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The proposed approach to SARS preparedness and response reflects what
has been learned to date about SARS-CoV transmission and the interventions
that were used to contain the 2003 global outbreaks.
A. Lessons Learned
- SARS-CoV
disease is a serious, often fatal, infectious disease with the potential
for rapid spread.
- The
vast majority of febrile respiratory illnesses will not be SARS-CoV
disease.
- Laboratory tests, although sensitive and specific,
do not reliably detect SARS-CoV early in the course of disease.
- Clinical features of SARS-CoV disease are nonspecific, but diagnosis
can be guided by a history of exposure risk.
- In the absence of effective drugs or a vaccine, SARS-CoV disease
can be controlled by the rapid and efficient use of the basic public health
control strategies of surveillance and containment.
- SARS-CoV transmission is neither regional nor national but rather
confined to limited geographic – and even institutional – settings;
response strategies must therefore reflect local characteristics and resources.
- SARS response activities can overwhelm public health and healthcare
resources.
- The potentially substantial health, social, and economic impact
of SARS-CoV requires a swift and bold response that is appropriate to the
situation yet minimizes unnecessary disruptions and respects human dignity.
B. Basic and Enhanced Response Elements
The foundation of the proposed approach is a set of fundamental elements
on which communities might base their preparedness and response activities.
Examples of these basic response elements are:
- Surveillance
for cases of SARS-CoV disease or suspicious clusters of pneumonia,
with appropriate diagnostic testing
- Rapid isolation and appropriate management of potential cases
of SARS-CoV disease
- Rapid and efficient identification, evaluation, and monitoring
of contacts
- Issuance of travel alerts/advisories, screening of ill travelers
at airports, and implementation of other border control measures to
prevent international spread
- Timely dissemination of communication messages to the public
health and healthcare communities and the public
Communities may supplement these basic elements with enhanced control
measures that might be needed to address an escalating outbreak, changing
transmission patterns or characteristics, variations in compliance, uncertainties
about the effectiveness of basic control measures, feasibility and acceptability
of specific interventions, or political pressures. Possible enhanced
activities might include:
- Establishment
of designated sites for evaluation of possible SARS patients
- Screening of incoming and/or departing passengers at airports,
ports, and land border crossings
- Quarantine of close contacts of cases or of persons potentially
exposed to SARS-CoV by their presence at a particular function, setting,
or institution
- Closing schools, canceling large gatherings, or implementing
other “snow day”-type measures for increasing social distance
as temporary measures to slow transmission in an affected community
C. Information for Action
As the level of SARS-CoV transmission during an outbreak is dynamic,
response activities, by necessity, must also be dynamic. The key to understanding
transmission dynamics and knowing when to escalate the response at the
local level is a surveillance system that provides ready access to timely
information on the number of new cases, the likely source of exposure
for cases, the number of cases not previously identified as contacts,
and the number of contacts (prospective cases) with high-risk exposures
to known cases.
D. Coordination and Consistency
Although jurisdictions will need to adjust the types and level of response
measures to local conditions and resources, they will also need to coordinate
with adjacent jurisdictions to ensure consistency among responses and
minimize confusion or mistrust that may derive from inexplicable differences
in outbreak control strategies.
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