SARS Questions and Answers

What is SARS?
Severe acute respiratory syndrome (SARS) is a respiratory illness that has recently been reported in Asia, North America, and Europe. For additional information, check the World Health Organization's (WHO) SARS Web site or visit other pages on
CDC's SARS Web Site.

What are the symptoms and signs of SARS?
The illness usually begins with a fever (measured temperature greater than 100.4°F [>38.0°C]). The fever is sometimes associated with chills or other symptoms, including headache, general feeling of discomfort and body aches. Some people also experience mild respiratory symptoms at the outset.
After 2 to 7 days, SARS patients may develop a dry, nonproductive cough that might be accompanied by or progress to the point where insufficient oxygen is getting to the blood. In 10 percent to 20 percent of cases, patients will require mechanical ventilation. For more information, see the MMWR Dispatch.

If I were exposed to SARS, how long would it take for me to become sick?
The incubation period for SARS is typically 2 to 7 days; however, isolated reports have suggested an incubation period as long as 10 days. The illness usually begins with a fever (>100.4°F [>38.0°C]) (see signs and symptoms, above).

Do some people who recover from SARS become sick again or relapse?
At this time we do not have a full understanding of the natural course of illness in persons infected with the SARS coronavirus (SARS Co-V). It will be important to learn what factors might influence illness progression and recovery. Such factors could be related to the virus itself, how the body's immune system reacts to the virus, how infection with the virus is treated, or other possibilities. CDC and other scientists are trying to learn the answers to these important questions.

What medical treatment is recommended for patients with SARS?
CDC currently recommends that patients with SARS receive the same treatment that would be used for any patient with serious community-acquired atypical pneumonia.

Is the use of ribavirin (or other antiviral drugs) effective in the treatment of patients with SARS?
At present, the most efficacious treatment regimen, if any, is unknown. In several locations, therapy has included antivirals such as oseltamivir or ribavirin. Steroids also have been given orally or intravenously to patients in combination with ribavirin and other antimicrobials. In the absence of controlled clinical trials, however, the efficacy of these regimens remains unknown. Early information from laboratory experiments suggests that ribavirin does not inhibit virus growth or cell-to-cell spread of one isolate of the new coronavirus that was tested. Additional laboratory testing of ribavirin and other antiviral drugs is being done to see if an effective treatment can be found.

Is there a test for SARS?
Several laboratory tests can be used to detect the SARS-associated coronavirus (SARS-CoV). A reverse transcription polymerase chain reaction (RT-PCR) test can detect SARS-CoV in clinical specimens, including blood, stool, and nasal secretions. Serologic testing also can be performed to detect SARS-CoV antibodies produced after infection. Finally, viral culture has been used to detect SARS-CoV. Currently, all serologic testing for SARS-CoV in the United States is being done at CDC. However, CDC has begun to make coronavirus testing materials available to state health departments and other laboratories.

What is a PCR test?
PCR (or polymerase chain reaction) is a laboratory method for detecting the genetic material of an infectious disease agent in specimens from patients. This type of testing has become an essential tool for detecting infectious disease agents.

What does serologic testing involve?
A serologic test is a laboratory method for detecting the presence and/or level of antibodies to an infectious agent in serum from a person. Antibodies are substances made by the body's immune system to fight a specific infection.

What does viral culture and isolation involve?
For a viral culture, a small sample of tissue or fluid that may be infected is placed in a container along with cells in which the virus can grow. If the virus grows in the culture, it will cause changes in the cells that can be seen under a microscope.

SARS?
There are some common-sense measures that you can take to prevent the spread of SARS that apply to many infectious diseases. The most important is frequent hand washing with soap and water or use of alcohol-based hand rubs (See Guideline for Hand Hygiene in Health Care Settings). In addition, you should avoid touching your eyes, nose, and mouth with unclean hands and encourage people around you to cover their nose and mouth with a tissue when coughing or sneezing.

How is SARS spread?
The primary way that SARS appears to spread is by close person-to-person contact. Potential ways in which SARS can be spread include touching the skin of other people or objects that are contaminated with infectious droplets and then touching your eye(s), nose, or mouth. This can happen when someone who is sick with SARS coughs or sneezes droplets onto themselves, other people, or nearby surfaces. It also is possible that SARS can be spread more broadly through the air or by other ways that are currently not known.

What does "close contact" mean?
The primary way that SARS appears to spread is by close person-to-person contact. Close contact might occur when between people live together in the same household or if someone is providing care to a SARS patient. Examples include kissing or embracing, sharing eating or drinking utensils, close conversation (within 3 feet), physical examination, and any other direct physical contact between people. Close contact does not include activities such as walking by a person or sitting across a waiting room or office for a brief period of time.

