Coronavirus SARS-CoV1 infection (SARS)

Essential Evidence

Last Updated on 2020-05-08 © 2020 John Wiley & Sons, Inc.

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Authors:
M. Joyce Green, MD, Assistant Professor, Penn State Health Hershey Medical Center
Pete Yunyongying, MD, FACP, Associate Professor , Carle-Illinois College of Medicine, University of Illinois
Mark H. Ebell, MD, MS, Professor, College of Public Health, University of Georgia
Mindy A. Smith, MD, MS, Clinical Professor, Department of Family Medicine, Michigan State University
Sandeep Jalli, DO, Postgraduate Year 1, Augusta University/University of Georgia Medical Partnership

Editor:
Mark H. Ebell, MD, MS, Professor, College of Public Health, University of Georgia

Overall Bottom Line

  • The most common presenting symptoms of SARS are fever, chills, myalgia, malaise, and cough. 1 Test patients for SARS-CoV using PCR only if no other cause of pneumonia can be found 72 hours after starting a workup and if the patient has risk factors for SARS. Consult public health authorities prior to testing. G5C
  • Supportive care is the mainstay of treatment. Although most patients were treated with corticosteroids and antivirals, there is little evidence that these interventions improved outcomes, and they are known to have ill effects. C 2
  • The case fatality ratio in over 8000 cases reported by the WHO was 9.6%. G18C

Background

  • Severe acute respiratory syndrome (SARS) is a viral lower respiratory illness caused by SARS-CoV1 that is frequently associated with rapid progression resulting in acute respiratory distress syndrome (ARDS). 3

Incidence

  • During the largest outbreak of the disease, over 8000 cases of SARS were identified across at least 29 countries from November 2002 to July 2003. G18
  • The last known outbreak of SARS involved laboratory workers in China and was contained by 2004 (WHO, n.d.).
  • Most cases occurred in mainland China, with other large-scale outbreaks in Hong Kong, Singapore, and Canada. G18

Other Impact

  • The case fatality ratio was 9.6% among the reported cases. G18

Causes of the Condition

  • The cause of SARS is the coronavirus SARS-CoV-1. 4

Pathophysiology

  • The SARS coronavirus is a single-stranded enveloped RNA virus that binds to the angiotensin-converting enzyme 2 receptor to gain entry to host cells. 5
  • Himalayan palm civets, Chinese ferret badgers, and raccoon dogs have all been found to carry the SARS coronavirus, but it is currently believed that the host for SARS is most likely bats. 6
  • The incubation period of SARS is between 2 and 14 days, and hospital admission typically occurs 3 to 5 days after the onset of symptoms. 7
  • One of the hallmarks of the SARS coronavirus is diffuse alveolar damage, which is noted on the histopathology of deceased individuals. This is probably responsible for the severe respiratory symptoms. 4
  • About 20% to 30% of patients progress to respiratory failure and require mechanical ventilation. 1
  • Overall, 80% of hospitalized patients with SARS will have persistent ground-glass opacities on chest radiographs 1 month following hospitalization, while 95% will show these changes on chest CT scans. 1

Risk Factors

Risk Factor
Living in or traveling to an endemic area for SARS