Semin Respir Crit Care Med 2007; 28(2): 201-212
DOI: 10.1055/s-2007-976492
Copyright © 2007 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Severe Acute Respiratory Syndrome (SARS) Coronavirus

Matthew P. Muller1 , Allison McGeer1
  • 1Department of Microbiology, Mount Sinai Hospital, Toronto, Ontario, Canada
Further Information

Publication History

Publication Date:
25 April 2007 (online)

ABSTRACT

The global severe acute respiratory syndrome (SARS) outbreak was the first pandemic of the 21st century. Although the outbreak was successfully controlled, evidence that SARS emerged from an animal reservoir has raised concerns that another pandemic could occur. This review discusses the likelihood of another SARS pandemic and reviews the epidemiological and clinical features of the disease with an emphasis on the clinical presentation, diagnosis, and management of SARS.

REFERENCES

  • 1 Summary of probable SARS cases with onset of illness from 1 November 2002 to 31 July 2003 (revised 31 December, 2003). 2003 Accessed at: http://www.who.int/csr/sars/country/table2004_04_21/en/
  • 2 WHO .Severe acute respiratory syndrome (SARS): report by the secretariat. January 2004 http://Available at: www.who.int/gb/ebwha/pdf_files/EB113/eeb11333%20rl.pdf
  • 3 Consensus document on the epidemiology of severe acute respiratory syndrome (SARS). 2003 Accessed 20/05/2005, at: http://www.who.int/csr/sars/en/WHOconsensus.pdf
  • 4 Zhong N S, Zheng B J, Li Y M et al.. Epidemiology and cause of severe acute respiratory syndrome (SARS) in Guangdong, People's Republic of China, in February, 2003.  Lancet. 2003;  362 1353-1358
  • 5 Update: outbreak of severe acute respiratory syndrome-worldwide, 2003.  MMWR Morb Mortal Wkly Rep. 2003;  52 241-246, 248
  • 6 WHO issues a global alert about cases of atypical pneumonia: cases of severe respiratory illness may spread to hospital staff. 2003 Accessed July 30, 2006, 2006, at: http://www.who.int/mediacentre/news/releases/2003/pr22/en/
  • 7 World Health Organization issues emergency travel advisory. 2003 Accessed July 30, 2006, 2006, at: http://www.who.int/csr/sars/archive/2003_03_15/en/
  • 8 Drosten C, Gunther S, Preiser W et al.. Identification of a novel coronavirus in patients with severe acute respiratory syndrome.  N Engl J Med. 2003;  348 1967-1976
  • 9 Ksiazek T G, Erdman D, Goldsmith C S et al.. A novel coronavirus associated with severe acute respiratory syndrome.  N Engl J Med. 2003;  348 1953-1966
  • 10 Peiris J S, Lai S T, Poon L L et al.. Coronavirus as a possible cause of severe acute respiratory syndrome.  Lancet. 2003;  361 1319-1325
  • 11 Kuiken T, Fouchier R A, Schutten M et al.. Newly discovered coronavirus as the primary cause of severe acute respiratory syndrome.  Lancet. 2003;  362 263-270
  • 12 Fouchier R A, Kuiken T, Schutten M et al.. Aetiology: Koch's postulates fulfilled for SARS virus.  Nature. 2003;  423 240
  • 13 Peiris M, Anderson L J, Osterhaus A DME, Stohr K, Yuen K Y. Severe Acute Respiratory Syndrome. Oxford, UK; Blackwell 2005
  • 14 Guan Y, Zheng B J, He Y Q et al.. Isolation and characterization of viruses related to the SARS coronavirus from animals in southern China.  Science. 2003;  302 276-278
  • 15 Tu C, Crameri G, Kong X et al.. Antibodies to SARS coronavirus in civets.  Emerg Infect Dis. 2004;  10 2244-2248
  • 16 Kan B, Wang M, Jing H et al.. Molecular evolution analysis and geographic investigation of severe acute respiratory syndrome coronavirus-like virus in palm civets at an animal market and on farms.  J Virol. 2005;  79 11892-11900
