Materiały źródłowe

• #1 Severe acute respiratory syndrome (SARS) – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/sars/diagnosis-treatment/drc-20351771

  Scientists havent yet found an effective treatment for SARS. […] And antiviral medicines that clear up infections caused by viruses havent shown much benefit. […] Hospital care for SARS involves easing symptoms while the SARS virus runs its course. Care might include receiving fluids through a vein and extra oxygen if needed.

• #2 Severe Acute Respiratory Syndrome (SARS)

  https://my.clevelandclinic.org/health/diseases/10856-severe-acute-respiratory-syndrome-sars

  No, there isnt a cure for SARS. And like many viruses, there arent any specific antiviral medications that treat it. […] People who were severely ill were put on mechanical ventilation if they couldnt breathe on their own. […] People with mild symptoms could treat themselves with pain relievers and fever reducers much the same way youd take care of yourself with a cold or the flu.

• #3 SARS (Severe Acute Respiratory Syndrome): Symptoms and Treatment

  https://www.webmd.com/lung/lung-what-is-sars

  At the time of the original outbreak, there were no targeted treatments available for SARS. Antiviral drugs like ribavirin and lopinavir/ritonavir were used. So were corticosteroids (commonly known as steroids). The best treatment strategy for SARS remains unknown. […] People with SARS were mostly given supportive care, such as antibiotics to fight off other infections while they recovered, or steroids to reduce swelling in the lungs. In serious cases, they could be given blood plasma from someone who already recovered from SARS and whose plasma would have antibodies. […] If their symptoms were mild, they recovered at home, taking over-the-counter medications for a fever or muscle aches. But if the symptoms got worse, they may have gone to a hospital for more treatment, like getting fluids or oxygen.

• #4 Severe acute respiratory syndrome (SARS) Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/severe-acute-respiratory-syndrome-sars

  People who are thought to have SARS should be checked right away by a provider. If they are suspected of having SARS, they should be kept isolated in a hospital. […] Treatment may include: […] Antibiotics to treat bacteria that cause pneumonia (until bacterial pneumonia is ruled out or if there is bacterial pneumonia in addition to SARS) and to treat bacterial infections that could occur in addition to SARS […] Oxygen, breathing support (mechanical ventilation), or chest therapy […] In some serious cases, the liquid part of blood from people who have already recovered from SARS has been given as a treatment. […] There is no strong evidence that these treatments work well. There is evidence that the antiviral medicine, ribavirin, does not work. Newer antivirals have not been tried as the disease has not occurred recently.

• #5 Severe Acute Respiratory Syndrome (SARS) in Children

  https://healthlibrary.methodisthealthsystem.org/Library/DiseasesConditions/Pediatric/Cardiology/90,P07741

  There are some antiviral medicines that may help in treating the SARS virus. But SARS most often is treated with supportive therapy, which may include: […] SARS is treated with supportive therapy and sometimes with antiviral medicines. Your child may be given IV fluids and oxygen or other breathing help.

• #6

  https://www.advocatehealth.com/health-services/lung-respiratory-care/severe-acute-respiratory-syndrome-sars

  SARS treatment options include: […] There still isnt an effective treatment for SARS coronavirus 1 despite a global effort to develop one. Until an effective treatment is created, your doctor will use advanced care to help ease symptoms and prevent the spread of the virus. […] Antiviral treatments and medications may help prevent severe illness in high-risk patients. […] Corticosteroids: These medications may be given to decrease inflammation in the lungs, which helps with breathing. […] Supportive treatments: Oxygen therapy, hyperbaric oxygen therapy (HBOT), intravenous (IV) fluids and medications to address symptoms like fever and cough. […] Mechanical ventilation: In severe cases where patients struggle to breathe independently, ventilators are used to ensure they receive sufficient oxygen. […] It is important to note, antibiotics do not kill the SARS coronavirus 1 virus.

