BMJ  2003;326:1402 (21 June), doi:10.1136/bmj.326.7403.1402

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SARS Reference

Eds Bernd Sebastian Kamps, Christian Hoffmann

Flying Publisher, pp 85 Available to download for free at http://SARSreference.com/

Rating:

On 6 June 2003, as has become my habit, I glanced at the World Health Organization's global epidemic curve for severe acute respiratory syndrome (SARS). With infection control procedures finally taking hold in China, the shape of the curve was moving downwards and approximating the bell shape so cleanly described in epidemiology textbooks.

The relative brevity of the bell for the 21st century's first major epidemic can be attributed to an aspect of 21st century medicine that had never before been tested so singularly, and completely: multinational collaboration, real time epidemiological updates, and online medical publication all made possible through digital connections. The speed with which data, experience, successes, and failures were shared appears to have slowed the epidemic.

The recent spate of online SARS offerings has provided more than graphs and data: it has also given us a SARS textbook. SARS Reference intends to summarise information on the SARS outbreak each month for the duration of the epidemic. The first edition, covering information available since the outbreak began in November 2002 and current as of 6 May 2003, was written over 14 days by a group of volunteers and posted at SARSreference.com on 8 May 2003. So far, it has been translated into Chinese and Spanish, and the editors promise to release copyright to individuals who are willing to translate it into other languages. They report that there is currently no sponsorship for the site, nor would any be accepted.

SARS Reference is a comprehensive summary of what we know to date. It is well organised into nine chapters, from the epidemiology of outbreaks in different countries to SARS in children. Each is available in printable format, and extensively referenced. The strongest sections are those on virology and diagnostic testing. Sections on transmission/prevention and case definition rely heavily on recommendations from the US Centers for Disease Control and WHO, with some support from the published literature.

Both for SARS medicine and for online publishing, this is an important step forward. Its greatest strengths are its comprehensive review of the literature, an abundance of links to authoritative internet sites, and refreshingly clear writing. Unfortunately, there is no mention of peer review and no assurance that the information offered is accurate enough to guide appropriate management of a group of SARS patients. Further, as evidence of varying quality accumulates, and changes from observational to experimental, the task of synthesising and summarising it will be less easy, and will require critical analysis that is not offered here.

Clicking on WHO's website, I opened the epidemiological curve for Toronto, my home. It also showed a nice bell curve. Two of them, actually, and the second seemed not quite done. Apparently, there are lessons that this disease has yet to teach us, and for the time being, there seems no better record than SARSreference.com

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Canadian Medical Association Journal, Ottawa, Ontario, Canada james.maskalyk{at}cma.ca

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