  • 17 Chinese SMEC . Molecular evolution of the SARS coronavirus during the course of the SARS epidemic in China.  Science. 2004;  303 1666-1669
  • 18 Song H D, Tu C C, Zhang G W et al.. Cross-host evolution of severe acute respiratory syndrome coronavirus in palm civet and human.  Proc Natl Acad Sci USA. 2005;  102 2430-2435
  • 19 Yu D, Li H, Xu R et al.. Prevalence of IgG antibody to SARS-associated coronavirus in animal traders-Guangdong Province, China, 2003.  MMWR Morb Mortal Wkly Rep. 2003;  52 986-987
  • 20 Li W, Shi Z, Yu M et al.. Bats are natural reservoirs of SARS-like coronaviruses.  Science. 2005;  310 676-679
  • 21 Lau S K, Woo P C, Li K S et al.. Severe acute respiratory syndrome coronavirus-like virus in Chinese horseshoe bats.  Proc Natl Acad Sci USA. 2005;  102 14040-14045
  • 22 Low D E. Why SARS will not return: a polemic.  CMAJ. 2004;  170 68-69
  • 23 Lim P L, Kurup A, Gopalakrishna G et al.. Laboratory-acquired severe acute respiratory syndrome.  N Engl J Med. 2004;  350 1740-1745
  • 24 Senior K. Recent Singapore SARS case a laboratory accident.  Lancet Infect Dis. 2003;  3 679
  • 25 China confirms SARS infection in another previously reported case: summary of cases to date-Update 5. 2004 Accessed July 28, 2006, 2006, at: http://www.who.int/csr/don/2004_04_30/en/index.html
  • 26 Liang G, Chen Q, Xu J et al.. Laboratory diagnosis of four recent sporadic cases of community-acquired SARS, Guangdong Province, China.  Emerg Infect Dis. 2004;  10 1774-1781
  • 27 Fleck F. SARS virus returns to China as scientists race to find effective vaccine.  Bull World Health Organ. 2004;  82 152-153
  • 28 Zheng B J, Wong K H, Zhou J et al.. SARS-related virus predating SARS outbreak, Hong Kong.  Emerg Infect Dis. 2004;  10 176-178
  • 29 Li W, Moore M J, Vasilieva N et al.. Angiotensin-converting enzyme 2 is a functional receptor for the SARS coronavirus.  Nature. 2003;  426 450-454
  • 30 Li W, Wong S K, Li F et al.. Animal origins of the severe acute respiratory syndrome coronavirus: insight from ACE2-S-protein interactions.  J Virol. 2006;  80 4211-4219
  • 31 Cowling B, Muller M P, Wong I et al.. Alternative methods of estimating an incubation distribution: examples from SARS.  Epidemiology. 2007;  18 253-259
  • 32 Peiris J S, Yuen K Y, Osterhaus A D, Stohr K. The severe acute respiratory syndrome.  N Engl J Med. 2003;  349 2431-2441
  • 33 Chan-Yeung M. Severe acute respiratory syndrome (SARS) and healthcare workers.  Int J Occup Environ Health. 2004;  10 421-427
  • 34 Wong T W, Lee C K, Tam W et al.. Cluster of SARS among medical students exposed to single patient, Hong Kong.  Emerg Infect Dis. 2004;  10 269-276
  • 35 Fowler R A, Guest C B, Lapinsky S E et al.. Transmission of severe acute respiratory syndrome during intubation and mechanical ventilation.  Am J Respir Crit Care Med. 2004;  169 1198-1202
  • 36 Scales D C, Green K, Chan A K et al.. Illness in intensive care staff after brief exposure to severe acute respiratory syndrome.  Emerg Infect Dis. 2003;  9 1205-1210
  • 37 Loeb M, McGeer A, Henry B et al.. SARS among critical care nurses, Toronto.  Emerg Infect Dis. 2004;  10 251-255
  • 38 Booth C M, Matukas L M, Tomlinson G A et al.. Clinical features and short-term outcomes of 144 patients with SARS in the greater Toronto area.  JAMA. 2003;  289 2801-2809
  • 39 Lee N, Hui D, Wu A et al.. A major outbreak of severe acute respiratory syndrome in Hong Kong.  N Engl J Med. 2003;  348 1986-1994
  • 40 Lau J T, Fung K S, Wong T W et al.. SARS transmission among hospital workers in Hong Kong.  Emerg Infect Dis. 2004;  10 280-286
