Anguilla’s Director of Health Services, Dr. Franklin Lloyd, has submitted the following article on the new disease –SARS - which is now a source of much world-wide concern:

SARS or Severe Acute Respiratory Syndrome, is a viral disease affecting primarily the respiratory system of humans and causing severe and sometimes fatal illness in its victims.

This disease is new and our knowledge of its causative agent and its clinical course are being studied aggressively by scientists all over the world. So what do we know so far about SARS?

The syndrome was first recognised in February 2003 in Hanoi, Vietnam, by WHO investigator Carlo Urbani MD. Dr. Urbani died on March 29 of the disease. To date, WHO has tallied 1,622 cases and 58 deaths from the disease. Most infected persons improve with supportive care after about one week, but about 10 percent decline and need mechanical ventilation. Those with other illnesses are at greater risk of deterioration.

It seems that the causative agent is likely to be a coronavirus. This is one type of virus that causes common colds. The symptoms of SARS are very non-specific and include most often, high fever, dry cough, breathing difficulties. Less frequently headaches, muscle aches, rashes and diarrhea. There are no diagnostic tests yet to positively identify the virus but there is hope that a PCR (Polymerase chain reaction) test under investigation in Hong Kong might prove useful.

So far SARS seems to be spread primarily by close contacts with travellers, presumably since these are in an enclosed area for prolonged periods. However, an outbreak in an apartment complex in Hong Kong on March 31, has been traced to a single resident, raising fears that transmission may be easier than expected. It is known that coronaviruses can survive in the environment for 2 to 3 hours and therefore the possibility of objects being contaminated and acting as agents of transfer (fomites) is real.

There is no known treatment for SARS at present. Viruses typically do not respond to antibiotics, however, these are often used in severe cases to prevent or treat secondary bacterial infections. Antiviral medicines such as Ribavirin have been tried as have steroids. However, no clear benefit has been proved so far. The University of Hong Kong has claimed some success with immunoglobulin therapy but it is too early to give a definitive verdict. The definitive treatment for many viral infections is immunization but this would take years to develop.

WHO has issued guidelines and advisories relating to travel, surveillance and recommended protective measures. This information can be viewed on the WHO website. Travel is not restricted but persons coming from high risk areas are advised to be extremely vigilant and to report any suspicious symptoms. Airport and port authorities are recommended to undertake screening of passengers for international travel. Suspected cases should be isolated and full protective measures instituted for all attending staff.

In this time of heightened awareness and increased tension, there is obviously concern about SARS. However, simple protective measures, avoidance of unnecessary travel to high risk areas and active contact tracing can go a long way in reducing the spread of this disease.

Dr. Franklin Lloyd

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