Keep SARS on your radar —just like other critical issues
Rapid influenza tests could help you differentiate between the common flu and a case of severe acute respiratory syndrome (SARS), but their usefulness is limited. If the test shows your patient has influenza B, you safely can rule out SARS unless there are extraordinary circumstances, such as a confirmed SARS outbreak in your own community, says Brian F. Keaton, MD, FACEP, attending physician in the department of emergency medicine at Summa Health System in Akron, OH.
"Your patient is probably not going to be unlucky enough to have influenza and SARS at the same time," he says. "If you’re sure he has flu, you can stop worrying about whether he has SARS."
Common sense is crucial, now more than ever
However, that doesn’t mean you can just use a rapid influenza test on everyone and not give another thought to SARS. The tests are sensitive but not necessarily specific, so you still will have to exercise considerable clinical judgment.
Just how much should you worry about SARS? That’s a hard question to answer, the experts say, and you really won’t know until you see if SARS recurs and where. Even though you need to be aware that SARS could show up in your ED, the experts say you should keep in mind that SARS is a zebra, and you’re much more likely to be overrun by horses.
"If you’re in a community where you know you have a raging influenza outbreak and no reported cases of SARS, the likelihood that the next patient through the door has flu is relatively high and the likelihood that the next patient has SARS is very low," Keaton says.
"The ultimate nightmare is that you have large outbreaks of both diseases in the same community at the same time," he points out. "Then you have a bigger problem in sorting patients, and the only prudent way to approach it is to treat everyone as if they have SARS," Keaton adds.
Even that extreme case may not be as bad as it sounds, he says. The treatment protocol for both is similar anyway, with supportive care, appropriate respiratory isolation, and improved hand washing.
"SARS needs to be on your radar just like terrorism, drug abuse, child abuse, and myocardial infarction are all on your radar," Keaton says. "You’ve got a lot of things that you need to be aware of. It’s the nature of the emergency department that you don’t know what’s going to come in the door next, so you have to be ready."
That advice is seconded by Arnold S. Monto, MD, professor of epidemiology at the University of Michigan School of Public Health in Ann Arbor.
He says emergency staff don’t have to worry too much about SARS until the moment they hear that the disease has popped up again in some other community. Consider that news an alarm that means you need to start looking more carefully at potential cases in your ED, he explains.
It would be extremely unlikely that the first case of SARS this fall occurred in a small, rural town, for example, Monto says.
"If it’s going to come back, it probably will start transmitting and be recognized because everyone is in a heightened state of awareness in those places where transmission has occurred in the past," he says. "So you’ll get a warning of sorts, even though you still may face a tremendous diagnostic challenge for individual patients."
More public attention this year on SARS
One thing may be better this year than in the first SARS outbreak, Monto says. Health authorities are on the lookout for SARS, and politicians seem to have learned that they shouldn’t keep SARS outbreaks secret, he says. Thus, the ED physician in Chicago is likely to hear about a SARS outbreak in China as soon as it happens.
"That means you can raise your suspicion level immediately, not after you’ve had a dozen people from China through your ED while the authorities debate whether to release information," he says. "That’s an improvement over last year."
Rapid influenza tests could help you differentiate between the common flu and a case of severe acute respiratory syndrome (SARS), but their usefulness is limited.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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