1. SARS outbreak

2. SARS Outbreak March 107 MDs and 4 nurses reported sick March 1150 staff screened, 23 admitted, ward closed March 12Clinical teaching suspended March 13 Index case identified March 17Medical school moved back to campus

3. 156 patients 138 traceable to the index case 20 doctors 34 nurses 15 allied health 16 medical students

4. SARS: a triphasic disease Max. daily body temperature ( o C) Days after onset of disease Viral replicative phase Immune hyperactive phase Pulmonary-destruction phase

5. Treatment Protocol Broad spectrum antibiotics IV Ribavirin High dose steroids Convalescent serum Supportive care

6. Response to Rx Board-spectrum Antimicrobial * (%) N=138 Ribavirin + Corticosteroid # (%) N=138 IV Methyl- prednisolone + (%) N=107 Sustained response0 (0)16 (11.6)50 (46.7) Partial response0 (0)9 (6.5)45 (42.1) No response138 (100)113 (81.9)12 (11.2)

7. All patients in PWH N=277 Discharged: 147 (53%) ICU admission: 51 (18.4%) Died: 18 (6.5%) Mortality : median age 76 (44-84) years

8. Convalescent Plasma

9. Convalescent Plasma vs more MP 3 MP + CS (n = 19) 4 or more MP (n = 21) P values Age38.747.90.087 Admission LDH258.1247.70.7 Discharge rate by 21 days 73.7%19%0.001 No. of deaths050.049

10. Outcome of patients who received CS before day 16 vs later date ≤ Day 16 (n = 36) Day 16 (n = 14) P values Discharge rate by day 21 51.6%0%0.02 Death rate0%28.6%0.02