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SARS and the Modern Day Pony Express (the World Wide Web)

The Chinese University of Hong Kong, Prince of Wales Hospital Shatin, New Territories, Hong Kong

In early March 2003, an outbreak of severe acute respiratory syndrome (SARS) occurred in southern China, Hong Kong, Vietnam, and Singapore. Several persons traveling through these regions were affected. As a result of this exposure, new cases have subsequently presented in Canada, the United States, Australia, and Europe.

SARS is a highly infectious atypical pneumonia currently thought to be spread by droplets. The diagnosis of SARS is based on a combination of clinical and imaging findings. Typical symptoms are fever, chills, myalgia, cough, and shortness of breath. The diagnosis is currently made or excluded on the basis of the presence or absence of radiographic or CT imaging findings in a patient with typical symptoms. Serologic markers of exposure are currently being developed.

Our hospital was the initial epicenter of this disease locally, where more than 40 staff members (doctors, nurses, and auxiliary personnel) and several patients from one ward became ill, some seriously, within a short time. More than 1500 chest radiographs and 50 CT examinations were obtained on infected patients and in patients with suspected infections by week 2.

Because SARS is a new disease not previously recognized, doctors globally would not be aware of the expected radiographic and CT findings. To disseminate this newly found information as widely and quickly as possible, we have established a link to our departmental Web site, www.droid.cuhk.edu.hk. This link originally presented examples of 12 radiographic and eight high-resolution CT appearances of SARS, with a recommended imaging algorithm and precautionary guidelines to be used by medical personnel who examine potentially infected patients. A cine-loop of a typical CT examination has been added.

A brief e-mail message was sent to as many radiology colleges as could be found, requesting them to inform their members. Similar messages were sent to our own radiology colleagues overseas asking them to pass the information to their colleagues and to the editors of the main radiology journals, as well as to www.auntminnie.com and Diagnostic Imaging. We also sent letters via e-mail to the American and European societies of thoracic imaging, accident and emergency colleges, community medicine colleges, and the World Health Organization. In addition, messages were sent to the chiefs of service of all radiology departments in Hong Kong and to all local private radiologists. It took three persons fully employed 1.5 days to set up the Web site link, load the relevant images and text, search for relevant e-mail addresses, and send out messages. This task was completed within 1 week of our first recognizing the disease.

Although serious epidemics such as SARS occur rarely, the occurrence does highlight the potential benefit of the World Wide Web to enable the radiology community to be informed at very short notice regarding the expected imaging findings and recommended algorithms in potential pandemic situations. Information that may facilitate the investigation of suspected cases in other regions across the globe can be speedily disseminated. To this end, we received many positive comments from individual radiologists, radiology colleges, accident and emergency colleges, and imaging societies. Links to our Web site (which has received more than 167,000 visits in the past 4 weeks) have been added to the World Health Organization and other related Web sites.

The only obstacle encountered was that e-mail addresses for many of the different colleges (radiology and nonradiology) could not be obtained on short notice, so circulation was patchy and incomplete. In this respect, a single registrar comprising e-mail addresses of all radiology colleges globally would be helpful if a similar situation occurs in the future. Reservation was expressed by some that displaying the radiographic appearances may limit the impact of any subsequent scientific presentation, particularly because establishing a clinically informative Web site or Web site link is not currently judged as an academic achievement. However, this reservation was considered insignificant when weighed against the need to inform others of the radiographic appearances of SARS as quickly as possible.

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