Question
Are patients with SARS infectious to others during the incubation period? If so, how infectious? Should asymptomatic healthcare workers looking after SARS patients isolate themselves from household contacts?
Stewart Chan, MBBS
Response From the Expert
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Greg S. Martin, MD Assistant Professor, Medicine, Division of Pulmonary Medicine, Emory University School of Medicine; Director, Emory Pulmonary Clinic, Grady Memorial Hospital, Atlanta, Georgia |
Your question is a good one and is being asked by a growing number of physicians as severe acute respiratory syndrome (SARS) expands in prevalence. Providing a direct answer to your question is difficult because of the new and evolving nature of SARS. However, the most recent data suggest that SARS is at least strongly associated with, if not caused by, a coronavirus. As with most respiratory viruses, it is probably fair to assume that individuals may be infectious during the incubation period of 2-10 days. Once a patient is symptomatic, transmission to others is known to occur. For care of symptomatic patients, the Centers for Disease Control and Prevention (CDC) recommends that healthcare workers use personal protective equipment appropriate for standard, contact, and airborne precautions (eg, hand hygiene, gown, gloves, and N95 respirator) with the addition of eye protection.
The CDC has published a number of guidelines and position papers on SARS, including information specific for clinicians, which are continually updated based on the most current knowledge. I have adapted their statement on healthcare exposure management below, as a most relevant and up-to-date answer to your question.
Healthcare workers who have unprotected exposure to SARS should be vigilant for fever or respiratory symptoms during the 10 days following exposure; those who develop fever or respiratory symptoms should limit interactions outside the home and should not go to work, school, out-of-home child care, church, or other public areas. Symptomatic healthcare workers should use infection control precautions to minimize the potential for transmission and should seek healthcare evaluation. In advance of the evaluation, healthcare providers should be informed that the healthcare worker may have been exposed to SARS.
If symptoms do not progress to meet the suspect SARS case definition within 72 hours after first symptom onset, the healthcare worker may be allowed (after consultation with infection control, occupational health, and/or local public health authorities) to return to work.
For healthcare workers who meet or progress to meet the case definition for suspected SARS (eg, develop fever and respiratory symptoms), infection control precautions should be continued until 10 days after the resolution of fever, provided respiratory symptoms are absent or improving. Suspected SARS should be reported to local health authorities immediately.
Exclusion from duty is not recommended for an exposed healthcare worker if he or she does not have either fever or respiratory symptoms; however, the worker should report any unprotected exposure to SARS patients to the appropriate facility point of contact immediately.
Active surveillance for fever and respiratory symptoms should be conducted on healthcare workers with unprotected exposure, and the worker should be vigilant for onset of illness. Workers with unprotected exposure developing such symptoms should not report for duty, but should stay home and report symptoms to the appropriate facility point of contact immediately.
Passive surveillance (eg, review of occupational health or other sick leave records) should be conducted among all healthcare workers in a facility with a SARS patient, and all healthcare facility workers should be educated concerning the symptoms of SARS.
Close contacts (eg, family members) of SARS patients are at risk for infection. Close contacts with either fever or respiratory symptoms should not be allowed to enter the healthcare facility as visitors and should be educated about this policy. A system for screening SARS close contacts, who are visitors to the facility, for fever or respiratory symptoms should be in place. Healthcare facilities should educate all visitors about use of infection control precautions when visiting SARS patients and their responsibility for adherence to them.