Severe Acute Respiratory Syndrome (SARS)
Learn About SARS
Severe acute respiratory syndrome (SARS) is an infectious condition that can cause serious respiratory illness or death.
• SARS is caused by a coronavirus, the family of viruses that causes the common cold. SARS is a rapidly progressive respiratory illness that is spread from person to person.
• An outbreak of SARS occurred in 2003 and started in China but progressed worldwide before it was contained.
• There have been no cases of SARS anywhere in the world since 2004.
What is SARS?
SARS is a severe respiratory illness that can be spread from person to person. An outbreak of SARS occurred in 2002-2003 and started in China but progressed worldwide and caused the death of almost 1 out of every 10 people infected. SARS is highly contagious and is transmitted by respiratory droplets or contact with other bodily fluids. People develop symptoms from the infection two to seven days after they are exposed and can spread the infection to other people.
How SARS Affects Your Body
Symptoms of infection usually occur 2 to 10 days after exposure. SARS infection initially causes a fever (greater than 100.4°F or 38°C), headache, and fatigue. Respiratory symptoms include a dry cough and shortness of breath develop 2 to 7 days after the first symptoms. Most patients have pneumonia that can be seen on a chest x-ray by day 7 to 10. Some patients become very ill and require mechanical ventilation.
How Serious is SARS?
Infection with SARS is a life threatening condition, especially in adults older than 60. Overall, one out of 10 patients infected with SARS will die and one out of 2 of patients over the age of 60 will die. Most people infected with SARS develop serious infection and will need to go to the hospital.
SARS Symptoms, Causes, and Risk Factors
SARS ranges from an asymptomatic infection in a few people to severe infection and death. Overall, SARS causes symptoms that are similar to the flu. However, these symptoms may progress and 70% of patients develop a serious respiratory illness. Older people and people with other medical conditions are at increased risk for severe infection and death.
What are the symptoms of SARS?
The most common symptoms of SARS are:
What Causes SARS?
SARS is caused by a new coronavirus. This type of virus is one of the most common types of virus that causes the common cold.
What are the Risk Factors?
Risk factors for infection include exposure to someone who is infected with the virus or traveling to an area where the virus is known to be spreading. People at increased risk for severe infection are usually older (> 60), have unusual symptoms, are male, or other medical illnesses including diabetes and chronic hepatitis B. During the original outbreak, health-care workers were at increased risk of infection because they were exposed to infected patients.
When to See Your Doctor
You should see your doctor if there has been an outbreak of SARS, you have traveled to the area of the outbreak, or you have been exposed to someone who has traveled to the area and you have a fever greater than 100.5°F, cough, chest pain, or difficulty breathing. Most importantly, try to avoid exposing other people and stay away from public areas until you know that you do not have SARS. Even if you are only mildly ill, you should report a possible SARS infection to your doctor to help control the spread of the infection.
Diagnosing and Treating SARS
There are different types of lab tests to confirm a case of SARS antibody tests, isolation of the virus, and others. In addition, a chest x-ray or chest CT scan will often show findings of pneumonia with SARS. You should notify your doctor if you think you have SARS so that you can be tested and treated.
What to Expect
SARS can be a rapidly progressive respiratory illness. There are only a few cases of SARS in patients with no or even mild symptoms. Most patients (70%) develop persistent or recurrent fever and shortness of breath, but about 30% of people have significant improvement in 1 week.
How is SARS Diagnosed?
The CDC has published specific guidelines for when your doctor should suspect a case of SARS. Lab tests to detect SARS virus include a blood test, a nasal swab or a sample from your stool or urine, or growing the virus in culture. Your doctor may send these lab tests if you have symptoms consistent with possible SARS and close contact within 10 days with a person suspected of having SARS or travel within 10 days to an area with documented transmission of SARS.
How is SARS Treated?
- Currently there is no medication that can treat SARS. Many treatments have been studied but, due to the rapid spread and control of the infection, no definite treatment has been found.
- People with mild illness can remain at home and try not to spread the virus to other people.
- Sicker people are usually hospitalized and therapy focuses on supportive treatment including intravenous fluids, oxygen, and possible antibiotics to treat other infections.
How Can You Prevent SARS?
- The best way to prevent SARS includes good handwashing with soap and water, using facemasks, and avoiding contact with people infected with the virus.
- If you are caring for a patient at home with SARS, limit exposure as much as possible. Do not share silverware, bedding, or clothing unless it has been washed with hot water and soap.
- Encourage the person with SARS to wear a mask when exposed to other people and cover his/her mouth when coughing or sneezing. Wear gloves whenever possible to protect yourself from bodily fluids that may be contaminated with the virus.
