Assessing Actual Cases and Mortality Rate
• Patients were admitted with flu-like illness and never developed pneumonia; a serological test is needed.
• If suspect SARS cases are excluded from accounting, the mortality rate jumps from 7 to 15 percent.
• We do not yet know what an asymptomatic SARS infection looks like or how frequently it occurs; this also affects the mortality rate.
• The concept of super-spreaders is confounded by infection control; some so-called super-spreaders may be shedding more virus or may be more efficient transmitters.
• Case reporting is further confounded because gastrointestinal and respiratory illness are commonly reported by people returning from travel.
Sequelae with SARS
• A connection between SARS and diabetes has been observed in a number of countries but more data is needed.
• Psychological impacts of fear among recovered patients and communities will need to be addressed.
• Recovered patients are anecdotally reporting low energy, hyperactive airways, and cough.
Site and Extent of Infection
• Initial infection appears to be in the upper respiratory tract but the mode of spread to other tissues is not known.
• Patients appeared viremic but this may have been a result of cytokines.
• In Hong Kong, virus is found in epithelial sheds, though it does not appear to cause CPE there.
• Viral load goes up in the first week, following onset of symptoms, and decreases thereafter.
• There is a six-log range of viral load over the course of illness, possibly explaining super-spreading.