• #7 Information Regarding Severe Acute Respiratory Syndrome (SARS) | Occupational Safety and Health Administration

  https://www.osha.gov/emergency-preparedness/sars

  Severe acute respiratory syndrome (SARS) is an emerging, sometimes fatal, respiratory illness. […] Treatment consists of antibiotics and steroids, with other options being explored. […] Between 10 and 20 percent of SARS patients have required ventilator support for a period of time. […] The CDC provides recommendations for those handling human remains of SARS patients. […] Workers handling human remains of SARS patients should use respiratory protection (N95 or higher filter efficiency) and protective garments including surgical scrub suit, surgical cap, impervious gown or apron with full sleeve coverage, eye protection (e.g., goggles or face shield), shoe covers and double surgical gloves with an interposed layer of cut-proof synthetic mesh gloves. […] If an employee experiences a fever and respiratory symptoms after contact with a patient known to be infected with SARS, the CDC recommends that the employee be excluded from duty.

• #8 Treatment of severe acute respiratory syndrome

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7088345/

  In patients who deteriorated irrevocably despite receiving pulse methylprednisolone, convalescent plasma, obtained from patients who recovered from SARS, had been used as a last resort. […] Noninvasive positive pressure ventilation (NIPPV) is a form of ventilatory support through a tight-fitting facemask or nasal mask frequently administered in combination with continuous positive airway pressure or bi-level positive airway pressure for patients with impending respiratory failure. […] The present therapy of SARS is less than satisfactory, and much effort has been expended in looking for novel treatment modalities. […] The optimal treatment regimen for SARS remains elusive. Randomized controlled treatment trials should be done, especially through international collaboration, to discover the best form of therapy.

• #9 Management of Critically Ill Patients with Severe Acute Respiratory Syndrome (SARS)

  https://www.medsci.org/v01p0001

  Severe acute respiratory syndrome (SARS) is frequently complicated with acute respiratory failure. In this article, we aim to focus on the management of the subgroup of SARS patients who are critically ill. Most SARS patients would require high flow oxygen supplementation, 20-30% required intensive care unit (ICU) or high dependency care, and 13-26% developed acute respiratory distress syndrome (ARDS). The management of critically ill SARS patients requires timely institution of pharmacotherapy where applicable and supportive treatment (oxygen therapy, noninvasive and invasive ventilation). Superimposed bacterial and other opportunistic infections are common, especially in those treated with mechanical ventilation. Appropriate use of personal protection equipment and adherence to infection control measures is mandatory for effective infection control. […] Much of the knowledge about the clinical aspects of SARS is based on retrospective observational data and randomized-controlled trials are required for confirmation.

• #10 Lessons from Severe Acute Respiratory Syndrome (SARS) | RT

  https://respiratory-therapy.com/disorders-diseases/critical-care/acute-disorders/lesson-from-sars/

  Principles of infection control and ventilator management taken from the SARS epidemic may serve during future viral outbreaks. […] Twenty-five percent of patients who are diagnosed with SARS develop acute respiratory distress syndrome and will need mechanical ventilation. The ventilatory management of patients with SARS does not differ much from that for patients with ARDS alone. A low tidal volume lung protective strategy should be adopted, with the target tidal volumes at 6 mL per ideal body weight. Plateau pressures are preferably kept less than 30 cm H2O. This is modeled after the recommendations from the National Institutes of Health ARDS Network. Either volume- or pressure-control ventilation can be used. High levels of positive end-expiratory pressure (PEEP) may be used to maintain a PaO2 greater than 55 mm Hg. PEEP helps to increase end-expiratory lung volume, recruits unventilated alveoli, decreases intrapulmonary shunt, and improves V/Q (ventilation perfusion) matching.

• #11 SARS & MERS Virus: Symptoms, Causes, and Treatment

  https://patient.info/chest-lungs/sars-and-mers-virus

  During the SARS-CoV-2 (COVID-19) pandemic the following general principles for treatment were developed: […] Mild illness was treated supportively in the community whilst isolating the infected person. Those people at higher risk of developing severe illness because of age or underlying medical conditions were recommended to receive paxlovid or remdesevir antiviral treatments. […] Moderate illness requiring hospitalisation for intravenous fluids and extra oxygen were also given remdesevir and dexamethasone – either alone or in combination. […] Severe illness was supported in a high dependency or critical care environment by intubation and ventilation (to help with breathing) and vasopressor medicines to help maintain blood pressure. The patients are usually kept lying on their tummies – clinicians call this 'nursing prone’. The patient will be kept in strict isolation with barrier procedures in place to prevent the spread of infection. If ventilation isn’t helping them recover then extra-corporeal membrane oxygenation (ECMO) may be tried. At the same time combinations of other antiviral treatments (baricitinib or tocilizumab) were given with dexamethasone.

• #12 Treatment of severe acute respiratory syndrome

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7088345/

  Many treatment options, including antiviral agents, immunosuppressive agents, convalescent plasma, immunoglobulin, noninvasive positive pressure ventilation (NIPPV), and traditional Chinese medicine (TCM), have been introduced on the basis of different rationales. […] Ribavirin has been chosen for use due to its wide spectrum of activity, despite being rather weak against SARS-CoV. Protease inhibitors are now under study because of the experimental evidence that they can inhibit the 3C-like (3CL) protease, which is essential for the life cycle of the SARS-CoV. […] Ribavirin was chosen for use empirically due to its broad antiviral spectrum and the assumption that it could provide coverage for the corticosteroid treatment, which was widely utilized at that time. In the end, over 90% of the patients in Hong Kong received ribavirin.

• #13 Treatment Options for Severe Acute Respiratory Syndrome, Middle East Respiratory Syndrome, and Coronavirus Disease 2019: a Review of Clinical Evidence

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7533202/

  Ribavirin which is a guanosine analogue has been demonstrated to have antiviral activity against a broad range of DNA and RNA viruses. In clinical practice, it has been mostly used in the treatment of respiratory syncytial virus infection, chronic hepatitis C infection, viral hemorrhagic fevers, and several other severe and life-threatening viral infections. In a prospective cohort study on the Hong Kong population, initial SARS patients were given antibiotics for pneumonia and oseltamivir for influenza infection. If the fever remained after 2 days from hospitalization, patients were given ribavirin in the combination with a low dose of prednisolone or hydrocortisone. High dose of methylprednisolone for 3 consecutive doses up to 6 doses were given after day 3 – 4 if fever persisted or lung shadow increased. Ribavirin and a low dose of corticosteroid were continuously given up to a max of 12 days until the resolution of lung opacity was completed. The combination of broad-spectrum antibiotics, ribavirin, and corticosteroids was also used to treat patients in other observational studies.

• #14 Treatment of severe acute respiratory syndrome

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7088345/

  Ribavirin is associated with a number of significant adverse effects. The most important one is anemia, with one study reporting a drop in hemoglobin of 2 g/dl or more in 49% of patients. […] In the quest for effective agents against the SARS-CoV, the protease inhibitor lopinavir, when combined with ribavirin, has been found to reach the synergistic inhibitory concentration against the SARS-CoV in laboratory testing. […] The findings from the above two studies suggest that LPV/r, when combined with ribavirin, may be an effective agent against SARS. […] The use of corticosteroids may, nevertheless, be associated with enhancement of viral replication due to suppression of the innate immune response. […] The use of corticosteroids in SARS, especially at high doses and for prolonged periods, has been accompanied by significant side effects.

• #15 CEUFast – Severe Acute Respiratory Syndrome (SARS)

  https://ceufast.com/course/severe-acute-respiratory-syndrome-sars

  While there is no specific therapeutic regimen currently available for SARS patients, work continues to develop an immunization for prevention or specific antiviral agents to treat this condition. Care centers on supportive care measures and infection control to prevent spread. As many as 20% percent of patients require significant respiratory support, including mechanical ventilation. Family members must be advised regarding infection control procedures. Most practitioners use clinical protocols similar to those for community-acquired pneumonia when treating a suspected or probable SARS case. Broad spectrum antibiotics, including a flouroquininolone or macrolide are used. Patients in Hong Kong and Toronto were also treated with the antiviral ribavirin. Most clinicians do not recommend ribavirin because of the drugs toxicity, including hemolytic anemia and electrolyte imbalance.

• #16 Treatment Options for Severe Acute Respiratory Syndrome, Middle East Respiratory Syndrome, and Coronavirus Disease 2019: a Review of Clinical Evidence

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7533202/

  It was reported in the WHO meeting that an anti-HIV drug named lopinavir/ritonavir (LPV/r) could have the mortality risk reduction among patients with SARS. There were no deaths among 34 patients who received LPV/r combined with ribavirin, whereas 10% of 690 patients who received ribavirin alone had died at the 30 days from the onset of symptoms. However, the mortality rate was not significantly different between two groups. In another retrospective matched cohort study of Hong Kong SARS patients, the standard treatment of ribavirin and corticosteroid was provided to patients at the initial time of SARS confirmation. LPV/r (lopinavir 400mg and ritonavir 100 mg every 12 hours) was added to standard treatment as initial therapy, or it was given without ribavirin as a rescue therapy. Combination with LPV/r as the initial therapy significantly reduced the mortality on day 21, compared with ribavirin and corticosteroids alone.

• #17 Insights of Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) pandemic: a current review | Biological Procedures Online | Full Text

  https://biologicalproceduresonline.biomedcentral.com/articles/10.1186/s12575-020-00141-5

  Lopinavir/ ritonavir (Kaletra) is used in combination with other medicines to treat adults and children over 14days of age who are infected with human immunodeficiency virus HIV-1. […] Remdesivir, an antiviral agent initially used in Ebola virus clinical studies, revealed even more effective results against COVID-19 in vitro. […] Remdesivir inhibits RNA-dependent-RNA-polymerase (RdRp) with its broad-spectrum antiviral activities against RNA viruses including SARS-CoV and MERS-CoV along with human CoV-229 E and CoV-OC43 replications. […] In various clinical trials have been conducted on patients infected with SARS-CoV-2 with oxygen saturation below 94% (with/without oxygen support), the patients were treated with remdesivir (200mg) intravenously for 10days and from the first day (100mg) daily over the next 9days.

• #18 Insights of Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) pandemic: a current review | Biological Procedures Online | Full Text

  https://biologicalproceduresonline.biomedcentral.com/articles/10.1186/s12575-020-00141-5

  The European Medicines Agency recommends remdesivir positively for the treatment of SARS-CoV-2. […] The chemical structure of chloroquine (CQ) and hydroxychloroquine (HCQ) are closely related. […] Several studies have revealed that both drugs have antiviral activity in vitro through different mechanisms. […] In China 15 clinical trials were conducted to test the efficacy and safety of CQ or HCQ in the treatment of COVID-19, 8 of which were based on the administration of CQ, 6 were of HCQ, and another included both CQ and HCQ. […] Tocilizumab, an immunosuppressive agent, has also been found to be effective in vivo in COVID- 19 patients in China. […] There is a dilemma of anti-inflammatory therapy, balancing the risk and benefit ratio is a critical issue. […] Numerous clinical studies have reported the efficacy of glucocorticoids in the treatment of coronavirus pneumonia (such as SARS and MERS) or influenza pneumonia, but no consensus has been reached. […] Baricitinib, a JAK inhibitor as well as an AAK1 inhibitor, was suggested a possible candidate for the treatment of COVID-19, considering its relative safety and high affinity.

• #19

  https://www.who.int/health-topics/severe-acute-respiratory-syndrome

  While no treatment or cure was available at the time of the emergence of SARS, the emergence of a closely related disease COVID-19 lead to the rapid development of several antivirals and vaccines. Antivirals such as polymerase and protease inhibitors against SARS-CoV-2 are likely to be effective against SARS-CoV-1. COVID-19 vaccines may provide some level of cross-protection against SARS; however, the extent of such cross-protection remains to be studied. […] Controlling outbreaks relies on containment measures including: […] Personal preventive measures to prevent spread of the virus include frequent hand washing using soap or alcohol-based disinfectants. For those with a high risk of contracting the disease, such as health care workers, use of personal protective equipment, including a mask, goggles and an apron is mandatory. Whenever possible, household contacts should also wear a mask.

• #20 SARS: Symptoms, Vs. COVID-19, Treatment, Prevention & More

  https://www.healthline.com/health/severe-acute-respiratory-syndrome-sars

  Theres no established treatment specifically for SARS. However, some COVID-19 treatments, such as nirmatrelvir/ritonavir (Paxlovid) and molnupiravir, would likely be effective against SARS. […] Antiviral medications and steroids are sometimes taken to reduce swelling of the lungs, but theyre not effective for everyone. […] Supplemental oxygen or a ventilator may be prescribed if necessary. […] In severe cases, blood plasma from someone who has already recovered from SARS may also be administered.

• #21 Treatment of severe acute respiratory syndrome

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7088345/

  The best treatment strategy for severe acute respiratory syndrome (SARS) is still unknown. Ribavirin and corticosteroids were used extensively during the SARS outbreak. Ribavirin has been criticized for its lack of efficacy. Corticosteroids are effective in lowering the fever and reversing changes in the chest radiograph but have the caveat of encouraging viral replication. The effectiveness of corticosteroids has only been suggested by uncontrolled observations, and the role of these agents in therapy remains to be established by randomized controlled studies. Both ribavirin and corticosteroids have very significant side effects. The lopinavir/ritonavir combination has been shown to reduce the intubation rate and the incidence of adverse clinical outcomes when used with ribavirin. When patients deteriorate clinically despite treatment with ribavirin and corticosteroids, rescue treatment with convalescent plasma and immunoglobulin may be beneficial. Noninvasive positive pressure ventilation is a sound treatment for SARS patients with respiratory failure if administered with due precaution in the correct environment. Interferons and other novel agents may hold promise as useful anti-SARS therapies in the future. The experience with traditional Chinese medicine is encouraging, and its use as an adjuvant should be further investigated.

• #22 SARS: Systematic Review of Treatment Effects | PLOS Medicine

  https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0030343

  The SARS outbreak of 20022003 presented clinicians with a new, life-threatening disease for which they had no experience in treating and no research on the effectiveness of treatment options. […] In response to the WHO request we conducted a systematic review of the published literature on ribavirin, corticosteroids, lopinavir and ritonavir (LPV/r), type I interferon (IFN), intravenous immunoglobulin (IVIG), and SARS convalescent plasma from both in vitro studies and in SARS patients. […] Despite an extensive literature reporting on SARS treatments, it was not possible to determine whether treatments benefited patients during the SARS outbreak. Some may have been harmful. […] Of 29 studies on steroid use, 25 were inconclusive and four found that the treatment caused possible harm. […] It is disappointing that none of the research on SARS is likely to be useful in helping to decide on the best treatments to use in such an outbreak.

• #23 SARS: Systematic Review of Treatment Effects | PLOS Medicine

  https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0030343

  The most commonly used treatments for SARS are associated with adverse effects when used for other conditions. […] This review has found evidence of avascular necrosis and steroid-induced psychosis in SARS patients. […] Seven studies of treatment with convalescent plasma or IVIG, three with IFN type I, and two with LPV/r were inconclusive by the criteria used in our analyses.

• #24 Treatment Options for Severe Acute Respiratory Syndrome, Middle East Respiratory Syndrome, and Coronavirus Disease 2019: a Review of Clinical Evidence

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7533202/

  Interferons (IFNs) have been known as important glycoprotein that can inhibit viral replication. In an open-label study of 22 SARS patients, oral prednisone 50 mg or intravenous methylprednisolone 40 mg was given every 12 hours. IFN alfa-1 was provided with an increasing dose from 9 g/d to 15 9 g/d during 2 to 10 days of the treatment. A combination of IFN alfa-1 and corticosteroid significantly decreased disease-related impaired oxygen saturation and creatinine kinase levels, compared with corticosteroid alone. […] Given the effectiveness of agents that were used in the treatment of SARS, Momattin et al. suggested the therapeutic schedule for oral ribavirin, LPN/r, peginterferon alfa-2a, and convalescent plasma as possible therapies for patients diagnosed with MERS. Ribavirin was suggested with the dose adjustment but the doses were still higher than those given to SARS patients. A similar treatment schedule with SARS for LPV/r (lopinavir 400 mg/ ritonavir 100 mg twice daily for 10 days) with or without ribavirin was proposed.

• #25 Treatment Options for Severe Acute Respiratory Syndrome, Middle East Respiratory Syndrome, and Coronavirus Disease 2019: a Review of Clinical Evidence

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7533202/

  In the ELACOI trial, arbidol monotherapy was suggested for the potentially clinical benefit compared with supportive care among patients with the mild or moderate disease. […] Two recently open-label trials reported findings for the effect of favipiravir on the treatment of COVID-19. […] Regarding the use of corticosteroids for COVID-19 pneumonia, the Chinese Thoracic Society suggested the low-to-moderate dose of methylprednisolone or equivalent for no more than one week. […] Antimalarial drugs including chloroquine and hydroxychloroquine (HCQ) have been reported for their antiviral activities against SARS and COVID-19 in-vitro. […] A meta-analysis of 32 studies showed that convalescent plasma might reduce the mortality rate among patients with coronavirus infection and severe influenza. […] Recently, tocilizumab, an immunosuppressive drug used to treat rheumatoid arthritis has become a promising candidate for COVID-19 treatment.

