Overview:
The following guidelines are suggested for business traveler to SARS case areas. They do not guarantee a traveler, or those that come in contact with them, will not be exposed to SARS.

The CDC and WHO currently list high-risk travel warning areas as: Mainland China; Hong Kong; Singapore; Hanoi, Vietnam and Toronto Canada. SARS currently is suspected in 25 countries and the above list is subject to change. Some countries and locations will put business travelers at a higher risk depending on the length of stay and the conditions of the countries health care system. In addition to the countries listed above, visits to infected hospitals and clinics in case areas have been demonstrated to increase the risk of exposure.

Individuals traveling to any SARS case areas are urged to take extreme caution. Travel to high-risk areas should be limited to necessary travel only. If travel can be avoided, it should be until the CDC or WHO list the area as again safe. The mortality rate (death rate) of infected individuals is as high as 25% for individuals confined to hospitals in parts of China and from 3.5% to 9% in other countries. The USA has not experienced any deaths at this time but is expected to if the disease continues to spread. SARS is a highly contagious disease with no known vaccines, easily used identification tests, or firm medical management procedures. Individuals that contract SARS at any age or level of health may die from the disease. SARS, which is caused by the coronavirus, continues to mutate and may get more or less virulent as time goes on. At this time there is not enough information about the disease to take anything less than the most conservative position when traveling or returning from a SARS travel warning area. Travelers should remain skeptical of reports of disease control from any country if not verified by the WHO and CDC combined.

Symptoms of SARS:

SARS is a respiratory illness believed caused by the coronavirus. In some cases, it is being referred to as Atypical Pneumonia because of its close resemblance to pneumonia. The criteria for SARS are: temperature of 100.5 degrees or more, one or more clinical findings of respiratory illness (i.e. cough, shortness of breath, difficulty breathing, hypoxia, or radiographic findings of either pneumonia or acute respiratory distress syndrome), travel to an area with documented or suspected community transmission of SARS, and/or close contact within 10 days of onset of symptoms with either a person with a respiratory illness who traveled to a SARS area or a person known to be a suspect SARS case. In a limited number of cases individuals also had diarrhea.

What is the incubation period for SARS?

Typically it is 2 through 10 days. The illness begins generally with an onset of fever of 100.4 or more. The fever is often associated with chills and/or rigors and might be accompanied by other symptoms including headache, malaise and myalgia. After 3 through 7 days, a lower-respiratory phase begins with the onset of a dry, nonproductive cough or dyspnea. In 10% to 20% of cases the respiratory illness is severe enough to require incubation and mechanical support.
Suggested guidelines for travelers:

Primary transmission is believed to occur through direct contact with an infected individual. Droplets of moisture or body fluids appear to be the path the virus travel through. It is believed that touching the eyes, nose or mouth after touching an infected area will spread the disease. SARS may also be spread more broadly through the air or other means not currently understood.

The first line of defense with any infectious disease is proper general hygiene. Carry an alcohol-based hand cleaner and use it as needed. Frequent use of soap and water to wash hands is extremely important. Avoid shaking hands when possible. When using a restroom, the door handles, sink handles and toilet handles may be contaminated. Using an alcohol disinfectant after using a restroom may eliminate exposure to the virus. Touching areas that are used frequently by others should be a constant concern and reminder to clean your hands.

Use of masks, gloves goggles:

There is no study on the effectiveness of the use of masks with the SARS coronavirus. Similar viruses have been effectively removed or reduced with some masks, up to 95% with the use of a N-95 mask (surgical masks seen on TV and in the media have little or no impact on the virus). Air filtration systems worn on the neck and sold in some catalogs will not be effective. Most N-95 masks have a one-time usage, which is generally less than 24 hours. If a contaminated mask is touched with an ungloved hand it can spread the disease. You must clean hands after touching a mask. Masks must be tightly fitted. Facial hair will prevent a tight fit. Rubber gloves and eye protection should be used in areas where infection is present. Do not reuse gloves, masks or protective eye gear unless they are specifically designed to be cleaned. The use of masks, gloves or protective glasses or goggles is advised when traveling in high-risk case areas despite the social stigma associated with this. Once a traveler is at a location where they feel safe they may choose to limit some of these safeguards. Never discontinue proper hand hygiene. SARS HAS IN SOME HOSPITAL ENVIRONMENTS BEEN TRANSMITTED TO INDIVIDAULS USING ALL THE ABOVE PROTECTION. THERE IS NO GUARANTEE OF IMMUNITY. Current thinking by the CDC is that risk can be reduced by not eliminated.

