Should parents be worried
about SARS in children?
Robert P. Lindeman, MD, PhD
Natick Pediatrics, PC

President Bush has declared Severe Acute Respiratory Syndrome (SARS) to be a disease for which an affected person may be subject to quarantine. Similar orders from national authorities had already been issued in Singapore, Hong Kong, and Ontario. This executive order represents the first time since the "Spanish Flu" pandemic of 1918-19 that a large-scale quarantine program has been implemented in the United States. As a result, there is a great degree of concern about SARS in the U.S., particularly among parents of young children.

What do we know about SARS?
Very little can be said about SARS with a great degree of certainty. This is, by all accounts, a new disease: The first cases of SARS started appearing in the Guangdong province of China in November 2002. Since then, SARS has been reported in a total of 17 countries. The cause is not known for certain, but early indications point to a previously unknown virus in the family of viruses that cause the common cold.

As of this writing, all confirmed or suspected cases of SARS in the U.S. have occurred in people who have traveled to countries known to have large numbers of cases, or in patients who come in close contact with SARS patients (either in households or health care settings). Casual contact with a SARS patient at schools, other institutions, or public places has not resulted in reported transmission in the U.S.

The symptoms of SARS are similar to those of influenza, or "the flu." The illness usually begins with a body temperature greater than 100.4°F. SARS patients often have shaking chills, overall feeling of discomfort, and body aches.

After 2 to 7 days, SARS patients may develop a dry cough that might be accompanied by, or progress to, the point where insufficient oxygen is getting to the blood. Ten to twenty percent of patients will require a respirator. Between 3 - 4 percent of patients ultimately die of SARS. There have been no reported deaths in the U.S.

Do children get SARS?
According to the Centers for Disease Control and Prevention (CDC), few cases of SARS have been reported in children under 15. Worldwide, there are no published statistics on deaths from SARS among children. It appears that older patients are more likely to die from SARS than younger patients. We may speculate, therefore, that the younger the patient, the greater the chances of full recovery from SARS.
There are several reasons why there have been relatively few children with SARS. First, infected children may not become as ill as adults, and are therefore less likely to have received medical attention for their symptoms. In my opinion, this is the most likely explanation.
Second, children may be less susceptible to infection with the SARS virus, although I believe this possibility is unlikely, given a child’s normal behavior patterns that would easily favor transmission of such an infection.

Finally, it is possible that few children have been exposed to SARS-infected adults. However, given the 7- to 10-day length of a typical illness and the evidence to suggest that household contacts are at risk of infection, it seems unlikely that an affected patient would not come into contact with children.

Children and viruses
To the best of our knowledge the SARS virus is spread in one of two ways:
1) inhalation of large droplets spread by a coughing or sneezing SARS patient, and 2) touching a surface that has become contaminated with the mucus or saliva of a SARS patient, and then touching one’s own face. It is believed that the SARS virus survives on surfaces for at least one hour.

These two ways of virus transmission are precisely why children so often come down with colds: they sneeze without covering their mouths, and they tend to touch objects (including other children) and then touch their faces. This being the case, children should be more likely to come in contact with the virus, just as they are more likely to come in contact with cold viruses. Yet, few children are reported to be ill with SARS, It is not known if any adults have contracted the SARS virus from a child, but given what we currently know about the virus and its spread, child-to-adult transmission remains a distinct possibility.

What you should do
The most important thing to do is to remain calm. Though very little is known about SARS, what little we do know suggests that we are not facing another Spanish Flu epidemic. Although 3 - 4% of patients diagnosed with SARS worldwide have died, there have been no reported deaths in the U.S. and all the affected patients have recovered fully.

The individuals at risk for contracting SARS remain people who have traveled to China, Singapore, or Vietnam, as well as household contacts of SARS patients and healthcare workers who care for SARS patients.

The principles for avoiding infection with SARS are the same for the precautions one should take to avoid infection with any respiratory virus, including the common cold virus.

Frequent, thorough hand washing for 30 seconds with soap and water is essential, and good hand-washing techniques can be taught to a child as young as age two.

Children should be taught to cover their mouths when sneezing or coughing. The hand is not the best receptacle for a sneeze, since the child’s hand instantly transforms into a device for spreading viruses; the crook of the elbow is better. As with hand washing, nose blowing can be taught to even very young children.

Viruses are also spread by contact. We must assume that a young child with a respiratory virus is covered with virus particles from head to foot, particularly his/her hands. The sick child need only touch a tabletop. Then another person touches the tabletop and then touches his/her nose or eyes. Now this person is infected, without having touched the sick child directly.

The solution to the problem of virus transmission by children is to keep them home when they have colds. This is easier said than done, but if SARS should become established on American shores, parents will have to take their children’s sniffles more seriously, and keep them home when they are ill.

The best, most up-to-date sources of information about SARS can be found at one of two web sites: The SARS page at the CDC web site can be found at http://www.cdc.gov/ncidod/sars/index.htm. Here you can find guidelines and recommendations, as well as travel advisories. The other useful source is the World Health Organizations SARS page: http://www.who.int/csr/sars/en/.

For more information about Natick Pediatrics, or to talk to the doctor, please call the office at (508) 655-9699.

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Medical Office Building
MetroWest Medical Center
Leonard Morse Campus
67 Union Street, Suite 305
South Natick, MA 01760

(508) 655-9699
(508) 655-2984 fax

Posted: April 17, 2003