Coronavirus SARS-CoV1 infection (SARS)

Essential Evidence

Last Updated on 2021-03-10 © 2021 John Wiley & Sons, Inc.

Printer Friendly

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

Editor:
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.

Treatment

Bottom Line

  • Respiratory failure is the major cause of mortality in SARS-Cov1 infection and occurs in around 25% of patients. C 1
  • There is no randomized trial evidence regarding treatment. C 1 7
  • If mechanical ventilation is required, ventilator settings should mimic those required for the treatment of ARDS. C 1

Drug Therapy

  • Corticosteroids were used for the treatment of almost all cases of SARS-Cov1 and in a retrospective analysis were associated with lower overall mortality and hospital stay. There is no specific recommendation regarding dosing or regimen. 7 However, in subsequent systematic reviews corticosteroids have not been found to be helpful in treatment of SARS-Cov1 or MERS, with potential harms including increased mortality, complications, and delayed clearance of viral RNA from the respiratory tract. They are not routinely recommended based on interim WHO guidance. 21
  • For patients whose medical treatment regimen for SARS-Cov1 were known, about half were treated with ribavirin. 7 However, a retrospective analysis found no obvious clinical benefit of ribavirin. 7 In addition, testing of the SARS-Cov1 coronavirus in vitro shows that ribavirin has no activity against it. Ribavirin was also associated with an increased risk of anemia, which increases the risk of death in SARS-Cov1 patients. 10
  • In an uncontrolled study, interferon was associated with improvement in oxygenation, but the same patients were also given high-dose corticosteroids. 7
  • A case control study of 75 patients with SARS-Cov1 concluded that use of lopinavir-ritonavir in addition to standard therapy was associated with a decreased death rate. 11
  • See chapter on SARS-CoV2 for information on treatment of COVID 19.

Other Treatment

  • A trial randomized 249 patients with SARS-Cov1 to ECMO or usual care, and found no statistically significant evidence of benefit. However, a high rate of crossovers makes the trial difficult to interpret. 14