Criteria for the Severe Acute Respiratory Syndrome (SARS) from the Chinese Ministry of Health

 

Criteria for SARS:

(1) epidemiologic

(1.1) close contact with a person (a) confirmed to have SARS, (b) belonging to a group of infected persons with SARS, or (c) has definite evidence of infecting others

(1.2) history of traveling to OR residing in an area with local transmission AND onset of SARS <= 2 weeks

(2) signs and symptoms:

(2a) acute onset with fever > 38°C with or without chills (fever may not be the first symptom if onset following surgical operation or with a comorbid condition)

(2b) concurrent headache, joint pain, muscle pain, fatigue, and/or diarrhea

(2c) usually no catarrhal symptoms in the upper respiratory tract

(2d) cough that is mainly dry with little sputum but may be bloody

(2e) tachypnea, dyspnea or respiratory distress

(2f) pulmonary exam may be negative or may show wet rales or signs of consolidation

(3) laboratory test findings: The WBC count generally does not change but the lymphocyte count will decrease.

(4) chest radiograph findings include:

(4a) patchy and spotty infiltrating changes of various degrees

(4b) reticular changes

(4c) rapid progression to diffuse patchy changes, usually with multilobe or bilateral involvement

(4d) slow absorption and disappearance of changes

(4e) inconsistency between chest X-ray changes and clinical signs and symptoms

The chest X-ray should be repeated in 1-2 days if initially negative.

(5) no significant therapeutic response to antibiotic therapy

 

NOTE: The criteria were proposed prior to availability of specific coronavirus testing.

 

Clinically confirmed case:

(1) 1.1 and 2 and 4 and 5

(2) 1.2 and 2 and 3 and 4

 

Clinically suspected:

(1) 1.1 and 2 and 3

(2) 1.2 and 2 and 4

(3) 2 and 3 and 4

 

Criteria for severe SARS - one or more of the following:

(1) respiratory difficulty (tachypnea with respiratory rate > 30 breaths per minute)

(2) hypoxemia (PaO2 < 70 mm Hg or oxygen saturation < 93% while on oxygen at 3-5 liters per minute)

(3) diagnosis of acute lung injury or ARDS

(4) chest radiograph showing multi-lobe involvement with extent greater than one third of the lung field, OR rapid progression to greater than half of lung field within 48 hours

(5) shock or multi-organ dysfunction syndrome

(6) history of severe comorbid condition prior to onset of SARS

(7) complications of other infections

(8) age of patient > 50 years