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JAMA NEWS RELEASES
NEW STUDY PROVIDES DETAILED EVALUATION OF SARS OUTBREAK IN TORONTO
FOR IMMEDIATE RELEASE: 9:30 A.M. (CT) TUESDAY, MAY 6, 2003
Media Advisory: To contact corresponding author Allan S. Detsky, M.D., Ph.D., call David Davenport at 416/586-3161. To contact editorial author Henry Masur, M.D., call Dianne Needham at 301/496-2563.
NEW STUDY PROVIDES DETAILED EVALUATION OF SARS OUTBREAK IN TORONTO
CHICAGO—The majority of cases of severe acute respiratory syndrome (SARS) in the Greater Toronto Area were related to hospital exposure, according to a study released today by The Journal of the American Medical Association (JAMA). The study is being released early on JAMA's website (www.JAMA.com) because of the public health concern about SARS. The study will be printed in a later issue of The Journal.
Christopher M. Booth, M.D., and colleagues from the University of Toronto and ten hospitals in the Greater Toronto Area, along with Toronto Public Health, reviewed data collected from patients treated in these hospitals for SARS between March 7 and April 10, 2003. The authors of this study included the physicians who supervised or directly provided care for all of the patients with SARS in these Greater Toronto Area hospitals.
According to background information provided by the authors, the first cases of SARS in Canada involved a family of Hong Kong descent who live in Toronto. They had traveled to China and stayed with a group of people who probably had SARS. Upon return to Canada, one family member became ill and died. Another family member was admitted to a local community hospital which became the epicenter for the Toronto outbreak, the authors describe. "SARS spread to other patients and healthcare workers within this hospital prior to significant awareness of SARS by the Canadian medical community," the authors write. "Other Toronto hospitals were affected when patients were transferred between institutions. This led to additional infection of patients, healthcare workers, and hospital visitors."
The study analyzed data from 144 patients with SARS. The average age of the patients was 45 years and 61 percent were female. Half of the patients (51 percent) were healthcare workers and three-quarters (77 percent) of patients were exposed to SARS in the hospital setting; as healthcare workers, patients, or visitors. The median time from self-reported earliest known exposure to onset of symptoms was six days for early warning symptoms such as headache, malaise or muscle pains, seven days for self-reported fever, eight days for diarrhea, and nine days for cough or difficult or labored breathing, the authors report. The majority of the patients (88 percent) were treated with ribavirin, an antiviral drug. Twenty-nine patients (20 percent) were admitted to the intensive care unit with or without mechanical ventilation.
"There were eight deaths in our cohort of 144 hospitalized SARS patients. Six of these patients had diabetes. Of the other two patients; one had cancer and the other had no co-morbid disease other than being a former smoker. As of April 17, most individuals (103/133, 72 percent) had recovered and were discharged from the hospital," the authors note.
"In conclusion, it is important to recognize that despite the widespread implications of severe acute respiratory syndrome, overall 21-day survival in our study was 93.5 percent," the authors write. "The remarkable spirit of international collaboration between clinicians, researchers and government agencies, needs to continue in an effort to better understand and control this emerging infectious disease."
(JAMA. 2003;289:(DOI 10.1001/jama.289.21.JOC30885).)
EDITORIAL: SARS: PROVIDING CARE IN THE FACE OF UNCERTAINTY
In an accompanying editorial, Henry Masur, M.D. and colleagues from the National Institutes of Health, Bethesda, Md., write that Booth and co-authors, "deserve enormous credit for developing their comprehensive description of this outbreak so rapidly during a period when health care professionals in Toronto have been overwhelmed with clinical and public health responsibilities."
"Much of the attention and concern that SARS has appropriately elicited is because current knowledge regarding the transmission of this disease is rapidly evolving, and clinicians must provide patient care while dealing with a degree of uncertainty."
"Health care leaders, like the front-line caregivers, must also recognize their responsibilities," the editorial authors state. "They must provide equipment and environmental controls that maximize the safety of their health care staff. While much can be done with appropriate equipment in existing facilities, the issue of whether the United States needs better containment facilities for patients with SARS and those with other contagious pathogens must be carefully reexamined."
"Global efforts have described this new syndrome with dramatic speed, and identified and sequenced the apparent etiologic agents. With expedited efforts to develop a specific diagnostic test for SARS-associated coronavirus, with effective infection control techniques, and concentrated efforts to develop effective therapies and vaccines, there is much reason for optimism. Only time will tell whether the disease will reappear when seasons again change, or when the virus is re-introduced by some unexpected vector," the editorial concludes.
(JAMA. 2003;289:(DOI 10.1001/jama.289.21.JED30036).)
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