a global alert of a multicountry outbreak of SARS, an atypical pneumonia of as yet unidentified etiology. According to WHO, the syndrome was first recognized on February 26, 2003, in Hanoi, Vietnam.

According to WHO, as of March 25, 2003, SARS cases have been reported in the United States, Canada, China, Taiwan, France, Germany, Hong Kong, Ireland, Italy, Singapore, Slovenia, Spain, Switzerland, Thailand, Vietnam, and the United Kingdom. A total of 456 cases and 17 deaths have been reported to date.

SARS appears to be transmitted by close contact only, most probably via airborne droplets; the majority of new cases have been reported in healthcare workers and family members of affected persons. At the present time, there is no evidence of community spread of the disease.

The cause of SARS is still uncertain. On March 24, the CDC announced that a new coronavirus is the prime suspect in the search for the cause of SARS. Several days prior to that, WHO reported evidence that Metapneumovirus, a recently discovered genus of the Paramyxoviridae family of viruses, which is known to cause pneumonia in humans, might be responsible for the disease.

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There has been no conclusive testing of with respect to Colloidal Silver and SARS; therefore, Healthy Christian Living can not make any justifiable claims as to its effectiveness against the virus.

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