The disease first appeared in November 2002 and has since spread rapidly across the globe. At last count, there were 2,781 suspected cases in 17 countries and 111 deaths, according to the Centers for Disease Control and Prevention (CDC) in Atlanta.
In the United States, 166 cases have been identified in 30 states, none of them fatal. But SARS' rapid spread in Asia and Canada has U.S. officials on alert. Health officials said statewide and interstate communications networks set up after the Sept. 11, 2001 terrorist attacks have been the states' first line of defense against SARS.
"One of the things we learned in the aftermath of 9/11 and anthrax is the importance of ongoing communication between the CDC and public health agencies," said Helen Fox Fields, senior director for infectious disease policy at the Association of State and Territorial Health Officials (ASTHO).
"At this point, communication has been the primary tool [to prevent spread of the disease]," said Jonathan Fielding, a physician and director of public health for Los Angeles County, which works closely with state laboratories and the California Department of Health Services.
States are getting the word out about symptoms and effective treatment of the disease using an array of communications tools ranging from the Internet to the telephone to the old-fashioned postal service.
The CDC is hosting weekly conference calls with state epidemiologists and public health information officers so states can disseminate up-to-date information to doctors and health care workers, Fields said.
In Hawaii, health department officials are engaged in "active surveillance," meaning they call the 46 state hospitals and urgent care centers on a regular basis to talk to physicians, said state health department spokeswoman Laura Lott.
"[SARS] is just one more thing we need to be vigilant about, one more thing that needs our time, attention and resources," Lott said.
Forty-six of the 50 state health department web sites have prominently displayed SARS health warnings or links to SARS information from the CDC site or the World Health Organization (WHO) site. Of the exceptions -- Idaho, Kansas, West Virginia and Wyoming -- only Kansas is investigating a case of SARS.
In California, where there are 37 suspected SARS cases, the Los Angeles County Department of Health Services is writing letters and sending e-mail updates to every licensed physician in the county, said spokeswoman Maria Iacobo. The updates outline changes in the CDC disease definition, symptoms and the proper procedures to treat or isolate patients.
The New Jersey Department of Health and Senior Services, which is investigating three SARS cases, is holding weekly teleconferences with hospital staff and public health agencies to detail how to identify and report such cases.
Los Angeles County's Fielding and other public health officials said health care workers are now more alert and ready to handle emergencies and outbreaks like SARS. ASTHO's Fields, for example, said states have used federal bio-terrorism funds to hire additional epidemiologists and expand Internet capacity and rapid fax capabilities.
"Any new disease is stressful for the state public health community, even when, like SARS, there are less than 200 cases domestically," Fields said. "In general states are cautiously looking at this issue to see where this is going to go. They're kind of watching the epidemic unfold."
Officials are also asking that the public keep the threat posed by the disease in perspective. No one has died from it in the United States: by comparison, some 36,000 Americans die each year from common types of influenza, according to the CDC web site.
