SARS: What WHO says

• How can SARS be recognised? The illness usually begins with fever (temperature is above 100.4 F or 38 C). Accompanied by chills, headache, discomfort and body aches (pain in the muscles).

Mild signs related to breathing passages in the beginning. After 2-7 days, the patient develops a dry cough that progresses to breathing difficulty. This breathing difficulty becomes severe in some of the patients. However as these symptoms, up to a point mimic flu, you should suspect SARS only if the patient has visited a country or an area where SARS is occurring or the patient has come in contact with some one suspected to be suffering from the disease. It spreads rapidly in short time and can even cause death (3 to 4 per cent). Besides, at present, there is no cure and no vaccine to prevent the disease

• What is the cause of SARS? A new Coronavirus is the cause of the disease.

• How does SARS spread and for how long does a person remain a risk to others? When some one sick with SARS coughs or sneezes, the droplets of infection can infect others who are nearby (Like TB and small pox).

It is believed that SARS virus can travel short distances. The virus can survive for sometime (3 hours) after coming out from the patient. Whether infection can be spread through the objects contaminated by the infected persons, is not certain yet though it is being verified.

Patients with SARS can spread infection to others as long as they have signs of the disease. It is therefore advised that a patient who is suspected to be suffering from the symptoms of SARS should be kept isolated for a period of 10 days after the cough and fever have subsided.

• Is it safe to travel by air or by other means of pubic transportation during the SARS epidemic? International travellers should follow the travel advisory that is issued and updated regularly by WHO. It states clearly which areas are suspect for transmission of disease, and therefore, people should avoid visiting. It also gives guidelines for actions by passengers travelling from infected areas and for airline and airport staff.

For national travel, the guidance issued by national authorities should be followed. In areas from where the SARS epidemic is reported, the advice would be to avoid crowded areas, including public transportation. However, if you need to travel on the public transport system e.g. bus, train and other shared vehicles, it is advisable to keep your mouth and nose covered to avoid possible exposure to the infection.

• What is the advice on children going to school if SARS is occurring in the area? The decision to close down the schools and educational institutions is made by the local authorities and it is based on the advice from health department.

If SARS is a problem and schools have been closed, then children should stay at home. They should avoid going to crowded public places to prevent getting infected from a patient with SARS. This will help to prevent infection from SARS patients to others.

• What is the advice about visiting crowded public places to prevent SARS? Crowded public places e.g. shopping malls (bazaars, cinema halls, stadiums) should be avoided during the epidemic. If they have to be visited, then precaution of covering the mouth and nose completely should be observed.

• Are there any travel restrictions relating to SARS? The travel advice is announced regularly by WHO in consultation with the countries involved. The new travel advice is intended to limit further international spread of the epidemic of SARS by restricting travel to areas where the reasons for the pattern of spread of the disease are not well understood. This advice is proposed to be reviewed regularly by the experts and will change as more information becomes available. Local health authorities should be contacted to get upto date details about the affected areas.

• Is SARS related to bio-terrorism? According to currently available information, SARS does not seem to be related to bio-terrorism.

• Who are the people at the risk of getting SARS? Travellers and businessmen who have travelled to countries that are reporting SARS. Health care workers who are responsible for providing care to patients suspected of SARS. Those who do not observe the recommended infection control measures are at risk. Household members of patients suspected to be suffering from SARS.

• How should these people, who must deal with a SARS patient, protect themselves? In the household, measures to control the spread of SARS should be continued for 10 days after the symptoms of fever, cough and respiratory system are gone.

Patients suspected to be suffering from SARS should not go to work, school and other public places especially crowded places. Since the disease spreads mainly by coughing or sneezing, patients suspected of SARS should wear a specially designed mask.

People who are in close contact with a patient suffering from SARS should also wear such a mask. If this is not available use a surgical mask to get at least some protection from the disease. Use disposable gloves while handling the body fluids of the patients suffering from SARS. The gloves should be discarded after use and the hands should be cleaned thoroughly with soap and hot water.

Sharing of utensils, towels, bedding of a SARS patient with other members of family should be avoided. The above items should be washed thoroughly with soap and hot water before reuse. Toilets, sinks, and other surfaces should be cleaned several times in the day with ordinary household cleaners. Hand hygiene is important. Hands should be thoroughly cleaned frequently with soap and hot water to prevent the spread of SARS. Used masks and gloves should be burnt promptly and not reused.

• Is there a cure for SARS? So far, there is no specific cure. The disease should be treated like an atypical pneumonia of unknown cause. Regular consultations are going on amongst doctors to discuss the best treatment of the disease.

Antibiotics are given but they are of doubtful value. Antibiotics may be useful in tackling secondary infections. In the patients who are admitted, anti-virals and steroids are given but their role is not established. Supportive treatments for the symptoms and care have helped to a large extent e.g.

Medicines like Paracetamol to bring down the fever, and provision of ventilators to the 20% of the patients with breathing difficulty who may require them. Remember that 96% of all SARS patients have fully recovered with proper care and treatment.

• What should a person suspected to be suffering from SARS do? A health care worker should be contacted or a hospital facility visited and the patient suspected of the disease should inform the health care provider of any recent visit to a country/area where SARS is being reported or provide the history of contact with a patient suspected to be suffering from SARS. When the patient complains of breathing difficulty or shortness of breath, hospitalisation is advised.

• What is your advice to the health care workers regarding prevention of SARS? Health care workers should be vigilant and they should carefully screen those who have fever, cough or other symptoms of SARS. Health care workers who have symptoms of SARS and have a history of exposure to patients with SARS should not report for duty until 10 days after the relief from fever, cough and other respiratory symptoms. During this period they should stay away from the other health care workers, hospital staff and the community. Infection control measures that are recommended by the hospital/ health facility should be strictly followed.

• What has WHO done to control SARS ? WHO is coordinating the effort through laboratories and WHO collaborating centres to identify the cause of the disease.