Many of us have seen news reports on the World Health Organization's (WHO) investigation of several cases of an atypical pneumonia, being called Severe Acute Respiratory Syndrome or SARS. The following information (and Web sites that make additional information available) is being provided to enable parish nurses and health ministry personnel to be informed should they receive questions from congregation members.

Precautions for Pastors and Church Personnel
To date, National Health Ministries has been advised of no specific precautions impacting communion services or "passing of the peace" by the Center for Disease Control and Prevention. However, as with other infectious illnesses, one of the most important and appropriate preventive practices is careful hygiene.

In preparing communion, if one is handling items that will be distributed to or consumed by others, cleaning your hands thoroughly using either soap and water or waterless alcohol-based hand sanitizers removes potentially infectious materials from your skin and helps prevent disease transmission. Wearing latex gloves would also be helpful. NOTE: Please consult with a physician before using latex gloves when handling any "communal" material as life threatening allergies to latex exist. Vinyl gloves would be an alternate choice.

While there appears not to currently be a medical reason to revise or discontinue those portions of our services that place people in close proximity of one another, the level of concern among members of congregations might be taken into consideration as services are planned. Some faith groups in countries where SARS appears to be more virulent have chosen to issue warnings and advise against sharing the communion cup and the traditional handshake or embrace of peace.

In the case a pastor or volunteer making a hospital or home visitation with an individual suspected or known to have SARS, be certain to follow all precautions advised by the health professionals caring for the ill individual. While these at times might seem awkward, please remember that reliable information available about SARS indicates that among the highest risk groups are people in health care settings and workers taking care of people who are ill with SARS. Visitors may be at increased risk, as well.

Mission personnel or others, who in the last ten days have traveled to a known SARS area, could be at increased risk of developing SARS and should be vigilant for the development of fever (greater than 100.4° F) or respiratory symptoms (e.g., cough or difficulty breathing).

In the United States, the routine use of personal protective equipment (PPE) such as respirators, gloves and surgical masks for protection against SARS exposure is currently not recommended in the general workplace (outside the health-care setting).

Spread of SARS
It appears that all new cases of SARS being found in 2004 in are in China, while last year SARS was reported in the United States, as well as Canada, China, Hong Kong Special Administrative Region of China, Indonesia, Philippines, Singapore, Thailand, and Vietnam. Both the CDC (Center for Disease Control and Prevention) and the World Health Organization have daily alerts and case updates on their Web sites.

There is no evidence at this point that the disease spreads though casual contact, and it does appear that some of the persons infected are recovering—particularly if they suffered a mild case or were treated early.

Risk Factors
Cases of SARS continue to be reported primarily among people who have had direct close contact with an infected person, such as those sharing a household with a SARS patient and health care workers who did not use infection control procedures while caring for a SARS patient. In the United States, there is no indication of community transmission at this time. SARS has also occurred among air travelers, primarily travelers to and from Hong Kong, Hanoi, Singapore, and mainland China.

Information currently available about SARS indicates that people who appear to be most at risk are either health care workers taking care of sick people or family members or household contacts of those who are infected with SARS. That pattern of transmission is what would typically be expected in a contagious respiratory or flu-like illness. SARS appears to be spread through droplet transmission; namely, when someone sick with SARS coughs or sneezes droplets into the air and someone else breathes them in. It is possible that SARS can be transmitted more broadly through the air or from objects that have become contaminated.

Information to date suggests that people are most likely to be infectious when they have symptoms, such as fever or cough. However, it is not known how long before or after their symptoms begin that patients with SARS might be able to transmit the disease to others.

Cause
The exact cause of SARS is unknown at this time. However, scientists at CDC and other laboratories have detected a previously unrecognized coronavirus in patients with SARS. While the new coronavirus is still the leading hypothesis for the cause of SARS, other viruses are still under investigation as potential causes.

Symptoms & Contagion
SARS starts with a fever higher than 100.4°F [>38.0°C]. Other symptoms may include headache, an overall feeling of discomfort, and body aches. Some people also feel short of breath. After 3 to 7 days, the person may get a dry cough and have trouble breathing.

