Coronavirus SARS-CoV1 infection (SARS)

Essential Evidence

Last Updated on 2022-03-30 © 2022 John Wiley & Sons, Inc.

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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

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

Overall Bottom Line

  • The most common presenting symptoms of the SARS-CoV1 in 2003 were fever, chills, myalgia, malaise, and cough. 1 Test patients for SARS-CoV1 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-CoV1. 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 in 2003 was 9.6%. G18C
  • A separate chapter address infection with SARS-CoV2 and COVID-19.

Practice Guidelines

  1. Balboni A, Battilani M, Prosperi S. The SARS-like coronaviruses: the role of bats and evolutionary relationships with SARS coronaviruses. New Microbiol 2012 Jan;35(1):1-16.
  2. Centers for Disease Control. (n.d.) Appendix B1: Revised CSTE SARS Surveillance Case Definition. Retrieved from Severe Acute Respiratory Syndrome (SARS).
  3. Centers for Disease Control. (n.d.) Appendix F4: Guidelines for Collecting Speciments from Potential SARS Patients. Retrieved from Severe Acute Respiratory Syndrome.
  4. Centers for Disease Control. (n.d.) Clinical Guidance on the Identification and Evaluation of Possible SARS-CoV Disease among Persons Presenting with Community-Acquired Illness. Retrieved from Severe Acute Respiratory Syndrome: Clinical Evaluation and Diagnosis.
  5. Centers for Disease Control. (2012, July 07) Clinicial Guidance on the Identification and Evaluation of Possible SARS-CoV. Retrieved from
  6. Chan KS, Lai ST, Chu CM, Tsui E, Tam CY, Wong MM, Tse MW, Que TL, Peiris JS, Sung J, Wong VC, Yuen KY. (2003) Treatment of Severe acute respiratory syndrome with lopinavir-ritonavir: a multicentre retrospective matched cohort study. Hong Kong Med J 2003 Dec;9(6):399-406.
  7. Chiou HE, Liu CL, Buttrey MJ, Kuo HP, Liu HW, Kuo HT, Lu YT. Adverse effects of ribavirin and outcome in severe acute respiratory syndrome: experience in two medical centers. Chest 2005 Jul;128(1):263-272.
  8. Christian MD, Poutanen SM, Loutfy MR, Muller MP, Low DE. Severe acute respiratory syndrome. Clin Infect Dis 2004;38(10):1420–1427
  9. Cowling BJ, Muller MP, Wong IO, Ho LM, Lo SV, Tsang T, Lam TH, Louie M, Leung GM. Clinical prognostic rules for severe acute respiratory syndrome in low- and high-resource settings. Arch Intern Med 2006;166(14):1505-1511.
  10. Grant PR, Garson JA, Tedder RS, Chan PK, Tam JS, Sung JJ. Detection of SARS coronavirus in plasma by real-time RT-PCR. N Engl J Med 2003;349(25):2468-2469.
  11. Hui DS, Chan MC, Wu AK, Ng PC. Severe acute respiratory syndrome (SARS): epidemiology and clinical features. Postgrad Med J 2004;80(945):373-381.
  12. Ksiazek TG, Erdman D, Goldsmith CS, Zaki SR, Peret T, Emery S, Tong S, Urbani C, Comer JA, Lim W, Rollin PE, Dowell SF, Ling AE, Humphrey CD, Shieh WJ, Guarner J, Paddock CD, Rota P, Fields B, DeRisi J, Yang JY, Cox N, Hughes JM, LeDuc JW, Bellini WJ, Anderson LJ; SARS Working Group. A novel coronavirus associated with severe acute respiratory syndrome. N Engl J Med 2003;348(20):1953-1966.
  13. Lee N, Hui D, Wu A, Chan P, Cameron P, Joynt GM, Ahuja A, Yung MY, Leung CB, To KF, Lui SF, Szeto CC, Chung S, Sung JJ. A major outbreak of severe acute respiratory syndrome in Hong Kong. N Engl J Med 2003;348(20):1986-1994.
  14. Mahony JB, Richardson S. Molecular diagnosis of severe acute respiratory syndrome: the state of the art. J Mol Diagn 2005;7(5):551-559.
  15. Mazzulli T, Farcas GA, Poutanen SM, Willey BM, Low DE, Butany J, Asa SL, Kain KC. Severe acute respiratory syndrome-associated coronavirus in lung tissue. Emerg Infect Dis Emerg Infect Dis 2004;10(1):20-24.
  16. Peiris JSM, Yuen KY, Osterhaus ADME, Stöhr K.The severe acute respiratory syndrome. N Engl J Med 2003;349:2431-2441
  17. Vijay R, Perlman S. Middle East respiratory syndrome and severe acute respiratory syndrome. Curr Opin Virol 2016;16:70-76.
  18. World Health Organization. (2003) Summary of Probable SARS Cses With Onset of Illness from 1 November 2002 to 31 July 2003. Retrieved from Emergenceis preparedness, response: