Fast Five Quiz: Severe Acute Respiratory Syndrome (SARS)

Michael Stuart Bronze, MD


May 04, 2020

Currently, no definitive medication protocol specific to SARS has been developed, although various treatment regimens have been tried without proven success. Although guidelines specific for SARS have not been recently updated, the Centers for Disease Control and Prevention recommended that patients suspected of having SARS or confirmed as having SARS receive the same treatment that would be administered if they had any serious, community-acquired pneumonia.

The most widely used antiviral agent in SARS has been ribavirin (usually in conjunction with steroids). Despite early anecdotal reports of patients with SARS improving with a combination of ribavirin and steroids, ribavirin does not have proven activity against a virus from the Coronaviridae family. It does have significant adverse effects, including hemolysis. Ribavirin is unlikely of any clinical benefit in SARS.

In patients with SARS, the use of interferon alfacon-1 plus corticosteroids was associated with improved oxygenation, more rapid resolution of radiographic lung opacities, and lower levels of creatine phosphokinase. These findings, although encouraging, need to be supported by further studies.

Vaccines containing SARS-CoV nucleocapsid recombinant surface spike (S) protein have been shown to induce high levels of SARS-neutralizing antibody in animal models. However, the safety of these vaccines is a concern. Several studies reported that SARS vaccines exacerbated lung eosinophilic immunopathology and paradoxically manifested as a severe disease upon subsequent patient exposure to SARS-CoV infection. Currently, a SARS DNA vaccine encoding the S glycoprotein has been investigated in a phase 1 clinical trial. Although it was shown to be well tolerated in that study, further studies need to be performed before an optimal, yet safe, vaccine can be implemented clinically.

No specific antiviral treatment is recommended for COVID-19. Infected patients should receive supportive care to help alleviate symptoms. Vital organ function should be supported in severe cases. No vaccine is currently available for SARS-CoV-2. Avoidance is the principal method of deterrence. Numerous collaborative efforts to discover and evaluate effectiveness of antiviral agents (eg, remdesivir), immunotherapies (eg, hydroxychloroquine, sarilumab), monoclonal antibodies, and vaccines have rapidly emerged.

Read more about the treatment of SARS.

This Fast Five Quiz was excerpted and adapted from the Medscape Drugs & Diseases articles Severe Acute Respiratory Syndrome (SARS) and Coronavirus Disease 2019 (COVID-19).

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