  • 41 Seto W H, Tsang D, Yung R W et al.. Effectiveness of precautions against droplets and contact in prevention of nosocomial transmission of severe acute respiratory syndrome (SARS).  Lancet. 2003;  361 1519-1520
  • 42 Teleman M D, Boudville I C, Heng B H, Zhu D, Leo Y S. Factors associated with transmission of severe acute respiratory syndrome among health-care workers in Singapore.  Epidemiol Infect. 2004;  132 797-803
  • 43 Yu I T, Li Y, Wong T W et al.. Evidence of airborne transmission of the severe acute respiratory syndrome virus.  N Engl J Med. 2004;  350 1731-1739
  • 44 Ofner M, Lem M, Sarwal S, Vearncombe M, Simor A. Cluster of severe acute respiratory syndrome cases among protected health care workers-Toronto, April 2003.  Can Commun Dis Rep. 2003;  29 93-97
  • 45 Varia M, Wilson S, Sarwal S et al.. Investigation of a nosocomial outbreak of severe acute respiratory syndrome (SARS) in Toronto, Canada.  CMAJ. 2003;  169 285-292
  • 46 Yu I T, Wong T W, Chiu Y L, Lee N, Li Y. Temporal-spatial analysis of severe acute respiratory syndrome among hospital inpatients.  Clin Infect Dis. 2005;  40 1237-1243
  • 47 Muller M P, Richardson S E, McGeer A et al.. Early diagnosis of SARS: lessons from the Toronto SARS outbreak.  Eur J Clin Microbiol Infect Dis. 2006;  25 230-237
  • 48 Christian M D, Poutanen S M, Loutfy M R, Muller M P, Low D E. Severe acute respiratory syndrome.  Clin Infect Dis. 2004;  38 1420-1427
  • 49 Muller N L, Ooi G C, Khong P L, Nicolaou S. Severe acute respiratory syndrome: radiographic and CT findings.  AJR Am J Roentgenol. 2003;  181 3-8
  • 50 Muller N L, Ooi G C, Khong P L, Zhou L J, Tsang K W, Nicolaou S. High-resolution CT findings of severe acute respiratory syndrome at presentation and after admission.  AJR Am J Roentgenol. 2004;  182 39-44
  • 51 Chan M S, Chan I Y, Fung K H, Poon E, Yam L Y, Lau K Y. High-resolution CT findings in patients with severe acute respiratory syndrome: a pattern-based approach.  AJR Am J Roentgenol. 2004;  182 49-56
  • 52 Wang R, Sun H, Song L et al.. Plain radiograph and CT features of 112 patients with SARS in acute stage [in Chinese].  Beijing Da Xue Xue Bao. 2003;  35(Suppl) 29-33
  • 53 Ooi G C, Khong P L, Muller N L et al.. Severe acute respiratory syndrome: temporal lung changes at thin-section CT in 30 patients.  Radiology. 2004;  230 836-844
  • 54 Peiris J S, Chu C M, Cheng V C et al.. Clinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia: a prospective study.  Lancet. 2003;  361 1767-1772
  • 55 Wong K T, Antonio G E, Hui D S et al.. Severe acute respiratory syndrome: radiographic appearances and pattern of progression in 138 patients.  Radiology. 2003;  228 401-406
  • 56 Ooi G C, Daqing M. SARS: radiological features.  Respirology. 2003;  8(Suppl) S15-S19
  • 57 Fowler R A, Lapinsky S E, Hallett D et al.. Critically ill patients with severe acute respiratory syndrome.  JAMA. 2003;  290 367-373
  • 58 Lew T W, Kwek T K, Tai D et al.. Acute respiratory distress syndrome in critically ill patients with severe acute respiratory syndrome.  JAMA. 2003;  290 374-380
  • 59 Lee H K, Tso E Y, Chau T N, Tsang O T, Choi K W, Lai T S. Asymptomatic severe acute respiratory syndrome-associated coronavirus infection.  Emerg Infect Dis. 2003;  9 1491-1492
  • 60 Leung G M, Chung P H, Tsang T et al.. SARS-CoV antibody prevalence in all Hong Kong patient contacts.  Emerg Infect Dis. 2004;  10 1653-1656
  • 61 Rainer T H, Chan P K, Ip M et al.. The spectrum of severe acute respiratory syndrome-associated coronavirus infection.  Ann Intern Med. 2004;  140 614-619
