While diarrhea is common in people with SARS, the fecal–oral route does not appear to be a common mode of transmission. The basic reproduction number of SARS-CoV, R0, ranges from 2 to 4 depending on different analyses. Control measures introduced in April 2003 reduced the R to 0.4. Diagnosis
SARS-CoV may be suspected in a patient who has:
Any of the symptoms, including a fever of 38 °C (100 °F) or higher, and
Either a history of:
Contact (sexual or casual) with someone with a diagnosis of SARS within the last 10 days or
Travel to any of the regions identified by the World Health Organization (WHO) as areas with recent local transmission of SARS. Clinical criteria of Sars-CoV diagnosisEarly illness: equal to or more than 2 of the following: chills, rigors, myalgia, diarrhea, sore throat (self-reported or observed)
Mild-to-moderate illness: temperature of >38 °C (100 °F) plus indications of lower respiratory tract infection (cough, dyspnea)
Severe illness: ≥1 of radiographic evidence, presence of ARDS, autopsy findings in late patients.For a case to be considered probable, a chest X-ray must be indicative for atypical pneumonia or acute respiratory distress syndrome. The WHO has added the category of "laboratory confirmed SARS" which means patients who would otherwise be considered "probable" and have tested positive for SARS based on one of the approved tests (ELISA, immunofluorescence or PCR) but whose chest X-ray findings do not show SARS-CoV infection (e.g. ground glass opacities, patchy consolidations unilateral).The appearance of SARS-CoV in chest X-rays is not always uniform but generally appears as an abnormality with patchy infiltrates.
China officially apologized for early slowness in dealing with the SARS epidemic.The viral outbreak was subsequently genetically traced to a colony of cave-dwelling horseshoe bats in Xiyang Yi Ethnic Township, Yunnan.The outbreak first came to the attention of the international medical community on 27 November 2002, when Canadas Global Public Health Intelligence Network (GPHIN), an electronic warning system that is part of the World Health Organizations Global Outbreak Alert and Response Network (GOARN), picked up reports of a "flu outbreak" in China through Internet media monitoring and analysis and sent them to the WHO. While GPHINs capability had recently been upgraded to enable Arabic, Chinese, English, French, Russian, and Spanish translation, the system was limited to English or French in presenting this information. Thus, while the first reports of an unusual outbreak were in Chinese, an English report was not generated until 21 January 2003. The first super-spreader was admitted to the Sun Yat-sen Memorial Hospital in Guangzhou on 31 January, which soon spread the disease to nearby hospitals.In early April 2003, after a prominent physician, Jiang Yanyong, pushed to report the danger to China, there appeared to be a change in official policy when SARS began to receive a much greater prominence in the official media. Some have directly attributed this to the death of an American teacher, James Earl Salisbury, in Hong Kong. It was around this same time that Jiang Yanyong made accusations regarding the undercounting of cases in Beijing military hospitals.