Department of Health
Health Advisory on SARS
for Schools, Colleges and Universities
May 6, 2003

SARS is an acronym for "Severe Acute Respiratory Syndrome".

It is severe because it can cause a rapidly progressing pneumonia. About 6% (or 6 in 100), usually the elderly, may die of the infection.

It is acute, meaning it has a sudden onset, affecting previously healthy individuals. "Respiratory" refers to the main part of the body that is affected, the respiratory system or the lungs. The term "syndrome" stands for the group of signs and symptoms of SARS.

SARS is caused by a new virus that belongs to the Coronavirus family, the same family to which the common cold also belongs.

SARS starts as a sudden onset of fever, often high grade (>38^oC), and body weakness, muscle aches and chills, similar to any viral infection like flu. About three days after, the patient with SARS will develop signs of pneumonia such as cough and difficulty of breathing.

A person can get SARS from another person with SARS through close person-to-person contact. The most common route of transmission is through droplet spread, that is, when the unaffected person inhales or comes in contact with droplets of mucous that comes out of the affected person when he/she coughs or sneezes. Scientists are still studying the possible spread of the virus through feces and urine because the viruses are detected in these.

Persons can avoid getting SARS if all SARS patients are identified immediately before they become infectious to others. If all SARS patients are immediately isolated in the hospital until they recover and are no longer infectious, SARS will not spread in the community. From now on, everybody with fever and signs of infection should not go to school or to work and should avoid being near other people, even their own family, until they are sure they do not have SARS. If people ignore the fever and spread the SARS virus around, it will be very hard to stop the spread of the virus.

It is those who get sick who should think of the prevention of the infection to others around him/ her. Those who are not sick can try to avoid getting in close contact with someone who has SARS.

But how can we tell who has SARS from those who do not have SARS?

The doctors are using 3 criteria as a first net to catch those who may have SARS (suspect SARS):

1. travel or residence in a SARS affected country the previous 14 days before the onset of the illness, or

2. having taken cared of, live with or come in contact with bodily secretions of another person with SARS, AND

3. fever or history of fever within 14 days of travel or close contact with a person with SARS.

Those with either 1 or 2 AND 3 are suspected to have SARS. They will have to be closely observed in isolation from the others until the person develops other signs that are more definitely SARS, such as difficulty of breathing as a sign of pneumonia or chest x-ray showing pneumonia.

The other infections also start the same way as SARS, but will also reveal themselves when the sick person develops hemorrhage as in dengue hemorrhagic fever or the typical rashes of measles. There are other bacteria and viruses that can also cause pneumonia, and differentiating SARS from these will involve much hospital laboratory testing and clinical observation of the patient.

For the ordinary person, it is indeed very difficult to tell the difference between SARS and the other infections, and by that time you can tell the difference, SARS would have infected other already. Therefore, any fever should be regarded with caution. Home rest and home isolation until the real disease reveals itself will help a lot in preventing SARS from spreading.

The school should prepare itself to detect and isolate students who may come down with SARS. A School SARS Prevention and Control Standard Operating Procedure (SOP) should be developed and widely disseminated. This SOP should include all the school activities to inform parents and students about SARS and how to avoid it, and the procedures to follow when a student, a teacher or other school employees develop a fever. The most important procedure is to ensure that all students, teachers and other school employees stay home at the first sign of fever. Attached, Annex 1, is a list of the most important items that should be included in the school SARS SOP.

The school should be aggressive in its information drive to inform parents of the importance of cooperation with the SOP. Children should also cooperate fully so that they come forward when they feel febrile or weak. However, care must be taken to avoid malingering.

An important component of SARS prevention is keeping the school premised and contact surfaces clean and dis-infected. Daily dis-infection with the standard bleaching agents will prevent the virus from growing in the toilets and other wet areas. Mopping and drying after dis-infection will also prevent viral growth.

The school health staff should also learn to identify SARS suspects using the DOH triage screening for patients with fever or history of fever, Annex 2. A place should be provided to separate the febrile patient from others who may be suffering for non-febrile illness. Basic supplies, such as n95 face masks, soap and water for handwashing, should also be provided.