Public health experts think that SARS is spread by close contact between people. For example, the disease can spread from someone who is sick with SARS to healthcare workers who have taken care of them or to family members. It is most likely spread when someone sick with SARS coughs droplets into the air and someone else breathes them in. It is possible that SARS also can spread more broadly through the air or from touching objects that have become contaminated. SARS does not seem to spread easily by casual contact in large groups of people.

Treatment
There is no specific course of treatment and no known cure for SARS. CDC currently recommends that patients with SARS receive the same treatment that would be used for any patient with serious community-acquired atypical pneumonia of unknown cause. Several treatment regimens have been used for patients with SARS, but there is insufficient information at this time to determine if they have had a beneficial effect. Reported therapeutic regimens have included antibiotics to presumptively treat known bacterial agents of atypical pneumonia. Therapy also has included antiviral agents such as oseltamivir or ribavirin. Steroids also have been administered orally or intravenously to patients in combination with ribavirin and other antimicrobials.

There is no evidence at this point that the disease spreads though casual contact, and it does appear that some of the persons infected are recovering—particularly if they suffered a mild case or were treated early.

Precautions
The World Health Organization makes the following suggestions to minimize the risk of contacting SARS:

1. Restrict your travel to mainland China, Hong Kong, Singapore, and Hanoi. Travel to Canada does not appear to present as great a risk, though cases have been reported there, SARS does not seem to be spreading there right now.
2. Be sure you are current on all your shots. See your health care provider at least four to six weeks before travel to get the latest shots and facts you need. For more on CDC health advice for travel abroad, see www.cdc.gov/travel.
3. Check your health insurance. You may want to get more coverage for medical evacuation in case you get sick abroad. Ask the U.S. Department of State (DOS) about health care services in the country where you're going. DOS has a list of foreign health care providers and health care facilities at www.travel.state.gov/acs.html#medical.
4. If you get sick while traveling in an area affected by SARS, see a health care provider and say that you're worried about being exposed to SARS.
5. Don't travel while sick. Limit your contact with others as much as you can to help prevent the spread of any contagious disease you may have. If you don't know of any provider in the foreign country, call the U.S. embassy or consulate to get the name of a provider.
6. As with all contagious diseases, the best way to not get sick is to wash your hands often with soap and water. If you don't have soap and water, use alcohol-based hand rubs.
7. When you come back home from areas affected by SARS, if you were sick on your trip or return home sick, see your health care provider right away. Mention your symptoms and the countries you visited. You may be asked to fill out a form about your disease and give your name and address to public health authorities.
8. If you leave an area affected by SARS, a screener may ask you about your health before you board the plane.
9. When you come back from areas affected by SARS, you will get a travel alert card as you land. If you're not sick and didn't get sick abroad but may have been in touch with someone with SARS, check your health for the next ten days.

SARS Worldwide Travel Information
As a measure of precaution the World Health Organization is now recommending that persons traveling to Hong Kong and Guangdong Province of China consider postponing all but essential travel. This temporary recommendation will be reassessed in the light of the evolution of the epidemic in the areas currently indicated, and other areas of the world could become subject to similar recommendations if the situation demands.

The SARS situation in Hong Kong Special Administrative Region has developed features of concern: a continuing and significant increase in cases with indications that SARS has spread beyond the initial focus in hospitals. These developments have suggested environmental routes of transmission from a SARS infected person which may be related to contamination of common systems that link rooms or flats together. Despite the implementation of strict measures to control the outbreak, there has continued to be a small number of visitors to Hong Kong who have been identified as SARS cases after their return from Hong Kong. The epidemic in Guangdong Province of China, situated adjacent to Hong Kong, is the largest outbreak of SARS reported and has also shown evidence of spreading in the wider community

The U.S. Center for Disease Control and Preventions also advises that persons planning elective or nonessential travel to Hong Kong and Guangdong Province, People's Republic of China and Hanoi, Vietnam may wish to postpone their trips until further notice. Detailed information can be found on CDC's Traveler's Health Web site at www.cdc.gov/travel/.

SARS Updates
National Health Ministries will provide critical updated information as it becomes available. The World Health Organization and the Centers for Disease Control and Prevention (CDC) are still looking into the causes of SARS. For continuous new information and breaking news, visit: the CDC Web site at www.cdc.gov/ncidod/sars/ or the World Health Organization Web site at www.who.int/csr/sarscountry/en/.