Outbreak of Severe Acute Respiratory Syndrome (SARS)


Published: 10 April 2003

SARS is an alarming, new respiratory disease reported so far in Asia, North America, and Europe. The largest outbreaks have been in China, Hong Kong, Singapore, Vietnam and Canada.


SARS usually begins with a fever greater than 100.4°F (38.0°C) and sometimes other symptoms, including chills, headache and body aches. Some people also experience mild respiratory symptoms at the beginning. After 2 to 7 days, patients may develop a dry, nonproductive cough and have trouble breathing. In 10% to 20% of cases, patients have required mechanical ventilation. 

Spread of SARS

Experts think that SARS is spread by close contact between people. It is most likely spread when someone with SARS coughs droplets into the air and someone else, usually within 3 feet, breathes them in. SARS may spread more broadly through the air or from touching objects that have become contaminated.

SARS appears to be less contagious than influenza. Given international travel and the potential severity of the illness, however, SARS must be treated seriously.


SARS patients require prompt, professional medical care. Crewmembers with suspected cases of SARS must be treated at a port with good medical facilities. Receiving early medical attention increases the chance of recovery.

The best treatment is not yet known. Antibiotics have not been effective. Treatments have included antiviral agents, such as ribavirin, in combination with oral or intravenous steroids.

The illness can be severe, and even fatal, but with prompt medical attention, most patients should recover. The current fatality rate is 4%.

When SARS is suspected

According to the World Health Organisation, SARS should be suspected if (1) a person has a fever of over 100.4 °F (38.0°C) and (2) has a cough, shortness of breath and/or difficulty breathing, and (3) either has had close contact within 10 days of onset of symptoms with a SARS patient, or a history of travel within 10 days to a SARS-affected area.

If SARS is suspected, the owners/master should do the following:

  1. Urgently consult with a doctor as to whether the suspected case is likely to be SARS. If already in port, the crewmember should be examined by a doctor. 
  2. Be ready to proceed immediately to a port with good medical facilities. An airlift may not be possible, as many such services are refusing to carry SARS patients. 
  3. Follow the usual port health procedures for infectious diseases and any special SARS-specific procedures that exist. A number of authorities, such as those in the Philippines, Malaysia, Singapore, Hong Kong and the Panama Canal, have already imposed special procedures for vessels that have recently traded to SARS-affected ports. Other ports may commence similar procedures. The procedures vary, but may include vessel and crew screening and quarantining, advance health reporting and shore leave restrictions. These procedures may apply regardless of whether SARS is supected on board. Non-compliance could result in heavy penalities and even imprisonment. Contact local agents well in advance of arrival for further details. Be prepared for delays.
  4. Explain to the health authorities before arrival the sick crewmember’s symptoms and history of travel. Members should also inform Skuld, who will assist in making the necessary arrangements. Take care to limit spread of SARS to other crewmembers prior to arrival. In this regard, the Centers for Disease Control and WHO have recommended guidelines for SARS patients in homes, which we have adapted for a vessel:
  • The patient should be isolated in a single, well-ventilated room with separate bathroom facilities, if possible.
  • Interaction with the patient should be limited.
  • Crewmembers interacting with the patient should wash their hands frequently with liquid soap.
  • Disposable gloves should be used for any contact with body fluids of the patient.
  • The patient should cover his mouth or nose with a tissue before sneezing or coughing. The patient should also wear a surgical mask during close contact with other crewmembers.
  • Crewmembers interacting with the SARS patient should wear surgical masks and protective goggles. N95 or P3 masks are recommended. Members should supply their vessels with masks, goggles and gloves, especially when trading to known SARS-affected areas.
  • Crewmembers should avoid sharing utensils, towels and linen with the SARS patient until these items have been well washed.
  • Crewmembers should clean contaminated surfaces with good disinfectants.
  • Generally, crewmembers should maintain good health and observe good hygiene and sanitation practices. They should avoid touching their mouth, nose and eyes to prevent spreading the diseases. Key areas of the vessel should be disinfected regularly, especially shared and common areas, bathrooms, the galley and mess.

At the port

Upon arrival, the SARS patient may be hospitalized for 3 weeks or more. The crew and vessel may be examined or screened for SARS. Crewmembers with no symptoms of SARS, but who have been in close contact with the SARS patient, may be placed in quarantine for 10 days or more.

If a number of crewmembers are hospitalized and/or quarantined, or if the vessel is deemed contaminated, the vessel may be delayed or quarantined for some time. As many governments are very nervous about dealing with SARS, other problems may arise.

In SARS-affected ports, shore leave and contact with shore personnel should be limited appropriately and other precautions should be taken, such as increasing hygiene and sanitation.

Skuld is ready to assist any members with SARS-related questions or problems.

Much of the information above is from the US Centers for Disease Control (www.cdc.gov) and the World Health Organisation www.who.int/csr/sars/en/). Please check their sites for more information and regular updates.

We would like to thank the Hong Kong Shipowners Association and Seaborne Agencies Pte. Ltd. in Singapore for their contributions to this article.