SARS
Severe acute respiratory syndrome (SARS) is a viral
respiratory illness caused by a coronavirus, called
SARS-associated coronavirus (SARS-CoV). SARS was
first reported in Asia in February 2003. Over the next few
months, the illness spread to more than two dozen
countries in North America, South America, Europe, and
Asia before the SARS global outbreak of 2003 was
contained.
Etiologic Agent: SARS coronavirus (SARS- CoV), a
positive, single-stranded RNA virus belonging to a family
of enveloped coronavirus.
Incubation Period / Epidemiologic criteria:
1. Travel (including transit in an airport) within ten days
of the onset of symptoms to an area with current or
previously documented or suspected community
transmission of SARS.
2. Close contact within ten days of the onset of
symptoms with a person known or suspected to have
SARS.
Mode of Transmission:
1. The primary mode of transmission appears to be
direct. Mucous membranes (especially those of the eye,
nose and mouth) are always involved.
2. Contact by respiratory droplets (droplet spread)
produced when an infected person coughs or sneezes.
3. The virus also can spread when a person touches a
surface or object contaminated with infectious droplets
and then touches his or her mouth, nose, or eye(s).
4. Transmission through casual and social contact
occasionally occurs as a result of intense exposure to a
case of SARS (in workplaces, in vehicles) or in high-risk
transmission settings, such as healthcare and household
settings.
5. In addition, it is possible that the SARS virus might
spread more broadly through the air (airborne spread) or
by other ways that are not now known.
Signs and Symptoms:
• High fever (temperature greater than >100.4 F
(>38 C).
• Headache
• Overall feeling of discomfort
• Body aches
• Clinical findings of mild respiratory illness on
onset (e.g., cough, shortness of breath, difficulty
in breathing or hypoxia).
• Diarrhea (about 10% - 20%)
• After 2-7 days, SARS patients may develop a
dry cough.
Exams and Tests
Initial tests for persons thought to have SARS include
the following:
• Chest x-ray films
• Pulse oximetry (a test in which a probe connected
to a computer is placed on the finger or ear to
measure oxygen saturation in the blood)
• Blood cultures
• Sputum (fluid from the respiratory tract) Gram stain
and culture
• Testing for viral agents such as influenza A,
influenza B, and respiratory syncytial virus
• Urinary antigen testing for Legionella and
pneumococcal species (2 causes of
bacterial pneumonia).
Medications:
Treatment of SARS so far has been largely
supportive with antipyretics, supplemental
oxygen and ventilatory support as needed.
Iminocyclitol 7 has been found to have an inhibitory
effect on SARS-CoV in that it disrupts the
envelope glycoprotein processing.
Iminocyclitol 7 specifically inhibits the
production of human fucosidase and in
vitro trials yielded promising results in the
treatment of SARS, yet one problem exists. A
deficiency of fucosidase can lead to a
condition known as fucosidosis in which
there is a decrease in neurological function.
Treatment:
In December 2004 it was reported that Chinese
researchers had produced a SARS vaccine. It has been
tested on a group of 36 volunteers, 24 of whom
developed antibodies against the virus.
Suspected cases of SARS must be isolated, preferably
in negative pressure rooms, with complete barrier
nursing precautions taken for any necessary contact with nursing precautions taken for any necessary contact with
these patients. these patients.

There is some evidence that some of the more serious There is some evidence that some of the more serious
damage in SARS is due to the body's own immune damage in SARS is due to the body's own immune
system overreacting to the virus - a cytokine storm. system overreacting to the virus - a cytokine storm.
Research is continuing in this area. Research is continuing in this area.

A 2006 systematic review of all the studies done on the A 2006 systematic review of all the studies done on the
2003 SARS epidemic found no evidence that antivirals, 2003 SARS epidemic found no evidence that antivirals,
steroids or other therapies helped patients. A few steroids or other therapies helped patients. A few
suggested they caused harm. suggested they caused harm.

Nursing Management: Nursing Management:

1. Maintain the patient’s airway and adequate 1. Maintain the patient’s airway and adequate
oxygenation. oxygenation.

2. Teach the patient how to cough and perform deep- 2. Teach the patient how to cough and perform deep-
breathing exercises to clear secretions. Advise him/her breathing exercises to clear secretions. Advise him/her
to do this often. to do this often.

3. Obtain sputum specimens as needed. Teach the 3. Obtain sputum specimens as needed. Teach the
correct collection of specimen. correct collection of specimen.

4. Maintain adequate nutrition. 4. Maintain adequate nutrition.

5. Provide a calm environment as the patient needs rest. 5. Provide a calm environment as the patient needs rest.

6. Control the spread of infection by disposing the 6. Control the spread of infection by disposing the
secretions properly. secretions properly.

7. Control temperature by implementing cooling 7. Control temperature by implementing cooling

measures. measures.

8. Monitor vital signs closely and watch for danger signs 8. Monitor vital signs closely and watch for danger signs
like: like:

a. marked dyspnea a. marked dyspnea

b. thread, small, irregular pulse, b. thread, small, irregular pulse,

c. delirium with extreme restlessness c. delirium with extreme restlessness

d. cold, moist skin d. cold, moist skin

e. cyanosis and exhaustion e. cyanosis and exhaustion