Severe Acute Respiratory Syndrome (SARS) in Health Care Workers

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The summary below is from the full report titled "An Outbreak of Severe Acute Respiratory Syndrome among Hospital Workers in a Community Hospital in Hong Kong." It is in the 7 October 2003 issue of Annals of Internal Medicine (volume 139, pages 564-567). The authors are A.S. Ho, J.J.Y. Sung, and M. Chan-Yeung.

What is the problem and what is known about it so far?

Severe acute respiratory syndrome (SARS) is a serious disease caused by a virus (coronavirus). Symptoms include fever, body aches and pains, cough, and trouble breathing. Lung inflammation (pneumonia) is often severe, and patients may need machines to help them breathe. About 10% of patients may die. SARS primarily spreads by close person-to-person contact.

SARS was first described in February 2003 in a businessman who had recently traveled from China through Hong Kong to Vietnam. The businessman died of the illness, and the physician who diagnosed the condition subsequently died of SARS in March 2003. SARS spread rapidly in China; Hong Kong; Taiwan; and Toronto, Canada. As it spread, some people noticed that health care workers who cared for infected patients were at high risk for the disease.

Why did the researchers do this particular study?

To describe how health care workers got SARS from infected patients.

Who was studied?

40 health care workers with SARS in a community hospital in Hong Kong.

How was the study done?

The researchers looked at records of hospital workers infected with SARS between March 25 and May 5, 2003. The hospital had 529 beds and 1312 staff members, including 138 doctors, 500 nurses, and 126 health care assistants. The researchers traced when and where the hospital workers were infected. The researchers also asked the workers about protective measures that they had used and whether they had infected anyone else.

What did the researchers find?

During early weeks of the outbreak, about 8% of the health care assistants, 5% of the doctors, and 4% of the nurses got SARS. Most hospital workers were infected from direct contact with patients with SARS; most of those patients were in general wards and had not been suspected of having the disease. All infected hospital workers said they had used masks when caring for patients. Many hadn't used gowns, gloves, or eye shields. Infected hospital workers were identified quickly, usually within 2 to 3 days of developing symptoms. None infected their own families or close friends.

What were the limitations of the study?

The study was retrospective. Some health care workers' memories of wearing masks and using other protective measures could be inaccurate.

What are the implications of the study?

During initial stages of the outbreak, health care workers who had close contact with infected patients were at risk for getting SARS. Simply wearing masks without using other infection control measures didn't protect them.