• #26 SARS – Wikipedia

  https://en.wikipedia.org/wiki/SARS

  As SARS is a viral disease, antibiotics do not have direct effect but may be used against bacterial secondary infection. Treatment of SARS is mainly supportive with antipyretics, supplemental oxygen and mechanical ventilation as needed. While ribavirin is commonly used to treat SARS, there seems to have little to no effect on SARS-CoV, and no impact on patient’s outcomes. There is currently no proven antiviral therapy. Tested substances, include ribavirin, lopinavir, ritonavir, type I interferon, that have thus far shown no conclusive contribution to the disease’s course. Administration of corticosteroids, is recommended by the British Thoracic Society/British Infection Society/Health Protection Agency in patients with severe disease and O2 saturation of 90%. […] People with SARS-CoV must be isolated, preferably in negative-pressure rooms, with complete barrier nursing precautions taken for any necessary contact with these patients, to limit the chances of medical personnel becoming infected. In certain cases, natural ventilation by opening doors and windows is documented to help decreasing indoor concentration of virus particles. […] Some of the more serious damage caused by SARS may be due to the body’s own immune system reacting in what is known as cytokine storm.

• #27 Treatment of severe acute respiratory syndrome

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7088345/

  In patients who deteriorated irrevocably despite receiving pulse methylprednisolone, convalescent plasma, obtained from patients who recovered from SARS, had been used as a last resort. […] Noninvasive positive pressure ventilation (NIPPV) is a form of ventilatory support through a tight-fitting facemask or nasal mask frequently administered in combination with continuous positive airway pressure or bi-level positive airway pressure for patients with impending respiratory failure. […] The present therapy of SARS is less than satisfactory, and much effort has been expended in looking for novel treatment modalities. […] The optimal treatment regimen for SARS remains elusive. Randomized controlled treatment trials should be done, especially through international collaboration, to discover the best form of therapy.

• #28 Management of Critically Ill Patients with Severe Acute Respiratory Syndrome (SARS)

  https://www.medsci.org/v01p0001.htm

  Corticosteroid dosages should be high enough, especially in the severe cases, to abort the cytokine storm, and maintained for long enough to prevent the rebound phenomenon. […] Human gamma immunoglobulins have been used in selected SARS patients who continued to deteriorate despite treatment. […] Convalescent plasma collected from recovered SARS patients has been used in Hong Kong to treat severely ill patients not responding to corticosteroids. […] Despite all efforts, at least 50% of SARS patients would still develop acute hypoxemic respiratory failure, with up to 80% requiring supplemental oxygen. […] Both non-invasive and invasive ventilatory support has been applied to critically ill SARS patients. […] NIV delivers continuous positive airway pressure (CPAP) or bi-level pressure support through a tight-fitting facial or nasal mask.

• #29 Management of Critically Ill Patients with Severe Acute Respiratory Syndrome (SARS)

  https://www.medsci.org/v01p0001.htm

  When patients do not improve within one to two days of NIV or continue to deteriorate, or if NIV is contraindicated, endotracheal intubation and mechanical ventilation should be considered. […] Critically ill SARS patients on high dose corticosteroids and mechanical ventilation are particularly susceptible to superimposed bacterial and opportunistic infections. […] The case-fatality ratio (CFR) of SARS has been estimated to range from 0% to 50% depending on the age group affected. […] Based on the treatment principles presented above, we have developed a standard treatment protocol early on in the outbreak, comprising initially high (but not pulsed) dose methylprednisolone with tapering over three weeks. […] Many prognostic factors have been reported to independently predict adverse outcome in SARS. […] The cause of death in SARS is usually progressive respiratory failure with or without concomitant sepsis. […] Managing critically ill SARS patients is a challenging task.