  • 62 Ho K Y, Singh K S, Habib A G et al.. Mild illness associated with severe acute respiratory syndrome coronavirus infection: lessons from a prospective seroepidemiologic study of health-care workers in a teaching hospital in Singapore.  J Infect Dis. 2004;  189 642-647
  • 63 Fisher D A, Lim T K, Lim Y T, Singh K S, Tambyah P A. Atypical presentations of SARS.  Lancet. 2003;  361 1740
  • 64 Bitnun A, Allen U, Heurter H et al.. Children hospitalized with severe acute respiratory syndrome-related illness in Toronto.  Pediatrics. 2003;  112 e261
  • 65 Li G, Zhao Z, Chen L, Zhou Y. Mild severe acute respiratory syndrome.  Emerg Infect Dis. 2003;  9 1182-1183
  • 66 Hon K L, Leung C W, Cheng W T et al.. Clinical presentations and outcome of severe acute respiratory syndrome in children.  Lancet. 2003;  361 1701-1703
  • 67 Karlberg J, Chong D S, Lai W Y. Do men have a higher case fatality rate of severe acute respiratory syndrome than women do?.  Am J Epidemiol. 2004;  159 229-231
  • 68 Choi K W, Chau T N, Tsang O et al.. Outcomes and prognostic factors in 267 patients with severe acute respiratory syndrome in Hong Kong.  Ann Intern Med. 2003;  139 715-723
  • 69 Chan M H, Wong V W, Wong C K et al.. Serum LD1 isoenzyme and blood lymphocyte subsets as prognostic indicators for severe acute respiratory syndrome.  J Intern Med. 2004;  255 512-518
  • 70 Leung G M, Hedley A J, Ho L M et al.. The epidemiology of severe acute respiratory syndrome in the 2003 Hong Kong epidemic: an analysis of all 1755 patients.  Ann Intern Med. 2004;  141 662-673
  • 71 Zou Z, Yang Y, Chen J et al.. Prognostic factors for severe acute respiratory syndrome: a clinical analysis of 165 cases.  Clin Infect Dis. 2004;  38 483-489
  • 72 Tsui P T, Kwok M L, Yuen H, Lai S T. Severe acute respiratory syndrome: clinical outcome and prognostic correlates.  Emerg Infect Dis. 2003;  9 1064-1069
  • 73 Donnelly C A, Ghani A C, Leung G M et al.. Epidemiological determinants of spread of causal agent of severe acute respiratory syndrome in Hong Kong.  Lancet. 2003;  361 1761-1766
  • 74 Hui D S, Wong K T, Antonio G E et al.. Severe acute respiratory syndrome: correlation between clinical outcome and radiologic features.  Radiology. 2004;  233 579-585
  • 75 Chau T N, Lee P O, Choi K W et al.. Value of initial chest radiographs for predicting clinical outcomes in patients with severe acute respiratory syndrome.  Am J Med. 2004;  117 249-254
  • 76 Lai E K, Deif H, LaMere E A et al.. Severe acute respiratory syndrome: quantitative assessment from chest radiographs with clinical and prognostic correlation.  AJR Am J Roentgenol. 2005;  184 255-263
  • 77 Ko S F, Lee T Y, Huang C C et al.. Severe acute respiratory syndrome: prognostic implications of chest radiographic findings in 52 patients.  Radiology. 2004;  233 173-181
  • 78 Chen C Y, Lee C H, Liu C Y, Wang J H, Wang L M, Perng R P. Clinical features and outcomes of severe acute respiratory syndrome and predictive factors for acute respiratory distress syndrome.  J Chin Med Assoc. 2005;  68 4-10
  • 79 Chu C M, Poon L L, Cheng V C et al.. Initial viral load and the outcomes of SARS.  CMAJ. 2004;  171 1349-1352
  • 80 Ng E K, Hui D S, Chan K C et al.. Quantitative analysis and prognostic implication of SARS coronavirus RNA in the plasma and serum of patients with severe acute respiratory syndrome.  Clin Chem. 2003;  49 1976-1980
  • 81 Cheng V C, Hung I F, Tang B S et al.. Viral replication in the nasopharynx is associated with diarrhea in patients with severe acute respiratory syndrome.  Clin Infect Dis. 2004;  38 467-475
