Keeping informed


  • Health
  • Sunday, 20 Apr 2003

By MENG YEW CHOONG

Everything you wanted to know about SARS...well, almost everything. 

WHAT is SARS? 

SARS stands for Severe Acute Respiratory Syndrome, a disease caused by the SARS virus, which hails from the Coronaviridae family. 

What are the symptoms of SARS? 

Generally, SARS begins with a fever higher than 38 degrees Celcius, and other symptoms may include headache, a general feeling of discomfort, and body aches. Some may experience minor respiratory problems. After two days to a week, patients may develop a dry cough and have difficulties breathing. However, incubation period as long as ten days have also been reported. 

How does SARS spread? 

According to the Atlanta-based Centres for Disease Control and Prevention (CDC), SARS appears to be spread by close person-to-person contact, and most cases of SARS can be traced back to people who have cared for or lived with someone with SARS, or had direct contact with material (like respiratory secretions or other bodily fluids) that had been contaminated with the SARS virus.  

Other possible means where SARS can spread include touching one’s eyes, nose or mouth after touching someone else with SARS or objects contaminated with the SARS virus. The possibility that SARS can be spread broadly through the air as well as other means is still under investigation at this point.  

Is the SARS virus solely responsible for the outbreak, or are other pathogens involved as well? 

According to World Health Organisation (WHO) experts, extensive laboratory tests on monkeys have shown that the SARS virus is undoubtedly the primary agent behind SARS. However, work is going on to also find out the role of other pathogens like the human metapneumovirus (HMPV) and chlamydia, among others, in aggravating the status of those who already have contracted SARS.  

In Hong Kong, it was found that less than half of those who are infected by the SARS virus also have the HMPV, which comes from the Paramyxoviridae family (where Malaysia’s Nipah virus belongs).  

Given that health authorities have already identified the chief culprit, how close are they to coming up with a cure or vaccine? 

A week ago, scientists succeeded in sequencing the nucleotides of the SARS virus, and that is the prelude to coming up with a vaccine. However, it could be a long and torturous path (there is still no vaccine for the Human Immunodeficiency Virus after all these years) as coming up with a vaccine is not as simple as knowing the order of the nucleotides.  

That said, the sequence knowledge is necessary to help scientists as they struggle to come up with a fast and accurate test kit that can diagnose who has or doesn’t have the virus on them.  

The sequence knowledge is also needed for the development of antivirals or vaccines. Right now, the genetic information has already been injected into insect cells with the hope that the cells will produce parts of the SARS virus. From then, it is hoped that such parts will turn out to be non-pathogenic to humans, but are capable of inducing our bodies to produce an immune response against the virus. 

Can antibiotics work against the SARS virus? 

Strictly speaking, antibiotics (like those we take for bacterial sore throats and the like) cannot work against viruses for they are essentially “non-living things” (viruses, interestingly, are nothing more than a few strands of protein that are incapable of feeding themselves or reproducing by their own, and only demonstrate the properties of living things once they are in the host cell).  

Will dosing myself with vitamin C and other nutritional supplements help me fend off SARS? 

The argument of whether taking Vitamin C supplements can help ward of the common cold has yet to be settled until today since 1970, when Nobel laureate Linus Pauling hypothesised the taking in high concentrations (megadosing) of vitamin C can prevent colds and a host of other infections.  

As such, scientists are still a far way off from being able to pronounce that vitamin C can help you fight SARS. However, it has been recognised that vitamin C does help boost the immune system (the argument is on the dosage), and for those whose immunity is suspect (like the frail, the infirm, smokers, those who are highly-stressed), there is perhaps some limited value. 

Like all good things, too much vitamin C (or any other supplement) could be counterproductive (again, scientists disagree on this point for vitamin C), with some studies concluding that stomach pains, diarrhoea, or kidney stones may come about when one consumes the vitamin excessively (more than 1,000mg daily).  

How effective are masks in preventing one from catching SARS? 

If you are not in direct contact with SARS patients (like healthcare workers), the answer is no. Even then, WHO recommends not just any mask, but the N95 respirator masks, the same kind worn by those dealing with tuberculosis. In fact, a WHO spokesperson said that the panic buying of masks can in fact create a shortage for those who really need them like doctors and their patients.  

To put things into perspective, more people are killed by road accidents as well as substance abuse than SARS. As one doctor has said, it is of no help if you wear a mask, but do not fasten your seat belt when on the road.  

Additionally, other variables like the proper wearing of the mask, as well as the frequency of replacement, also come into play when measuring the effectiveness of masks on the SARS virus.  

Who is Carlo Urbani? 

He was the WHO physician who first identified SARS as a new infection after examining a 48-year old businessman who had travelled from China’s Guangdong province through to Hong Kong, and then to Hanoi. The businessman then died from the illness, while Dr Urbani himself succumbed to it on Mar 29 at Bangkok at the age of 46.  