How can I protect myself against SARS?
There are some common-sense measures that you can take to prevent the spread of SARS that apply to many infectious diseases. The most important is frequent hand washing with soap and water or use of alcohol-based hand rubs (See Guideline for Hand Hygiene in Health-Care Settings). In addition, you should avoid touching your eyes, nose, and mouth with unclean hands and encourage people around you to cover their nose and mouth with a tissue when coughing or sneezing.

How long is a person with SARS infectious to others?
Information to date suggests that people are most likely to be infectious when they have symptoms, such as fever or cough. However, it is not known how long before or after their symptoms begin that patients with SARS might be able to transmit the disease to others.

Who is most at risk of contracting SARS?
Most of the U.S. cases of SARS have occurred among travelers returning to the United States from other parts of the world affected by SARS. There have been very few cases as a result of spread to close contacts such as family members and health care workers. Currently, there is no evidence that SARS is spreading more widely in the community in the United States.

Should I wear a surgical mask to protect myself from getting SARS?
CDC does not recommend routine use of surgical masks when people are in public to prevent SARS.

Are there any times when a surgical mask should be worn to prevent the spread of SARS?
People who have -- or think they might have -- SARS should cover their mouth and nose with a tissue when coughing or sneezing. If possible, they also should wear a surgical mask during close contact with people who are not infected (for example, household members) to prevent the spread of infectious droplets. When a person with SARS is unable to wear a surgical mask, household members should wear surgical masks when in close contact with the patient.
Surgical masks should fit snugly around the mouth and nose. Masks are intended for use by one person only and should not be shared. Masks should be discarded when soiled or moist; changing masks daily is a good rule of thumb. Hand hygiene should be performed after handling a soiled mask. For additional information, see Infection-control Precautions for SARS Patients  and Their Close Contacts in Households.  

Should I be concerned about buying items which are made in countries where SARS has been found?
SARS appears to be transmitted mainly by direct contact with infectious material, including large respiratory droplets spread in the air when an infected person coughs or sneezes. Touching objects contaminated with infectious droplets and then touching your eye(s), nose, or mouth could result in transmission of SARS.
Contamination of environmental surfaces would be a particular concern in health-care settings and households where patients with SARS would be receiving care. Furniture, clothing, and other items imported from countries where SARS has been found would be expected to pose little, if any, risk of transmission of SARS.

Are there any travel restrictions related to SARS?
At this time there are no travel restrictions in place that are directly related to SARS. However, a CDC travel advisory recommends that individuals who are planning nonessential or elective travel to regions for which CDC has issued travel alerts and advisories may wish to postpone their trip until further notice. CDC has also issued a travel alert for Singapore to recommend that U.S. travelers observe precautions to safeguard their health. For additional information and updates about these travel notices, check the SARS Information for Travelers Web Site, which will be updated as necessary or check the Department of State Web Site for a list of DOS travel warnings related to SARS.

What if I must travel to a country where there is community spread of SARS? What precautions can I take?
As with all infectious illnesses, the first line of defense is careful hand hygiene. As a general rule, it is good practice to wash hands frequently with soap and water; if hands are not visibly soiled, alcohol-based hand rubs may be used as an alternative.

To minimize the possibility of infection, you may wish to avoid close contact with large numbers of people as much as possible. CDC does not recommend the routine use of masks while in public areas. For more information, visit CDC's Web Site and specifically read the Interim Guidelines About Severe Acute Respiratory Syndrome (SARS) for Persons Traveling to Areas with SARS.

What should I do if I have recently traveled to a country where cases of SARS have been reported?
You should monitor your own health for 10 days following your return. If you become ill with a fever of more than 100.4°F [>38.0°C] that is accompanied by a cough or difficulty breathing or that progresses to a cough and/or difficulty breathing, you should consult a health-care provider. To help your health-care provider make a diagnosis, tell him or her about any recent travel to regions where cases of SARS have been reported and whether you were in contact with someone who had these symptoms.

What is the difference between a “travel alert” and a “travel advisory” issued by CDC?
CDC issues two types of notices to travelers depending on specific situations: travel alerts and travel advisories. Travel alerts inform travelers of a health concern in a particular area and provide advice about specific precautions that should be taken. A travel advisory notifies travelers of potentially more serious situations and advises that non-essential travel be postponed.

What information about SARS is being provided to people traveling on ships?
SARS information contained on CDC's health alert cards is being provided by the major shipping associations and the International Council of Cruise Lines to people traveling on cargo ships and cruise ships at U.S. ports. Inspectors also are boarding ships if a passenger or crew member has been reported with symptoms matching the case definition of SARS.