  • 82 Chan J W, Ng C K, Chan Y H et al.. Short term outcome and risk factors for adverse clinical outcomes in adults with severe acute respiratory syndrome (SARS).  Thorax. 2003;  58 686-689
  • 83 Wong R S, Wu A, To K F et al.. Haematological manifestations in patients with severe acute respiratory syndrome: retrospective analysis.  BMJ. 2003;  326 1358-1362
  • 84 Cowling B J, Muller M P, Wong I O et al.. Clinical prognostic rules for severe acute respiratory syndrome in low- and high-resource settings.  Arch Intern Med. 2006;  166 1505-1511
  • 85 Muller M P, Tomlinson G, Marrie T J et al.. Can routine laboratory tests discriminate between severe acute respiratory syndrome and other causes of community-acquired pneumonia?.  Clin Infect Dis. 2005;  40 1079-1086
  • 86 Rainer T H, Cameron P A, Smit D et al.. Evaluation of WHO criteria for identifying patients with severe acute respiratory syndrome out of hospital: prospective observational study.  BMJ. 2003;  326 1354-1358
  • 87 Tambyah P A, Singh K S, Habib A G. SARS: understanding the coronavirus: accuracy of WHO criteria was similar in a “non-SARS” hospital in Singapore.  BMJ. 2003;  327 620
  • 88 Schrag S J, Brooks J T, Van Beneden C et al.. SARS surveillance during emergency public health response, United States, March-July 2003.  Emerg Infect Dis. 2004;  10 185-194
  • 89 Tsang K W, Lam W K. Management of severe acute respiratory syndrome: the Hong Kong University experience.  Am J Respir Crit Care Med. 2003;  168 417-424
  • 90 Sun Y, Yao W, Wang X et al.. Clinical diagnostic approach to severe acute respiratory syndrome: an institution's experience.  Chin Med J (Engl). 2003;  116 1464-1466
  • 91 Sung J J, Wu A, Joynt G M et al.. Severe acute respiratory syndrome: report of treatment and outcome after a major outbreak.  Thorax. 2004;  59 414-420
  • 92 WHO SARS International Reference and Verification Laboratory Network .Policy and Procedures in the Inter-Epidemic Period. 2004 Accessed at: http://www.who.int/csr/sars/guidelines/en/WHOSARSReferenceLab.pdf
  • 93 WHO guidelines for the global surveillance of severe acute respiratory syndrome (SARS), October 2004. 2004 Accessed at: http://www.who.int/csr/resources/publications/WHO_CDS_CSR_ARO_2004_1/en/index.html
  • 94 Chan K H, Poon L L, Cheng V C et al.. Detection of SARS coronavirus in patients with suspected SARS.  Emerg Infect Dis. 2004;  10 294-299
  • 95 Chan P K, To W K, Ng K C et al.. Laboratory diagnosis of SARS.  Emerg Infect Dis. 2004;  10 825-831
  • 96 Tang P, Louie M, Richardson S E et al.. Interpretation of diagnostic laboratory tests for severe acute respiratory syndrome: the Toronto experience.  CMAJ. 2004;  170 47-54
  • 97 Wu H S, Chiu S C, Tseng T C et al.. Serologic and molecular biologic methods for SARS-associated coronavirus infection, Taiwan.  Emerg Infect Dis. 2004;  10 304-310
  • 98 Hsueh P R, Hsiao C H, Yeh S H et al.. Microbiologic characteristics, serologic responses, and clinical manifestations in severe acute respiratory syndrome, Taiwan.  Emerg Infect Dis. 2003;  9 1163-1167
  • 99 Mahony J B, Richardson S. Molecular diagnosis of severe acute respiratory syndrome: the state of the art.  J Mol Diagn. 2005;  7 551-559
  • 100 Poon L L, Chan K H, Wong O K et al.. Early diagnosis of SARS coronavirus infection by real time RT-PCR.  J Clin Virol. 2003;  28 233-238
  • 101 Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network.  N Engl J Med. 2000;  342 1301-1308
  • 102 Poutanen S M, Low D E, Henry B et al.. Identification of severe acute respiratory syndrome in Canada.  N Engl J Med. 2003;  348 1995-2005
