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SARS: Questions and answers

The World Health Organization calls Severe Acute Respiratory Syndrome, or SARS, a new communicable disease that is a global health threat. More than 480 people have recently fallen ill from the potentially fatal disease, which has spread around the globe by air travel.
Here's a look at what is and isn't known about the mysterious disease:

What are the symptoms?

The disease spreads from person to person. It often begins with a high fever, headache and sore throat. Other possible symptoms include loss of appetite, confusion, rash and diarrhea. Not everyone has reacted the same way.

The WHO said doctors are on the lookout for those symptoms with:

  • a fever over 38 C AND

  • cough, shortness of breath, difficulty breathing AND

  • close contact with someone diagnosed with SARS or a history of travel to affected areas, including Toronto, Vancouver, Guangdong province in China, Hong Kong, Singapore and Hanoi, Vietnam.

The respiratory symptoms appear two to seven days after exposure.

The disease has been compared to influenza and pneumonia, but for lack of a better description, WHO has called the disease SARS. The Centers for Disease Control and Prevention notes the definition may include people who don't actually have the syndrome, but it is a starting point for investigation.

What causes SARS?

Researchers don't know whether bacteria or a virus causes SARS, and it may take several weeks to find out.
"It is most likely to be viral, but that is not a certain thing at this point," said Dr. Andrew Simor, head of microbiology and a specialist in infectious diseases at Toronto's Sunnybrook and Women's College Health Sciences Centre. Tests have failed to show it is influenza. The leading candidate has been human metapneumovirus, a family of microbes that can cause measles, mumps and canine distemper. Experts say the findings are based on electron microscope images, which aren't definitive. Other tests such as genetic profiling are needed to confirm the findings.
Researchers in the U.S. have seen a coronavirus, one of the viruses that causes the common cold. They say SARS could be caused by a combination of viruses. It is too early to tell. Microbiologists in Hong Kong believe they have identified a test to diagnose SARS, which they are perfecting.

What are the risks?
"If someone is in close contact with one of the probable cases they are at greater risk," said Dr. Colin D'Cunha, Ontario's Public Health Commissioner, on March 23. "For members of the general public, the risk appears to be otherwise slim and near zero." He added there is no evidence it spreads through casual contact.
Probable cases are people showing symptoms who have recently travelled to Asia or have been in close contact with other SARS patients. Suspect cases show symptoms, but have no travel or contact history. Dr. Jay Keystone, a travel and tropical disease specialist with the University of Toronto, said close contact is needed with someone who is infected. Ninety per cent of cases have been in unprotected health care workers, who have had direct contact with respiratory secretions (sneezes, coughs, nasal fluids) of SARS patients. He added SARS is moving quickly around the world because of air travel, but it isn't spreading rapidly within the community.

Where did SARS originate?
WHO has reported hundreds of cases in Hong Kong and Vietnam since February. An outbreak of pneumonia with similar symptoms struck Guangdong province in China last November and was brought under control in mid-February.
Doctors in Hong Kong are focusing their investigation on a hotel where seven guests contracted the ailment from a Chinese professor and carried it to Vietnam, Singapore and Canada.
No one knows how the disease spread in the hotel. Health officials have speculated the professor sneezed or coughed by an elevator. One expert pointed to the hotel's air conditioning system, but none of the hotel workers have become sick.

What does the Toronto quarantine mean?
Several health care workers at Scarborough Grace Hospital in Toronto's east end were exposed to SARS before they knew to take precautions. Access to the hospital has been restricted.
As a precaution, on March 26 Toronto's medical officer of health recommended everyone who has visited Scarborough Grace Hospital since March 16 should stay in their home for 10 days from the time of the visit. Their family members may go to work or school, but must wear a mask when at home and in contact with those who are at risk of infection.
Hospital visitors are unlikely to have had direct contact with SARS patients and they have "a very low risk of exposure." Health officials said isolating cases is a priority, and the extraordinary measures are the only way to manage the disease and protect people. Anyone who may be a contact of a SARS case through Scarborough Grace and has symptoms or concerns can call the Toronto Public Health Hotline at (416) 338-7600 for further information.
Infected health workers and their family members have been quarantined, meaning they cannot go to school or work, buy groceries etc.
Starting March 27, a community assessment clinic will open at the Women's College Campus of Sunnybrook and Women's College Health Sciences Centre. People with symptoms of SARS can go to the clinic to be assessed in an area isolated from the rest of the hospital.

What are governments doing?
On March 25, SARS became a reportable, virulent, communicable disease in Ontario. The change allows public health officers to quarantine infectious people and their family members for up to 10 days to track the disease and prevent it from spreading.
The Ontario government has set up an around-the-clock command centre to co-ordinate information on the spread of the virus. People with general questions about SARS can call Telehealth Ontario at 1-866-797-0000 to speak to a registered nurse.
Canadian, provincial and local health officials are working together to enhance surveillance and look for additional cases, including those arriving on international flights. Sick passengers are assessed in separate rooms and promptly taken from the airport to hospital. Laboratories around the world, including the National Microbiology Laboratory in Winnipeg, are trying to determine the origins and cause of the disease. On the other side of the Pacific, health officials in Singapore have quarantined more than 700 people who may be at risk. In Hong Kong, officials have called for all schools to be disinfected. Children with infected family members must avoid classes for a week.

What about travel?
"Given the uncertainties of the current situation, Health Canada believes it is prudent to await the outcome of national and international control measures before undertaking travel to these destinations," the advisory said.
Health Canada also warns travellers that health care services may not be up to handling SARS. For example, the only adequate hospital in Hanoi has been closed.
Health alert notices are handed out to all passengers arriving on international flights from all destinations other than the United States. The notices tell passengers to be on the look out for symptoms that may develop within 10 days of arriving, such as fever, cough, and breath. If so, they should seek immediate medical attention. Hospital staff are taking travel medical histories.
In Hong Kong, airplane passengers have become ill. The World Health Organization said on March 25 that air travel is safe, but its scientists are looking closely at the growing number of cases in Hong Kong to see whether it is more contagious than thought.
"We would want to be sure that it was people sitting next to that person and not the ventilation system in the airplane which was spreading the disease," said Dr. David Heymann, head of communicable diseases at WHO. "We have no evidence of the latter right now."
Health investigators have followed thousands of passengers who flew with SARS-infected travellers and did not become sick.

How are patients being treated?
In Toronto, those suspected of having SARS are being quarantined in rooms with a controlled air supply, said Dr. Simor. Anyone who goes into the room wears a special mask to filter out pathogens, as well as gloves and a gown. Hand washing is also important. Keystone said the simple masks people are wearing in Hong Kong would stop large droplets, but masks wouldn't work against fine, aerosol droplets. In Toronto, Simor said, patients are being treated with broad-spectrum antibiotics (in case it is caused by an as-yet unrecognized bacteria), and two antiviral drugs. One antiviral drug fights influenza and the other is a broad-spectrum antiviral that may have helped patients in Hong Kong

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