Before you travel, do not be afraid to ask your host about the status of SARS. Always check the CDC or WHO web locations for information on SARS in the traveling area, any transfer points and traveler warnings. (http://www.cdc.gov/) (http://www.who.int/en/). Make sure you are up to date on all shots (allow 4 to 6 weeks before travel). Inform family and business associates of your travel itinerary.

While traveling:

Avoid sitting around or near individuals on planes or in public transportation that are coughing or sneezing. The scope of transmission factors relating to the coronavirus on planes has not yet been fully identified. The closer you are to an infected individual the greater your chance of being infected. Planes use HEPA filters and this may reduce some of the issues related to air travel and the spread of the disease.

Avoid crowds. Eating out will be difficult and should be limited to better restaurants and locations that do not pack clients in tightly. Use of plastic utensils that are disposable is a consideration in some countries as is consuming cooked foods or pasteurized, filtered water or beverages

Avoid entertainment areas where large groups of individuals gather. Avoid individuals that appear sick (cough, running a fever, etc.). Carry a basic medical kit containing a thermometer, N-95 masks and disposable gloves, disinfectants and a list of contacts for your embassy, the local CDC or WHO representatives. In addition, each individual should have evacuation insurance or extra medical coverage for a potential extended stay if you do become sick. Because SARS closely resembles other infectious diseases you will likely be suspected of having SARS and be required to submit to quarantine.

If you do get sick while traveling, contact your local embassy or consulate office immediately. If at all possible, tell your health care provider about your symptoms prior to going to a clinic or emergency room to prevent further transmission to others. Do not travel while sick and limit contact with others. If you think you are sick, do not prolong seeing a doctor. Surviving SARS is very dependent on early detection. Use common sense in all cases.

While traveling overseas you may or may not be admitted to a hospital. You may be asked to leave your hotel or city. You may be quarantined in a special location and in some countries may not be allowed to see your own doctor or family members. You will need extra cash since you might find yourself unable to reach a bank or cash machines. Do not expect special treatment, private rooms or doctors or even necessary mechanical breathing equipment in some Asian countries. Expect disrupted travel in all cases. Suspected SARS carriers will not be allowed to travel. Current government SARS control discussion in several locations includes the halting of all air travel for all individuals. These bans may continue for weeks or months in locations where SARS cannot be contained. Continue to use the same common sense you would use in any travel situation especially poorly developed countries or locals.

When you return from a trip, you or your company may consider a self-imposed quarantine for 10 days to see if symptoms develop. Avoid sleeping in rooms with your children or spouse and avoid going to locations with large crowds. Contact a healthcare provider by phone if possible should any symptoms occur. Any member of your family, close friends or business relations that you are in contact with prior to 10 days from your return, who exhibit symptoms of SARS, should inform their healthcare provider about your travel location. They should tell their provider about the symptoms prior to going to any health care office if possible to prevent transmission to others in a health-care setting.

A word of wisdom:

You may not be concerned if you do or do not contract SAR. Do not, however, assume you cannot transmit the disease to others and cause significant health problems or death to family, friends, business associates or community members.

Companies are urged to develop SARS travel and healthcare policy for their workers that require travel to high-risk areas.

Businesses and travelers that use this information accept their own responsibility for safe travel. The Business Development group recommends all guidelines and information herein be researched separately for accuracy and current data on SARS. The Business Develop Group accepts no responsibility for how this information is used. Creating a policy or following a suggested policy or guideline from this document does not guarantee a traveler or related business; family or community member will not contract SARS. As with any infectious disease document as more is known about the disease the more policy and guidelines will change, update your policy frequently.

From: The Business Development Group

Contact: Peter Lytle 952-473-3831 plytle@bdgpartners.com

4/22/03

SARS (Severe Acute Respiratory Syndrome) Suggested Business Travel Guidelines