What are CDC's quarantine officials doing to prevent and control the spread of SARS?
CDC's quarantine inspectors or their designees are distributing Health Alert Cards to passengers returning in airplanes either directly or indirectly to the United States from regions for which CDC has issued travel alerts and advisories. The notices inform travelers about SARS and its symptoms and asks them to monitor their health for 10 days and to see a doctor if they get a fever with a cough or have difficulty breathing. CDC distributes more than 20,000 health alert notices each day to air travelers returning from the affected regions. Inspectors also are boarding airplanes if a traveler has been reported with symptoms matching the case definition of SARS.

WHO has Recommended Procedures for pre-departure screening of airline passengers from some countries for respiratory illnesses or other symptoms of SARS.

What does a quarantine inspector do?
Quarantine inspectors serve as important guardians of health at borders and ports of entry into the United States. They routinely respond to illness in arriving passengers and ensure that the appropriate medical action is taken.

What is considered routine health inspections of airplanes or ships versus what is happening now?
Routine health inspections consist of working with airline, cargo ship, and cruise ship companies to protect passengers and crew from certain infectious diseases. Quarantine inspectors meet arriving aircraft and ships reporting ill passengers and/or crew (as defined in the Foreign Quarantine Regulations and assist them in getting appropriate medical treatment.

What is the risk to individuals who may have shared a plane or boat trip with a suspected SARS patient?
Cases of SARS continue to be reported primarily among people who have had direct close contact with an infected person, such as those sharing a household with a SARS patient and health-care workers who did not use infection control procedures while attending to a SARS patient. SARS also has occurred among air travelers, primarily travelers to and from Hong Kong, Hanoi, Singapore, and mainland China.

CDC is requesting locating information from travelers who are on flights with people suspected of having SARS. CDC, with the help of state and local health authorities, is attempting to follow-up with these travelers for 14 days to make sure no one develops symptoms consistent with SARS.

Who actually notifies quarantine officials of potential SARS cases? Is it the crew of the airplane or ship? The passengers?
Under foreign quarantine regulations, the master of a ship or captain of an airplane coming into the United States from a foreign port is required by law to report certain illnesses among passengers. The illness must be reported to the nearest quarantine official. If possible, the crew of the airplane or ship will try to relocate the ill passenger or crew member away from others. If the passenger is only passing through a port of entry on his/her way to another destination, port health authorities may refer the passenger to a local health authority for assessment and care.

If I'm on board an airplane or ship with someone suspected of having SARS, will I be allowed to continue to my destination?
CDC does not currently recommend that the onward travel of healthy passengers be restricted in the event that a passenger or crew member suspected of having SARS is removed from the ship or airplane by port health authorities. All passengers and crew members may be advised by port health authorities to seek medical attention if they develop SARS symptoms.

What does a quarantine official do if a passenger is identified as meeting the case definition for suspected SARS?
Quarantine officials arrange for appropriate medical assistance to be available when the airplane lands or the ship docks, including medical isolation. Isolation is important not only for the sick passenger's comfort and care but also for the protection of members of the public. Isolation is recommended for travelers with suspected cases of SARS until appropriate medical treatment can be provided or until they are no longer infectious.

What does a quarantine official do if a passenger identified as meeting the case definition for suspected SARS refuses to be isolated?
Many levels of government (Federal, State, and local) have basic authority to compel isolation of sick persons to protect the public. In the event that it is necessary to compel isolation of a sick passenger, CDC will work with appropriate State and local officials to ensure that the passenger does not infect others.

CDC has recommended guidelines for medical aircraft that transport SARS patients. Should commercial airlines also follow these guidelines?
No. This guidance (available at this CDC Web Site) is intended specifically for air medical transport (AMT) service providers that use specialized aircraft to transport SARS patients. It should not be generalized to commercial passenger aircraft. These interim recommendations for AMT are based on standard infection control practices, AMT standards, and epidemiologic information from ongoing investigations of SARS, including experience from transport of 2 patients during this outbreak. Specific guidelines for airline crew and flight personnel of commercial aircrafts are available at this page. CDC also has developed Interim Guidance for Cleaning of Commercial Passenger Aircraft after a flight with a suspected SARS passenger.

What should I do if I think I have SARS?
If you are ill with a fever greater than 100.4°F (>38.0°C) that is accompanied by a cough or difficulty breathing or that progresses to a cough and/or difficulty breathing, you should consult a health-care provider. To help your health-care provider make a diagnosis, tell him or her about any recent travel to regions where cases of SARS have been reported and whether you were in contact with someone who had these symptoms.