SARS outbreak

SARS Outbreak

March 10 7 MDs and 4 nurses reported sick

March 11 50 staff screened, 23 admitted, ward closed

March 12 Clinical teaching suspended

March 13 Index case identified

March 17 Medical school moved back to campus

156 patients138 traceable to the index case

20 doctors34 nurses15 allied health16 medical students

SARS: a triphasic disease

Max. daily body temperature (oC)

Days after onset of disease

36

37

38

39

40

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21

Viral replicative phase Immune hyperactive

phasePulmonary-destruction phase

Treatment Protocol

Broad spectrum antibiotics

IV Ribavirin

High dose steroids

Convalescent serum

Supportive care

Response to Rx

Board-spectrumAntimicrobial* (%)

N=138

Ribavirin + Corticosteroid# (%)

N=138

IV Methyl-prednisolone+ (%)

N=107

Sustained response 0 (0) 16 (11.6) 50 (46.7)

Partial response 0 (0) 9 (6.5) 45 (42.1)

No response 138 (100) 113 (81.9) 12 (11.2)

All patients in PWH

• N=277

• Discharged: 147 (53%)

• ICU admission: 51 (18.4%)

• Died: 18 (6.5%)

• Mortality : median age 76 (44-84) years

Convalescent Plasma

Convalescent Plasma vs more MP

3 MP + CS

(n = 19)

4 or more MP

(n = 21)

P values

Age 38.7 47.9 0.087

Admission LDH 258.1 247.7 0.7

Discharge rate by 21 days

73.7% 19% 0.001

No. of deaths 0 5 0.049

Outcome of patients who received CS before day 16 vs later date

≤ Day 16

(n = 36)

Day 16

(n = 14)

P values

Discharge rate by day 21

51.6% 0% 0.02

Death rate 0% 28.6% 0.02