The community around the school, including the vendors, school bus drivers and other people who come in contact with the students and school employees should also be provide with adequate awareness on SARS and their cooperation should be sought.

The school should also be the source of timely and accurate information about SARS. The Department of Health will issue health advisories time and again. The schools should receive the official announcements and disseminate these. Unconfirmed rumors should not be disseminated, instead, these should be verified through the official channels of the Department of Education.

Much can be done by the schools and colleges through consistent messages and appeal for public cooperation, especially for immediate detection of suspect SARS and quarantine, a difficult but necessary sacrifice for the other members of the community. Good personal hygiene can be instilled if these are started among the very young children. These practices should include covering the mouth and nose when coughing, frequent handwashing especially after coming from the toilet, no spitting anywhere, and other personal actions.

If a student, teacher or employee was detected to have SARS, the school should assist the health authorities and local barangay leaders in identifying the persons who got into close contact with the SARS patient. They should help convince these contacts to go into quarantine and / or treatment. When the patient recovers from SARS, he or she should be assisted in integrating back into the school and community. While the scientists are still studying the matter for SARS, other viral infections usually confer immunity so that a person who has recovered from SARS is not longer infectious.

Aside from the cases of suspected SARS and their contacts, the DOH does not require any other information from the schools. School physicians, though, might want to monitor the cases of fever in their school to detect any rise, but this should be done not only for SARS but for other illnesses like dengue and measles as well. Appropriate prevention and control measures can be done when outbreaks in the school are detected early enough.

Annex 2 is a guide for outpatient screening of persons with fever or history of fever. School health physicians and nurses can use this to guide their detection and referral actions.

Schools with no school physicians or nurses can make arrangements with the local municipal health officer or rural health midwife for screening of patients with fever or history of fever.

All students and employees of the school should know what SARS is, what causes it, how it is transmitted and avoided so that they will not be scared of it or panic about it. Cooperation will prevent the spread of SARS. This has already been done in countries like Vietnam. We can also do the same thing in the Philippines.

Parents will be afraid that their children might get SARS in the school. Re-assure the parents by explaining what SARS is, how this is avoided and what the school is doing to protect the children and the school community. Motivate them to re-assure their children yet demand their commitment to take their children’s temperature daily and to cooperate with all the standard procedures developed by the school.

What are the DOH STOP SARS ATTACK hotlines?

The national DOH STOP SARS ATTACK hotlines are: 741-70-48, 743-83-01 loc 1901 and 0916-466-5823. The hotlines of the Bureau of Quarantine are: (632) 527-55-52, (632) 527-46-54 up to 55 and Fax: (632) 527-46-78. There is also a DOH website: http:/www.doh.gov.ph

Annex 1

Essential Contents of the School SARS SOP

What should be the school’s SOP to prevent SARS in the schools?
(Main contents of SOP)

Routine daily temperature taking before going to school (Temperature may or may not be taken again before the students enter the school premises or before mingling with the other students)

Routine washing of hands with soap before class, in between subjects, and after going to the toilet.

Home stay (with avoidance of contact with family members who are well) for students, teachers and other employees who come down with fever, until 2 days after the fever subsides

What to do when a student, teacher or other school employee is detected to have fever while in school?

(Usually, this should include putting a face mask on the feverish person and taking him to the school physician for evaluation using the SARS screening for persons with fever or history of fever; if the school does not have a physician, the nearest health center physician or rural health midwife can be consulted)

Depending on assessment, the student, teacher or other employee will be sent home immediately (conduct home if possible, still wearing facial mask) or refered to a SARS referral hospital for further assessment or confinement.

The illness of the students, teachers or other school employees who are sent home should be followed up. As soon as signs of pneumonia is detected, the patient should be confined in a SARS referral hospital.

The SOP should also include the persons who will be responsible for teaching parents, students and others about SARS, and the other school activities on SARS prevention and control