SARS Continues Global Spread As Scientists Race for Answers by Gina Shaw Some have compared it to the first known outbreak of Legionnairesí disease (legionellosis) in Philadelphia in 1976. Others recall the early, baffling days of AIDS when the disease was dubbed gay-related immune deficiency (GRID). The latest infectious disease to terrify the public and challenge the medical community is known as SARS (severe acute respiratory syndrome). So far, the potent respiratory illness has spread from its apparent origin point in China to Vietnam, Singapore, the United States, Europe, Canada, and more recently Australia and Brazil as well as several other countries. It has killed at least 229 people (as of April 23) and sickened nearly 4,000 others. Itís even killed the Italian infectious disease expert who first identified it, the World Health Organizationís Carlo Urbani. Calling the reaction to SARS ìworldwide panicî might be a little extreme, but no one appears to be taking any chances with the disease. The American Association for Cancer Research canceled its April annual meeting in Toronto after news of its recent outbreak, and Asian soccer officials have already canceled two Olympic qualifying events, and more may still be scuttled. The Centers for Disease Control and Prevention is discouraging travel to Vietnam, Hong Kong, mainland China and Singapore, and travel to Asia has plummeted, with those who have flown to Asian countries arriving at U.S. airports wearing face masks. In turn, all travelers entering Singapore, for instance, are being checked for the disease as part of that countryís massive ìisolate and containî strategy. The SARS story is developing so rapidly that this morningís information is outdated by this afternoon. As of this writing, a Loudoun County, Va., woman contracted the Washington areaís first confirmed case of SARS after returning from China complaining of suspicious symptoms. She was quickly isolated in a sealed hospital room on Feb. 17. Three other recent ìsuspectedî cases in Maryland are still being investigated, but no other cases of SARS have yet been confirmed in the areaóalthough there are two confirmed cases in southern Virginia, said Dr. William B. Furlong, infection control officer at the Virginia Hospital Center in Arlington, Va., which has treated two suspected cases of SARS that have proven to be other illnesses. Just how serious is SARS, what causes it, and how do you know if you might have it? First, a little perspective: So far, SARS hasnít had nearly the sweep and mortality levels of regular influenza, which kills some 36,000 people in the United States alone each year (and somewhere between 250,000 to 500,000 people around the world). But that could change: The flu is more common, but its mortality rate is lower than SARS. Only about 1 percent of people infected with most strains of influenza die from the illness, while SARS so far appears to have a mortality rate of 3 percent to 4 percentówith some estimates going as high as 10 percent. ìOur concern, mainly, is that this appears to be evolving into a pandemic,î said Furlong. The major conundrum with SARS, he added, is that scientists have only just learned what causes it. ìIt appears to be a coronavirus, a single-stranded RNA virus, which has been known to cause disease in both animals and humans,î Furlong said. (Scientists have now confirmed that a coronavirus is in fact the source of SARS.) ìThis kind of genetic information sometimes helps you design a treatment plan, but at this point the identifying information is so new that itís only a starting point.î SARS also seems to pack a one-two punch in how it infects people. ìUsually, we think of a disease as either respiratory or contact infectious,î Furlong said. ìWith tuberculosis, for example, you get it by breathing droplets exhaled into the air by an infected person, such as when they cough. With staph or salmonella, on the other hand, you can be exposed by direct contact with an infected person. In the case of SARS, however, the CDC recommends both respiratory and contact isolation for infected persons. Weíre treating it as very infectious on both fronts.î Another troubling aspect of SARS is that the symptoms are ìnonspecific,î which means they could signal any number of common, bothersome but usually not serious illnesses, as well as SARS. Symptoms include a fever, coughing, sneezing, chills and body aches, all of which can resemble a typical cold. So how do you decide whether to take a couple of Tylenol Cough and Cold tablets and head for bed or grab a face mask and head for the emergency room? The key distinguishing factor, Furlong said, is shortness of breath. If youíre coughing and sneezing and donít feel great, but you arenít having any trouble breathing, watchful waiting is probably your best course of action. ìBut shortness of breath is always a worrisome symptom regardless of the cause, and combined with the other symptoms like fever and cough, it equals a heightened risk factor for this syndrome,î said Furlong. (Thatís especially true if youíve traveled to an outbreak area recently.) ìItís a good way to decide whether or not youíre sick enough to be evaluated. At minimum, if you have shortness of breath, you should go in for a chest x-ray.î Thereís currently no known treatment for SARS, although multiple antibiotics and other agents are being tested. ìSince we only recently learned exactly what the infectious agent is, itís been difficult to develop a therapy,î Furlong noted. Fortunately, even for the 10 percent to 20 percent of people who do develop severe respiratory problems related to SARS, what physicians call ìsupportive careî (hospitalization on a ventilator or other respiratory assistance) will help the majority of them survive the disease. ìWe handle many other infectious agents with no specific treatment in the same way,î Furlong said. ìIf we manage care aggressively and intervene early, we can pull people through it.î Last yearís anthrax crisis helped prepare Washington-area hospitals to better handle this latest infectious disease outbreak, Furlong said. ìThe anthrax situation was very traumatic for the Washington area in terms of the fear that went along with it and the risk to the postal workers, but it did alert us as to how to deal with a larger crisis. It opened up the lines of communications between the various parts of the health care system, and we can communicate with each other much more quickly and definitively than before.î For the latest information on SARS, visit the Centers for Disease Control and Preventionís frequently updated Web site at www.cdc.gov/ncidod/sars/. Gina Shaw is the medical writer for The Washington Diplomat.