• #30 Management of Critically Ill Patients with Severe Acute Respiratory Syndrome (SARS)

  https://www.medsci.org/v01p0001.htm

  Severe acute respiratory syndrome (SARS) is frequently complicated with acute respiratory failure. […] The management of critically ill SARS patients requires timely institution of pharmacotherapy where applicable and supportive treatment (oxygen therapy, noninvasive and invasive ventilation). […] Ribavirin was the most commonly used empirical antiviral agent for SARS. […] Lopinavir-ritonavir co-formulation (Kaletra, Abbott Laboratories, USA) is a protease inhibitor for the treatment of human immunodeficiency virus (HIV) infection. […] Interferons are a family of cytokines with important roles in the cellular immune response. […] Traditional Chinese herbal medicine has been used concomitantly with other drugs to treat SARS in mainland China with good results reported. […] In the absence of an effective antiviral agent in the 2003 outbreak, most physicians had opted to use immunomodulatory agents, most commonly corticosteroids, in the treatment of SARS.

• #31 Insights of Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) pandemic: a current review | Biological Procedures Online | Full Text

  https://biologicalproceduresonline.biomedcentral.com/articles/10.1186/s12575-020-00141-5

  There are several approaches, have been put forward by many countries under the world health organization (WHO) recommendations and some trial drugs were introduced for possible treatment of COVID-19, such as Lopinavir or Ritonavir, Arbidol, Chloroquine (CQ), Hydroxychloroquine (HCQ) and most important Remdesivir including other like Tocilizumab, Oritavancin, Chlorpromazine, Azithromycin, Baricitinib, etc. […] There is no approved drug therapy for SARS, MERS, or even for COVID-19 infection in the current scenario, also lack clinical trial data on COVID-19 treatment makes the condition even worse. Various herbal treatments such as papain-like protease (PLpro), 3C-like protease (3CLpro) and alternative therapeutic drugs such as Lopinaviror, Ritonavir (HIV infections), Arbidol (influenza infection), Remdesivir (Ebola virus), Chloroquine and Hydroxychloroquine (Malaria), Tocilizumab (CRS secondary to CAR [chimeric antigen receptor] T-cell therapy), Teicoplanin (MERS-CoV), Glucocorticoids (pneumonia such as SARS and MERS), Baricitinib (Rheumatoid Arthritis) are in the active research trialsfor the treatment of COVID-19.

• #32 Insights of Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) pandemic: a current review | Biological Procedures Online | Full Text

  https://biologicalproceduresonline.biomedcentral.com/articles/10.1186/s12575-020-00141-5

  Supportive care is the only way to treat patients. […] Further understanding of the structure and function of COVID-19 virus will provides elaborative knowledge on invasion and pathogenesis, to support the discovery of antiviral therapies and precise vaccine development. […] Upon pathogen infection of the respiratory tract, the host immune system is activated to resist and clear the infection. […] Factors implicated in severe influenza include robust cytokine production, otherwise known as the Cytokine storm. […] The effectiveness of herbal treatment to control the contagious disease has been reported vastly in 2003 during severe acute respiratory syndrome (SARS) outbreak. […] The presence of potent antiviral properties in various plants would be greatly important in viral diseases especially in COVID-19 and as per the need of the patient and knowledge about target sites of different natural components; various herbs have been investigated for co-therapy in COVID-19 case.

• #33 Severe acute respiratory syndrome sars | Health and wellbeing | Queensland Government

  https://www.qld.gov.au/health/condition/infections-and-parasites/viral-infections/severe-acute-respiratory-syndrome-sars

  If a SARS epidemic recurs and you have travelled to a SARS-affected area in the last 10 days and developed fever, cough or shortness of breath, you should seek urgent medical assessment. As SARS is infectious, always phone the health facility and advise of possible SARS contact before attending. […] There is no specific treatment for SARS. Severe cases need hospitalisation for general supportive healthcare. […] Special precautions are needed for people who are suspected of having SARS and their carers. People may be isolated in hospital or in their home. Staff caring for them, along with any visitors, need to wear masks, eye protection, gloves and gowns to prevent the infection being spread. It is very important for the sick person and all people in contact with them to wash their hands frequently.

