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.


  • Severe acute respiratory syndrome (SARS-CoV1) in 2002-2003 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
  • Within months after its emergence in Guangdong Province in mainland China, it had affected more than 8000 patients and caused 774 deaths in 26 countries on five continents. 1
  • Most recently, COVID-19 (coronavirus disease 2019) is a different viral lower respiratory infection first reported in Wuhan City, China that has rapidly spread to become a pandemic. It is caused by novel coronavirus named 2019-nCoV and more recently SARS-CoV2.


  • During one of the largest outbreak of the disease, over 8000 cases of SARS-CoV1 were identified across at least 29 countries from November 2002 to July 2003. G18
  • The last known outbreak of SARS-CoV1 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 SAR-CoV1 cases in 2002 to 2003. G18

Causes of the Condition

  • The cause of SARS-CoV1 is the coronavirus SARS-CoV-1. 4


  • The SARS-CoV1 virus 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-CoV1, but it is currently believed that the host for SARS-CoV1 is most likely bats. 6
  • The incubation period of SARS-CoV1 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-CoV1 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-CoV1 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-CoV1