When Classical Singer asked me to write about the SARS epidemic, I initially declined. We are all aware of this condition from daily news reports, and some of us even from second and third hand personal stories. No one is an expert. The epidemic is still in its early stages, and new facets are emerging weekly. And yet, all of us need to come to grips with this in a reasonable manner. Singers especially, since they travel and are exposed to other singers, musicians and audiences in different parts of the world, need to formulate some strategy which is prudent but not unreasonably fearful. Life, personal and professional, must go on.
So, here are some of the facts we know, and some thoughts about how to cope.
What We Know:
1) SARS (Sudden Acute Respiratory Syndrome) is a new viral illness which first emerged in China, probably last fall. It is caused by a new form of Coronavirus and seems to have mutated from an older form, previously infective for birds only. The illness begins with moderate fever (greater than 100.4 degrees Fahrenheit), occasionally accompanied by headaches or body aches. After two to seven days, the patient develops symptoms of a respiratory illness: a dry, non-productive cough and shortness of breath. The difficulty breathing may lead to insufficient oxygen intake (hypoxia). A chest X-ray may show evidence of pneumonia. Some patients’ illness may progress to respiratory insufficiency, requiring intubation and artificial ventilation. In less than 6 percent of diagnosed cases, the disease is fatal.
2) The incubation period of the SARS virus is up to about 10 days. Persons who have traveled to SARS alert areas, such as China, within 10 days prior to developing symptoms are potential suspects.
3) We know that the virus is normally transmitted by personal contact or close proximity with an infected person. The transmission is through sputum, which can be passed from person to person either by actual physical contact or through droplets coughed out by a patient. Although quite infectious, the SARS virus appears to survive for only a relatively short period of time outside the body. Preliminary studies suggest that the virus survives for no more that 24 hours in dried sputum. We believe that patients with SARS are most infectious during the acute stage (cough, fever), but it is not clear whether the patient can transmit the virus during the earlier incubation period or how long the contagious stage lasts.
4) We know what the SARS virus looks like, both its appearance (microscopic image) and its structure (DNA genome). While these are important first steps towards getting a grip on the condition, they have no immediate clinical significance.
What We Don’t Know:
1) We don’t yet have a way of diagnosing the illness prior to the onset of clinical symptoms.
2) We don’t have a specific treatment. Although fewer than 6 percent of cases are fatal, patients who recover do so with non-specific treatment: respirators and other general supportive measures used for respiratory failure. Antiviral medications are being tried, but none so far have been specifically efficacious.
3) We don’t have a vaccine or any other preventive measures. Although we know the structure of the virus, even if this were stable, it would normally take about two years of clinical trials to develop a vaccine. And the structure is not stable-a mutated second form of the virus has been identified in Asia. It now appears that some patients thought to be over the illness have developed clinical recurrence. In this way, the condition differs from some other viral illnesses, such as chickenpox, where the infection confers immunity on the patient.
What to Do:
1) Don’t panic. Knowledge increases daily, and only based on knowledge, rather than irrational fear, can reasonable steps be taken. Although isolated cases have been identified in the USA, SARS is not an epidemic here. The chance of your catching SARS in your daily life is statistically insignificant. If you do, remember that medical care in the USA is much better than in China, and even there, only one case in 20 is fatal. In the USA, SARS is not lurking in Chinese restaurants. You don’t need to wear a mask on the streets.
2) If you travel, take the same precautions you would for avoiding a cold. Wash your hands frequently, particularly in public or shared spaces, such as airport,, train stations or hotels. Be aware of your hands. You probably shake hands, touch others, and touch your face several times a day. An alcohol-rub type hand cleanser is useful, and you can carry this with you. Avoid people who appear to be sick, particularly if you need to be in close quarters, such as on an airplane.
3) Although experts don’t specifically recommend wearing a face mask (except when in obvious contact with an ill person), you may consider wearing one when taking a long airplane flight. You need to weigh the “alarm factor” to others versus your own sense of security. Remember that the masks eventually saturate with water vapor from your breathing and should be changed every few hours.
4) If performing abroad, try to be aware of any respiratory illness among cast members. Not every cold is important, however. Authorities currently recommend taking precautions only if the person with the “cold” has traveled to affected parts of Asia within the previous 10 days.
5) Stay informed. There are numerous websites that can give you up-to-date information and recommendations, and you should certainly monitor these, particularly if you are planning to be singing in Asia. The best ones are the CDC (Center for Disease Control) website: www.cdc.gov/ncidod/sars and the WHO (World Health Organization) website: www.who.int/en/. Most of my knowledge comes from these sources, which explain things better, and with more authority. I would not, however, recommend that you cancel engagements unless they take you to parts of the world which authorities have declared to be high risk areas.
Disclaimer: The suggestions given by Dr. Jahn in these columns are for general information only, and are not to be construed as specific medical advice or advocating specific treatment which should be obtained only following a visit and consultation with your own physician.
