The severe acute respiratory syndrome (SARS) is responsible for the first pandemic of the 21st century. Within months after its emergence in Guangdong Province in mainland China, it had affected more than 8000 patients and caused 774 deaths in 26 countries on five continents. It illustrated dramatically the potential of air travel and globalization for the dissemination of an emerging infectious disease and highlighted the need for a coordinated global response to contain such disease threats. We review the cause, epidemiology, and clinical features of the disease.

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The severe acute respiratory syndrome.

Little evidence of increased thrombotic risk is available in COVID-19 patients. Our purpose was to assess thrombotic risk in severe forms of SARS-CoV-2 infection. All patients referred to 4 intensive care units (ICUs) from two centers of a French tertiary hospital for acute respiratory distress syndrome (ARDS) due to COVID-19 between March 3rd and 31st 2020 were included. Medical history, symptoms, biological data and imaging were prospectively collected. Propensity score matching was performed to analyze the occurrence of thromboembolic events between non-COVID-19 ARDS and COVID-19 ARDS patients. 150 COVID-19 patients were included (122 men, median age 63 [53; 71] years, SAPSII 49 [37; 64] points). Sixty-four clinically relevant thrombotic complications were diagnosed in 150 patients, mainly pulmonary embolisms (16.7%). 28/29 patients (96.6%) receiving continuous renal replacement therapy experienced circuit clotting. Three thrombotic occlusions (in 2 patients) of centrifugal pump occurred in 12 patients (8%) supported by ECMO. Most patients (> 95%) had elevated D-dimer and fibrinogen. No patient developed disseminated intravascular coagulation. Von Willebrand (vWF) activity, vWF antigen and FVIII were considerably increased, and 50/57 tested patients (87.7%) had positive lupus anticoagulant. Comparison with non-COVID-19 ARDS patients (n = 145) confirmed that COVID-19 ARDS patients (n = 77) developed significantly more thrombotic complications, mainly pulmonary embolisms (11.7 vs. 2.1%, p < 0.008). Coagulation parameters significantly differed between the two groups. Despite anticoagulation, a high number of patients with ARDS secondary to COVID-19 developed life-threatening thrombotic complications. Higher anticoagulation targets than in usual critically ill patients should therefore probably be suggested.

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High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study.

Severe acute respiratory syndrome (SARS) was caused by a previously unrecognized animal coronavirus that exploited opportunities provided by 'wet markets' in southern China to adapt to become a virus readily transmissible between humans. Hospitals and international travel proved to be 'amplifiers' that permitted a local outbreak to achieve global dimensions. In this review we will discuss the substantial scientific progress that has been made towards understanding the virus—SARS coronavirus (SARS-CoV)—and the disease. We will also highlight the progress that has been made towards developing vaccines and therapies The concerted and coordinated response that contained SARS is a triumph for global public health and provides a new paradigm for the detection and control of future emerging infectious disease threats.

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Severe acute respiratory syndrome

How mental health care should change as a consequence of the COVID-19 pandemic.

Neutrophil extracellular traps contribute to immunothrombosis in COVID-19 acute respiratory distress syndrome.

Allocating Scarce Medical Resources for Covid-19 The Covid-19 pandemic has already stressed health care systems throughout the world, requiring rationing of medical equipment and care. The authors ...

https://www.nejm.org/doi/pdf/10.1056/NEJMsb2005114?articleTools=true

Fair Allocation of Scarce Medical Resources in the Time of Covid-19.

Ending the coronavirus disease 2019 (COVID-19) pandemic through vaccination will require sufficient uptake, possibly through mandatory vaccination. At present, certain vaccines are required for children to attend school.1 Although vaccine mandates for adults are legal, they have generally been applied narrowly to select groups, such as health care workers, rather than broadly enforced.2 We surveyed the US public to assess acceptability of COVID-19 vaccine mandates.

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US Public Attitudes Toward COVID-19 Vaccine Mandates.

PURPOSE: To review radiographic findings of patients with probable severe acute respiratory syndrome (SARS) who were seen at a University of Toronto (Ontario, Canada) teaching hospital. MATERIALS AND METHODS: Findings were reviewed for 40 patients who fulfilled the World Health Organization criteria for probable SARS. A template was designed for the analysis of each serial radiograph to observe patterns and distribution of disease, interval changes, and complications. The majority of radiographs were anteroposterior views. A clinical database of these patients was also collected for clinical-radiologic comparison. RESULTS: The mean age of the patients (18 male, 22 female) was 42.7 years. Patients had a normal chest radiograph and focal, multifocal, and/or bilateral consolidation. The pattern of consolidation tended to be peripheral and poorly marginated and involved middle and lower lung zones. The serial sequence fell into two major subgroups, which correlated closely with clinical outcome. Consolidation...

Severe acute respiratory syndrome: radiographic review of 40 probable cases in Toronto, Canada.

Does the United States have enough physicians?—Yes.

For decades, experts have bemoaned a lack of sufficient primary care physicians in the United States. These fears came to a head during debate over the Affordable Care Act (ACA), when critics suggested that the millions of US residents gaining coverage under the ACA would further exacerbate the existing physician shortage. A 2011 American College of Surgeons report asserted that “even before [this] health care reform, the nation was headed for serious physician shortages and reform has only made it worse.”1 According to the updated report of the Association of American Medical Colleges (AAMC), released March 14, 2017, the AAMC still predicts a shortage of between 40 800 to 104 900 physicians by 2030.

Reassessing the Data on Whether a Physician Shortage Exists.

Affording health care has become a pressing national concern. According to a 2016 Gallup survey, 27% of individuals in the United States identified affordability as the country’s “most urgent health problem.”1 The level of concern is both severe and new. In the late 1990s, HIV/AIDS was the top health concern. In 2008, the leading health concern was accessing medical services. Today, 57% of individuals report that they worry “a great deal” about “the availability and affordability of healthcare.”1 More than 60% indicate that prescription drug prices should be a top healthcarepriority.Morethanaquarterof individualshave postponed care owing to cost.2 When discussing high health care costs, academics and policymakers cite multiple measures: total national health expenditures, health care inflation, health care spending as a percentage of the US economy, and health care “waste.” Many individuals in the United States, and even many health care professionals, have difficulty graspingthesemacroeconomicindicators.Howmuchis$3.2trillion? Furthermore, these measures are deeply impersonal. They describe health care spending at the national level. Why should a family be concerned if health care is 17.5% of gross domestic product? Most important, these measures track expenditures, not affordability. They do not describe the ability to pay for health care.

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Aaron Glickman

Papers

Fair Allocation of Scarce Medical Resources in the Time of Covid-19.

US Public Attitudes Toward COVID-19 Vaccine Mandates.

Severe acute respiratory syndrome: radiographic review of 40 probable cases in Toronto, Canada.

Reassessing the Data on Whether a Physician Shortage Exists.

Measuring the Burden of Health Care Costs on US Families: The Affordability Index.