- People are more likely to spread the virus to others after they have started having symptoms. People are most contagious between 7-10 days after symptoms begin, but people can continue to shed the virus for another 2 weeks.
- SARS patients should avoid contact with other people as much as possible until 10 days after their symptoms have resolved.
- The virus can survive on surfaces for as long as 6 days. It can be killed by washing with bleach or other household detergents.
Living With SARS
SARS ranges from an asymptomatic infection in a few people to severe infection and death. Most patients who get infected with SARS will have a rapidly progressive respiratory illness. Most patients will require hospitalization and 25 % of hospitalized patients will have severe illness and require intensive care units. However, most people fully recover from their illness.
What to Expect
Most patients who get SARS have a severe illness and can expect to be hospitalized. While in the hospital, patients will be isolated from other people to prevent the spread of the virus to other people including other health-care workers. Patients should be isolated in a negative-pressure room. Some patients will develop an infection severe enough to be in the intensive care unit. A small percentage of patients have long term effects, including depression or anxiety, cough, shortness of breath, lung disease, or kidney disease; however, most patients fully recover from their illness.
The treatment of a patient with SARS includes supportive care and symptom management including fever, cough, runny nose and dehydration. Unfortunately, there is no drug that has been found effective to treat this disease.
Patients with long term effects from SARS infection will typically develop respiratory symptoms. There are numerous support groups that can be found online for patients with long term respiratory problems, including the American Lung Association.
Questions to Ask Your Doctor about SARS
- What should I do if I think I have SARS?
- What should I do if I think someone close to me has SARS?
- How can I prevent SARS?
How SARS Is Prevented
Preventing SARS is similar to preventing any viral respiratory infection. The best way to prevent infections includes avoiding close contact with affected individuals. Using good hand washing with soap and water is important. Encourage people with viral respiratory infections to cover their mouth when coughing or sneezing.
With SARS, stricter measures are needed. Because patients with SARS are usually hospitalized, the health-care team will take care to ensure these proper ways to prevent spread of infection to visitors, other patients, and hospital staff. People are more likely to spread the SARS virus to others after they have started having symptoms. People are most contagious between 7 and 10 days after symptoms begin, but people can continue to shed the virus and continue to be contagious for another 2 weeks. Patients with SARS should avoid contact with other people as much as possible until 10 days after their symptoms have resolved. The virus can survive on surfaces for as long as 6 days. It can be killed by washing with bleach or other household detergents.
Suwantarat N and Apisarnthanarak A. Risks to healthcare workers with emerging diseases: lessons from MERS-CoV, Ebola, SARS, and avian flu. Curr Opin Infect Dis 2015, 28:349-361.
Stockman LJ, Bellamy R, Garner P. SARS: Systematic Review of Treatment Effects. PLoS Medicine. 2006;3e343.
Cleri DJ. Ricketti AJ, Vernaleo JR. Severe Acute Respiratory Syndrome (SARS). Infect Dis Clin Am. 2010; 24: 175-202.
Ksiazek TG, Erdman D, Goldsmith C, et al. A novel coronavirus associated with severe acute respiratory syndrome. N Engl J Med. 2003; 348:1953-66.
WHO guidelines for the global surveillance of severe acute respiratory syndrome (SARS). Updated recommendations, October 2004. http://www.who.int/csr/resources/publications/en/WHO_CDS_CSR_ARO_2004_1.pdf (Accessed August 2, 2015).
Centers for Disease Control and Prevention (CDC). Outbreak of severe acute respiratory syndrome–worldwide, 2003. MMWR Morb Mortal Wkly Rep 2003; 52:226.
In the Absence of SARS-CoV Transmission Worldwide: Guidance for Surveillance, Clinical and Laboratory Evaluation, and Reporting Version 2. http://www.cdc.gov/sars/surveillance/absence.pdf (Accessed August 2, 2015).
Lew TWK, Kwek TK, TK, Tai D, et al. Acute Respiratory Distress Syndrome in Critically Ill Patients with Severe Acute Respiratory Syndrome. JAMA. 2003;290(3):374-380.
Anderson, RM, Fraser C, Ghani, AC, et al. Epidemiology, transmission dynamics and control of SARS: the 2002-2003 epidemic. Philos Trans R Soc Lond B Biol Sci. 2004 Jul 29;359(1447):1091-1105.
Leung GM, Hedley AJ, Ho LM, et al. The Epidemiology of Severe Acute Respiratory Syndrome in the 2003 Hong Kong Epidemic: An Analysis of All 1755 Patients. Ann Intern Med. 2004; 141-6622-673.
Angel Coz, MD, FCCP
Margaret A. Disselkamp, MD
Date Last Reviewed