Should we really be scared of SARS?

How worried should we be? That’s the question that seeps into the public consciousness amid the continued barrage of news reports about this contagious new illness spreading around the world. It is a disease that didn’t even officially exist seven weeks ago but is now scaring the entire world. Today, there are more than 3,000 suspected cases in more than 30 countries around the globe. Severe Acute Respiratory Syndrome (SARS) has set off alarm bells among world health authorities, who have reacted quickly to contain its spread. And the intensity of their response, as well as the death of Dr. Carlo Urbani, the doctor who discovered the first clue that a dangerous new microbe was beginning to spread around the globe, is unnerving and confusing to many of us.

After all, each year there are millions of acute respiratory illnesses, such as pneumonia – and the source of many of them is never identified. While SARS has killed about more than 100 people so far, the flu kills 36,000 a year in the US alone. So why all the fuss about a disease that has so far affected relatively few people? The answer is simple and offers a lesson in the complexities of protecting public health: The mystery illness is new. Nobody has ever seen this particular type of pneumonia before. In the public health arena, something new and unknown is always cause for greater alarm, basically because you don’t know how bad it might get. "With a new and emerging disease, you have to respond with full force," says Dick Thompson, spokesman for the World Health Organization (WHO) in Geneva. "There’s a window of opportunity when you can eliminate these diseases before they become part of the common medical background. There’s a possibility that if we move fast enough, we can actually stop the disease."

But just because public health officials are alarmed doesn’t mean the rest of us should be. Some experts say that the scope of the illness very likely has been overestimated. "The potential for panic is a lot greater than the potential for the disease," says John Sensakovic, an infectious disease expert and associate dean of academic affairs at Seton Hall University School of Graduate Education. "They’re casting a very, very wide net. They’d rather capture 10 cases that aren’t real than miss one. It led at least one US newspaper to comment two weeks ago that it seemed more an epidemic of nervousness than of illness."

None of this is to say people should ignore public health warnings about SARS. So far, most of the cases have been tracked to people traveling in specific places in Asia, or family members, caregivers or medical personnel who have close contact with an infected person. It led the WHO to take the unprecedented step last April 2 of issuing a warning against non-essential travel to Hong Kong and China’s Guangdong province, the two most infected areas in the world.

"People who are traveling to Hong Kong and Guangdong should consider postponing their air travel until another time," cautions WHO infectious diseases chief Dr. David Heymann.

It seems prudent to heed that WHO advice until health authorities there attain a better handle on the problem.

The most troubling thing about this disease is how little we know about it. It’s unclear what causes it, although the best guess right now is that it’s a coronavirus – the virus that causes about a fifth of all colds. The symptoms, which include fever, cough and body aches, are similar to other respiratory illnesses. Currently, there is no proven treatment for the disease, although patients are often given antibiotics, oxygen and, in the most serious cases, ventilators to help them breathe. It’s estimated that more than 90 percent of the people who get the disease will get better. The remaining 10 percent will get very sick, of which about 4 percent will die.

Says Dr. Atilla Turgay, chief of the medical staff at Scarborough Hospital in Canada, the country most affected outside Asia, "The difficulty is we’re facing an enemy that has no known shape, no definite identity, and no known effective treatment – and that’s causing the most concern."

So what spooks medical experts is how little they know about SARS and how much damage it can wreak.

Key Facts

• Scientists say SARS is caused by a newly discovered coronavirus, the family of viruses which causes 10-15 percent of common colds. The US Centers for Disease Control and Prevention say evidence is mounting that the virus is the primary causative agent, but experts say some laboratory work still needs to be done to pinpoint its exact characteristics.

• SARS is a type of atypical pneumonia, which is usually caused by viruses such as the influenza virus, adenovirus and other respiratory viruses. Atypical pneumonia can also be caused by organisms such as the Legionella bacteria.

• The main symptoms of SARS are high fever, dry cough, shortness of breath or breathing difficulties. Changes in chest x-rays, which are indicative of pneumonia, also occur. SARS may be associated with other symptoms including chills, headache, muscular stiffness, loss of appetite, malaise, confusion, rash, and diarrhea. Health experts say the disease has an incubation period of between two and seven days, with three to five days being more common, before victims start showing flulike symptoms.

• The mortality rate appears to be between three and five percent. In Hong Kong, at least, those who are infected invariably develop severe pneumonia, which can cause numerous complications. Conditions of victims deteriorate quickly, in as little as five days.

• There is currently no specific cure for the disease. But doctors worldwide have been treating it with ribavirin – an antiviral drug – and steroids. Doctors say if treated early, most patients without serious illness can recover. A top Hong Kong doctor said two weeks ago that some of the worst-affected patients there were being successfully treated using antibodies in serum from recovered patients. The cocktail seems to be working, with most of the deaths thus far confined to the elderly and those with pre-existing medical conditions.

• WHO and Hong Kong experts say the virus spreads through droplets by sneezing or coughing and that such direct infection can occur within a radius of about three feet. The virus can also spread indirectly, as it can survive outside of the human body for three to six hours. Contact with any object that is tainted with droplets containing the virus – for example, a contaminated phone – could lead to infection if a person then touches his or her eyes, nose or mouth. The outbreak at Amoy Gardens apartment in Hong Kong, however, has led investigators to believe that other pernicious transmission modes might be more prevalent than first thought. For example, the SARS virus has now been isolated in feces, as well. Robert Webster, professor of virology at St. Jude Children’s Research Hospital in Memphis, Tennessee, says that prevention is actually simple. Just increase your standard of sanitation to the highest possible level. For example, wash your hands after going to the restroom. "It’s a matter of hygiene," he emphasizes.

• Health experts have not ruled out that it could be airborne, which raises its contagious nature and would make it harder to contain. These experts, however, say it is unlikely that sharing an elevator briefly with an infected person would be enough to pass the virus.

WHO says SARS appears to be less infectious than influenza and is not highly contagious when protective measures are used. Hong Kong officials say it can be killed by a solution of water and common household bleach.

• In a piece of good news, doctors at the US Centers for Disease Control and Prevention announced recently that they had developed two tests to detect the presence of the suspected virus in blood and tissue samples of possible SARS victims. They plan to distribute the diagnostic tests to hospitals shortly. These tests will facilitate the diagnosis of SARS early which will allow treatment to be started promptly.

So, should we be scared of SARS? I think we certainly should be concerned about SARS. We still don’t know many things about it and there is no definitive cure as yet. But we should look at this disease in a larger perspective. After all, with proper health measures, SARS is not considered a highly contagious disease. Unlike certain fulminating infections, its mortality rate of 3-5 percent is also relatively low. That’s just comparable to normal, non-contagious pneumonia. And remember: Even if you unfortunately get the disease, you have a 95 percent chance of recovering from it if it’s diagnosed early and treated well! And there are signs that the spread of this illness seems to be leveling off, at least in some parts of the world. After all, many viral outbreaks do tend to burn out, as the population naturally develops immunity to the particular pathogens. So, let us not take risks but let us not panic either, and allow our fear of SARS to control our day to day lives!