1.

SARS is caused by a new form of Coronavirus not previously seen in humans. Severity of the disease is variable - although majority of cases recover, 10 - 20% of hospitalized patients deteriorate and may progress to respiratory failure. The case fatality rate increases progressively with age from <1% in patients aged £ 24 years to over 50% in patients aged ³ 65 years.

2.

Being a new disease it has been managed with an empirical approach. As the initial presentation is rather non-specific, treatment often begins with a trial of antibiotics for community-acquired pneumonia of unclear etiology.  Oxygen therapy and other conventional supportive treatment will be used in accordance with the patient’s clinical condition and disease progression.

3.

There is currently no universally accepted specific treatment for SARS. Further treatment choices are often influenced by severity of illness and hypotheses on pathogenesis. Antiviral agents and immune modulation therapies have been used in Hong Kong basing on the proposed tri-phasic course of disease:

i)           Viral replication phase

ii)         Immune hyperactive phase

iii)        Pulmonary destruction phase

4.

Treatment will evolve as more evidence and experience becomes available. Clinicians should monitor and critically appraise the latest evidence and carefully balance the risks and uncertainties to the potential benefits of proposed treatment options, and to adjust according to individual patient characteristics and treatment response.

5.

In the SARS Clinical Management Workshop held in Hong Kong on 13 and 14 June 2003, organized by WHO and the HWFB of the HKSARG, and the WHO Global Conference on Severe on Acute Respiratory Syndrome (ASRS) held on 17 and 18 June 2003 (material available at http://www.who.int/csr/sars/conference/june_2003/en/), local and overseas delegates agreed that more collaborative efforts for controlled clinical trials would be needed to address the safety and efficacy of treatment choices proposed for SARS.