Severe acute respiratory syndrome (SARS) at the beginning

Abstract

Study objectives: In March 2003, an outbreak of severe acute respiratory syndrome (SARS) occurred at the Prince of Wales Hospital in Hong Kong, which resulted in the first major outbreak outside mainland China. This study aims to describe the epidemiology, clinical aspects, and consequences of this outbreak. Methods: Prince of Wales Hospital is a 1,400-bed tertiary teaching hospital in Hong Kong, a Special Administrative Region of China, with a population of 7 million. An outbreak resulted from 1 unrecognized index case on a medical ward admitted March 4, 2003. An epidemiologic study of the contact cases (staff, patients, and visitors), including demographics, contact history, clinical course, and follow-up, was undertaken. The hospital and political response was also studied. Results: Within 2 weeks of the first staff becoming affected, 138 hospital cases were reported, the hospital was closed, and spread to the community had become apparent. Clinical features of SARS (especially respiratory symptoms) required by the World Health Organization definition were not prominent, with fever, chills, myalgia, abdominal pain, and malaise being the only defining features. Many patients had radiologic pneumonia without symptoms. Blood test results typically showed leukopenia and lymphopenia. The typical course of the illness was throughout 2 weeks, with 20% of patients requiring ICU and 5% of patients dying. The economic and political impact of this disease was immediately apparent. Conclusion: This is a rapidly evolving epidemic that may have a profound impact on the world beyond the morbidity and mortality associated with the disease itself. Making the diagnosis is difficult, and at this stage, there is no test that will define patients with SARS.