• #34 Coronaviruses and Acute Respiratory Syndromes (MERS and SARS) – Infections – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/infections/respiratory-viruses/coronaviruses-and-acute-respiratory-syndromes-mers-and-sars

  Severe acute respiratory syndrome is a coronavirus infection that causes flu-like symptoms. […] If doctors think a person may have SARS, the person is isolated in a room with a ventilation system that limits the spread of microorganisms in the air. […] SARS is caused by a coronavirus. SARS is much more severe than most other coronavirus infections, which usually cause only coldlike symptoms. However, the Middle East respiratory syndrome (MERS) and COVID-19 are other severe illnesses caused by a coronavirus. […] SARS is spread from person to person through close contact with an infected person or through airborne droplets that were coughed or sneezed out by an infected person. […] If doctors think a person may have SARS, the person is isolated in a room with a ventilation system that limits the spread of microorganisms in the air. In the first and only outbreak of SARS, such isolation kept the virus from being transmitted and eventually eliminated it. […] People with mild symptoms need no specific treatment. Those with moderate difficulty breathing may need to be given oxygen. Those with severe difficulty breathing may need mechanical ventilation to aid breathing.

• #35 Severe Acute Respiratory Syndrome – MD Searchlight

  https://mdsearchlight.com/lung-disease-respiratory-health/severe-acute-respiratory-syndrome/

  With SARS, the focus is on preventing the spread of infection. If a patient is suspected of having SARS, its vital to identify them quickly and isolate them, adopting adequate measures to control the infection and prevent transmission. […] A process that uses clinical and epidemiological criteria should be in place to promptly recognize patients with suspected SARS. Measures to control the infection include contact precautions (using gloves, gowns, and eye protection), droplet precautions (securing a private room for the patient and limiting their movement), and airborne precautions (using N-95 respirators and making sure the isolation room has a negative pressure environment). […] In the early stages of the SARS epidemic, corticosteroids were trialed as a treatment, but they did not prove to be beneficial. In SARS patients, side effects of prolonged high-dose corticosteroid therapy were observed, such as avascular necrosis (death of bone tissue due to a lack of blood supply) and widespread fungal infection.

• #36 Severe acute respiratory syndrome | Nature Medicine

  https://www.nature.com/articles/nm1143

  Severe acute respiratory syndrome (SARS) was caused by a previously unrecognized animal coronavirus that exploited opportunities provided by 'wet markets’ in southern China to adapt to become a virus readily transmissible between humans. […] We will also highlight the progress that has been made towards developing vaccines and therapies. […] The concerted and coordinated response that contained SARS is a triumph for global public health and provides a new paradigm for the detection and control of future emerging infectious disease threats. […] SARS coronavirus: a new challenge for prevention and therapy. […] Potential for antiviral treatment of severe acute respiratory syndrome. […] Severe acute respiratory syndrome: clinical features, diagnosis and management. […] The antiviral effect of interferon- against SARS coronavirus is not mediated by MxA protein.

• #37

  https://myhealth.alberta.ca/Health/pages/conditions.aspx?hwid=uf6067

  Severe cases of SARS often require a hospital stay, especially if breathing problems develop. You will be placed in isolation to prevent passing the disease to others. There is no treatment that can cure SARS, but your symptoms will be treated to keep you as comfortable as possible. […] Researchers are currently trying to develop vaccines to prevent SARS infection. But no vaccines are being tested in humans yet.

• #38 Severe Acute Respiratory Syndrome (SARS) | UNDRR

  https://www.undrr.org/understanding-disaster-risk/terminology/hips/bi0068

  Severe acute respiratory syndrome (SARS) is a viral respiratory illness caused by a coronavirus called SARS-associated coronavirus (SARSCoV) (WHO, 2019). […] There is no cure or vaccine for SARS and treatment should be supportive and based on the patients symptoms (WHO, 2020). […] No vaccine or specific treatment is available for SARS but it is part of the priority list for the WHO Research and Development Blueprint for Action to Prevent Epidemics (WHO, 2016a).

• #39 Severe acute respiratory syndrome (SARS): lessons learnt in Hong Kong – Hui – Journal of Thoracic Disease

  https://jtd.amegroups.org/article/view/1270

  Many healthcare workers were infected while looking after the SARS patients on the medical wards in 2003. […] Carefully designed clinical trials are required to determine the optimal timing and dosage of any antiviral agents, convalescent plasma, and immuno-modulating agents in the treatment of the possibly immune-mediated lung injury in SARS and newly emerged infection such as the Middle East Respiratory Syndrome.

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