Aging Begins at 30

SARS: The First 100 Days

Ian Maclean Smith, M.D.
Emeritus Professor
Department of Internal Medicine
University of Iowa Hospitals and Clinics
Creation Date: July 2003
Last Revision Date: July 2003
Peer Review Status: Internally Peer Reviewed

Dr. Carlo Urbani (since dead of SARS) announced late in February 2003 that there was a new kind of pneumonia in patients in the Hospital in Hanoi, Viet Nam. The WHO organized many scientists from molecular biologists to shoe-leather epidemiologists (people who walk around asking penetrating questions) to investigate and they did so ever so well. By Kock's postulates (a summary of causality of an infectious disease) the disease has been shown to be due to SARS-associated corona virus or SARS-CoV. It is only distantly related to other corona viruses such as those causing some common colds. It comes initially from wild civets and raccoon dogs that are culinary delicacies in Southeast China.

Five to 15 days after exposure a pneumonia that is not very different from other less virulent pneumonias acquired in the community (outside a hospital) develops. Thereafter it spreads person to person. Health care workers have been particularly susceptible. It can be diagnosed by electron microscopy of sputum or (after the fact) by blood tests. An on-the-spot quick diagnostic test is desperately needed. The main diagnostic feature is exposure to a person from a SARS infected area (Hong Kong, Hanoi, Guangdong Province of China, Toronto, etc.). It has spread to more than 30 countries mainly by air travel. The WHO has now said that the disease has peaked, but it could reappear next winter. It was contained by widespread quarantine. There is now a coordinated effort worldwide to make an effective vaccine. The worldwide effort coordinated by WHO has been astonishing.

There have been more than 800 deaths, especially in health care workers. Economic and social effects have been seen in hospitals, airports, the travel industry, schools, and stock markets. Health care workers have also been discriminated against.

I can do little to add to this excellent summary, but there are symposia of definitive papers in the NEJM (May 15, 2003) and the Lancet (May 24, 2003) and the JAMA (June 4, 2003) as well as, continuous running reports in the Mortality and Morbidity reports from CDC in Atlanta.

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See related Patient Topics Lungs and Breathing or Severe Acute Respiratory Syndrome.

See related Provider Topics or Lungs and Breathing.

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