  • 103 Leong H N, Ang B, Earnest A, Teoh C, Xu W, Leo Y S. Investigational use of ribavirin in the treatment of severe acute respiratory syndrome, Singapore, 2003.  Trop Med Int Health. 2004;  9 923-927
  • 104 Knowles S R, Phillips E J, Dresser L, Matukas L. Common adverse events associated with the use of ribavirin for severe acute respiratory syndrome in Canada.  Clin Infect Dis. 2003;  37 1139-1142
  • 105 Chiou H E, Liu C L, Buttrey M J et al.. Adverse effects of ribavirin and outcome in severe acute respiratory syndrome: experience in two medical centers.  Chest. 2005;  128 263-272
  • 106 Chen F, Chan K H, Jiang Y et al.. In vitro susceptibility of 10 clinical isolates of SARS coronavirus to selected antiviral compounds.  J Clin Virol. 2004;  31 69-75
  • 107 Cinatl J, Morgenstern B, Bauer G, Chandra P, Rabenau H, Doerr H W. Glycyrrhizin, an active component of liquorice roots, and replication of SARS-associated coronavirus.  Lancet. 2003;  361 2045-2046
  • 108 Stroher U, DiCaro A, Li Y et al.. Severe acute respiratory syndrome-related coronavirus is inhibited by interferon- alpha.  J Infect Dis. 2004;  189 1164-1167
  • 109 Chu C M, Cheng V C, Hung I F et al.. Role of lopinavir/ritonavir in the treatment of SARS: initial virological and clinical findings.  Thorax. 2004;  59 252-256
  • 110 Mazzulli T, Farcas G A, Poutanen S M et al.. Severe acute respiratory syndrome-associated coronavirus in lung tissue.  Emerg Infect Dis. 2004;  10 20-24
  • 111 Oba Y. The use of corticosteroids in SARS.  N Engl J Med. 2003;  348 2034-2035 , author reply 2035
  • 112 So L K, Lau A C, Yam L Y et al.. Development of a standard treatment protocol for severe acute respiratory syndrome.  Lancet. 2003;  361 1615-1617
  • 113 Ho J C, Ooi G C, Mok T Y et al.. High-dose pulse versus nonpulse corticosteroid regimens in severe acute respiratory syndrome.  Am J Respir Crit Care Med. 2003;  168 1449-1456
  • 114 Tsang O T, Chau T N, Choi K W et al.. Coronavirus-positive nasopharyngeal aspirate as predictor for severe acute respiratory syndrome mortality.  Emerg Infect Dis. 2003;  9 1381-1387
  • 115 Wang H, Ding Y, Li X, Yang L, Zhang W, Kang W. Fatal aspergillosis in a patient with SARS who was treated with corticosteroids.  N Engl J Med. 2003;  349 507-508
  • 116 Hwang D M, Chamberlain D W, Poutanen S M, Low D E, Asa S L, Butany J. Pulmonary pathology of severe acute respiratory syndrome in Toronto.  Mod Pathol. 2005;  18 1-10
  • 117 Chan K S, Zheng J P, Mok Y W et al.. SARS: prognosis, outcome and sequelae.  Respirology. 2003;  8(Suppl) S36-S40
  • 118 Chan C W, Chiu W K, Chan C C, Chow E Y, Cheung H M, Ip P L. Osteonecrosis in children with severe acute respiratory syndrome.  Pediatr Infect Dis J. 2004;  23 888-890
  • 119 Hong N, Du X K. Avascular necrosis of bone in severe acute respiratory syndrome.  Clin Radiol. 2004;  59 602-608
  • 120 Loutfy M R, Blatt L M, Siminovitch K A et al.. Interferon alfacon-1 plus corticosteroids in severe acute respiratory syndrome: a preliminary study.  JAMA. 2003;  290 3222-3228
  • 121 Chan K S, Lai S T, Chu C M et al.. Treatment of severe acute respiratory syndrome with lopinavir/ritonavir: a multicentre retrospective matched cohort study.  Hong Kong Med J. 2003;  9 399-406
  • 122 Liu J, Manheimer E, Shi Y, Gluud C. Chinese herbal medicine for severe acute respiratory syndrome: a systematic review and meta-analysis.  J Altern Complement Med. 2004;  10 1041-1051

Allison McGeerM.D. 

Department of Microbiology, Rm. 210, Mount Sinai Hospital

600 University Ave., Toronto, Ontario, M5G 1X5, Canada

Email: amcgeer@mtsinai.on.ca

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