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INDEPTH: SARS
Medical journals report on SARS
Amina Ali, CBC News Online | July 15, 2003

Doctors working on the front lines have teamed up with laboratory scientists to document what they've learned about identifying and treating SARS. Journal editors have reviewed the studies and offered their perspectives on efforts to contain the disease and on the many questions that remain unanswered. Here's a look at some of the studies, editorials and commentaries:

Describing the outbreaks

  • Identification and containment of an outbreak of SARS in a community hospital Canadian Medical Association Journal, Hy Dwosh et al April 25, 2003
    How a community hospital cared for their first two SARS patients and used infection control measures to prevent further transmission.

  • Identification of Severe Acute Respiratory Syndrome in Canada, Susan M. Poutanen et al March 31, 2003.
    Abstract from The New England Journal of Medicine.
    (Full text in pdf format).
    This report summarizes the symptoms observed, diagnostic findings and outcomes for the first 10 cases of SARS identified in Canada in early March 2003.

  • British Medical Journal April 19, 2003.
    Outbreak of severe acute respiratory syndrome in Hong Kong Special Administrative Region: case report by Moira Chan-Yeung and W. C. Yu.
    The report describes the daily reported number of cases in Hong Kong, showing how the disease has spread rapidly from health-care workers to the community, and the drastic measures the government introduced to attempt to control the disease (such as vigorous tracing and quarantine of contacts and school closures).

  • Containing a new infection with new technology: a Web-based response to SARS
    by E. VanDenKerkhof et al. Canadian Medical Association Journal, May 13, 2003
    Using an electronic tool to screen hospital personnel and improve surveillance.

  • A Major Outbreak of Severe Acute Respiratory Syndrome in Hong Kong by Nelson Lee et al.
    Abstract from The New England Journal of Medicine, April 7, 2003.
    (Full text in pdf format).
    Researchers describe the clinical, laboratory and CT scan results and statistical findings from 138 cases of suspected SARS during a hospital outbreak in Hong Kong.

  • A Cluster of Cases of Severe Acute Respiratory Syndrome in Hong Kong by Tsang KW et al.
    Abstract from The New England Journal of Medicine, April 11, 2003
    (Full text in pdf format).
    This study describes the clinical presentation and course of disease in 10 epidemiologically linked Chinese patients diagnosed in February and March 2003 at hospitals in Hong Kong.

  • Clinical presentations and outcome of severe acute respiratory syndrome in children by KLE Hon et al.
    April 29, 2003 Abstract from The Lancet
    (Full text in pdf format).
    Researchers in Hong Kong followed the first 10 children with SARS who had been in close contact with infected adults. Their preliminary findings suggest young children develop a milder form of the disease than teenagers and adults.

  • World Health Organization's weekly epidemiological record
    A record of WHO's efforts including travel advice, researching SARS cases in China and scientific updates.

  • Centers for Disease Control's Morbidity and Mortality Weekly Report
    Reports on health and safety topics including updates on SARS cases in the U.S. and worldwide.

Identifying SARS Coronavirus

  • A Novel Coronavirus Associated with Severe Acute Respiratory Syndrome by Thomas G. Ksiazek et al.
    Abstract from The New England Journal of Medicine, April 10, 2003.
    Full text.
    Researchers used electron microscopes, immunology and molecular tests to identify a new coronavirus associated with SARS. They propose naming the virus Urbani SARS-associated coronavirus in honour of the WHO doctor who drew the world's attention to the new disease.

  • Identification of a Novel Coronavirus in Patients with Severe Acute Respiratory Syndrome by Christian Drosten et al.
    Abstract from The New England Journal of Medicine, April 10, 2003.
    Full text (in pdf format).
    German-led team uses cell culture and molecular techniques to grow a new coronavirus from Vietnamese patients. They say the virus might play a part in causing SARS.

  • Coronavirus as a possible cause of severe acute respiratory syndrome by Malik Peiris et al.
    The Lancet, April 8, 2003 (free registration required).
    Researchers in Hong Kong investigated the viral cause and clinical presentation of SARS in 50 patients from five clusters. Using blood and molecular tests they found a virus from the coronavirus family in some patients.

Psychological Impact

  • The immediate psychological and occupational impact of the 2003 SARS outbreak in a teaching hospital
    Canadian Medical Association Journal (in pdf format), April 16, 2003 by Robert Maunder et al.
    Descriptions of what staff and patients reported feeling during a SARS outbreak, such as anxiety and stigmatization.

  • Understanding how people understand, react and cope with SARS
    University of British Columbia consent form for questionnaire, by Anita DeLongis et al.
    Researchers are using a confidential online questionnaire to help understand the psychological factors and responses among those coping with the threat of exposure to SARS.

Journal Commentaries and Editorials

  • SARS: prudence, not panic
    Canadian Medical Association Journal, (in pdf format) April 23, 2003.
    Richard Schabas, chief of staff at York Central Hospital and former Ontario chief medical officer of health, says Ontario's strategy was based on unachievable expectations that quarantine would eliminate the disease. Instead, public health officials should plan "on getting used to living with SARS." Schabas recommends tightening infection control at hospitals, having public health officials focus on the basics, and developing and implementing strategies for managing SARS-like illnesses at family doctors' offices.

  • The race to outpace severe acute respiratory syndrome
    Canadian Medical Association Journal, (in pdf format) April 17, 2003.
    Dr. David Patrick, director of communicable disease epidemiology at the B.C. Centre for Disease Control, compares how British Columbia and Ontario responded to their first cases of SARS.

  • Emerging stronger from the China crisis
    The Lancet April 19, 2003 (free registration required).
    Journal editors comment on China's initial lack of openness on SARS and the country's ability to handle a crisis.

  • Severe acute respiratory syndrome revisited
    British Medical Journal April 19, 2003
    Maria Zambon, a deputy director of the Enteric, Respiratory and Neurological Virus Laboratory at London's Health Protection Agency, outlines the key questions that remain unanswered in identifying the cause of SARS.

  • Faster ... but Fast Enough? Responding to the Epidemic of Severe Acute Respiratory Syndrome
    The New England Journal of Medicine, April 2, 2003 (in pdf format).
    Dr. Julie Louise Gerberding from the U.S. Centers for Disease Control and Prevention reviews the progress and challenges of SARS research and containment as of early April.

  • Case Clusters of the Severe Acute Respiratory Syndrome
    The New England Journal of Medicine
    March 31, 2003 (in pdf format).
    Three weeks after the first WHO notice on SARS, journal editor Dr. Jeffrey Drazen reviews the rapid spread of the infectious disease and recommends doctors follow WHO's advice on isolation precautions.

  • Sudden acute respiratory syndrome
    British Medical Journal, March 29, 2003
    Infectious disease experts Maria Zambon and Karl Nicholson review the emergence of new diseases such as HIV and Ebola. They summarize symptoms and the clinical course of SARS infections as of March 29 and highlight unanswered questions, such as how to diagnose cases quickly.




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