What is the case fatality rate for SARS patients? 

Thus far, the death rate hovers at around 4%, though this is expected to change over time as the virus mutates, and medical science uncovers new frontiers.  

Can someone be infected by the SARS virus, yet be relatively unaffected by it or show no symptoms at all (asymptomatic), and at the same time, act as a spreader of the virus? 

Tests are ongoing to find out whether this could happen. 

What is the most effective disinfectant against the SARS virus? 

The disinfectants that can has been proven to work against other coronaviruses are bleach, alcohol (ethanol at 70-90% by weight), iodine, chlorhexidine, hydrogen peroxide, ammonia, quarternary ammonium, phenols, and formaldehyde (mixed with alcohol). However, it is important to follow the manufacturer’s guidelines for usage as printed on the label.  

Why does the CDC recommend alcohol-based handrubs to healthcare professionals as another means to combat SARS?  

Ethanol has been demonstrated to be fast-acting, and is less likely to give rise to skin irritation. However, the CDC has also emphasised that handrubs are not a substitute for good hand hygiene habits like washing with soap and water, and wearing disposable gloves. 

Can bodily fluids like saliva, urine, blood, or sweat, transmit the SARS virus? 

Thus far, virus particles have been found in the urine and faecal matter of the infected residents who stayed in Block E of Hong Kong’s Amoy Gardens.  

Can mosquitoes act as a vector for SARS? 

This has yet to be any evidence that insects, including cockroaches, can transmit SARS.  

How is the SARS virus related to the common cold virus? 

The common cold is a viral disease that has been associated with no less than 100 different viruses, including the human coronavirus (HCoV) and rhinovirus (the most common causal agent). The SARS virus, while being a coronavirus, falls under a genetically distinct subgroup (as opposed to its “common cold” cousins).  

According to Dr Robin Gopal of UK’s Central Public Health Laboratory, it is therefore, rather presumptious to extrapolate and deduce that the SARS virus will have the same pathogenicity (infectivity) as the common cold (thus far, influenza seems to be more easily caught compared to SARS).  

Meanwhile, efforts are underway to determine whether the SARS virus is another mutated form of HCoV, or a product of genetic recombination of human and animal coronaviruses. A battery of tests is also being conducted on a variety of animals to find out whether any of them are the source of the SARS virus.  

Is it safe to go to shopping complexes or other public venues? 

The current advisory is to avoid crowded places. The irony is that the above places are currently nowhere near crowded, if not pretty deserted. Seriously, there is absolutely no reason why one should not go out to shop or to jalan-jalan if he or she feels like it. Life needs to go on after all (besides, there is not an iota of evidence suggesting that SARS virus are “blowin’” in the wind, or the air-cond ducts). 

Can sharing toilet seats spread SARS? 

While there is no smoking gun to be found on this, the Amoy Gardens incident showed that the SARS virus particles can be present in the faeces and urine of those infected. As such, all the normal procedures in keeping toilets clean and hygienic should be carefully observed, along with proper hand washing and drying.  

What are the current treatment options for SARS? 

Ribavirin has been tested in Hong Kong for a relatively long period. Currently, its Department of Health is testing the efficacy of a combination of ribavirin with high doses of corticosteroids. 

However, ribavirin is not without its share of detrimental side-effects, which is nothing unusual or unexpected in any drug. Meanwhile, in vitro testing (testing outside the human body) has showed that the coronaviruses are resistant towards ribavirin. Needless, to say, a whole range of trials are going on at a frantic pace even as you read this pullout.  

What are the latest developments on the development of diagnostic tests for SARS? 

According to a statement on Thursday from WHO, the first step following the successful identification of the causal agent is the develop a data bank of specimens collected from a range of SARS patients worldwide, in addition to samples from individual patients at different stages of the disease, including recovery. 

With the “time-series” collection of specimens, it is hoped that a test smart enough to detect the virus at the very initial stages when people are capable of becoming “infectors”, as well as to determine the exact point in time when SARS survivors cease to be a threat to their friends and co-workers.  

WHO also acknowledged that existing polymerase chain reaction (PCR) tests are not good enough to rule out, with an acceptable degree of certainty, the presence of the virus in suspected or probable SARS cases early in the course of the disease. On the current PCR test kit manufactured by a German company (and supplied free at the moment), WHO said that the unquestioning usage of the tool could lead to a false sense of security in instances where those actually carrying the virus could be declared “clean” (false negative results).  

It added that in the absence of a “more reliable” diagnostic tool, hospital staff will have no option but to isolate suspected SARS cases and manage them according to standard infection control practices, which it acknowledged could be stressful both for patients as well as the healthcare service providers.  

Note: Answers are condensed from websites belonging to WHO, CDC as well as other health-related sites. 

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