EMERGENCE OF SARS necessitate removing the patient from isolation when a SARS outbreak is ongoing. A detailed contact history should include the travel history of the patient and his fam- ily members, as well as of their medical condition, and a much broader definition of contact is necessary, e.g., being in a hospital in which a SARS outbreak occurs. Tests for the SARS-CoV may be ordered, but their low sensitivity must be considered when deciding on the patient’s dispo- sition. Extreme measures, such as regarding all patients with respiratory infections as potential SARS cases, have also been advocated in other studies (12). Nebulizer therapy has been banned in many institutions in Hong Kong, and a protocol for delivering inhaled bronchodilators without nebulization to patients with asthma has been implement- ed in Singapore General Hospital. Issues, such as bed availability, will need to be weighed against the need to keep patients in isolation rooms. The number of patients that can be cared for will also be lower. The SARS out- break has focused attention on hygiene standards in our hospitals. Asymptomatic or pauci-symptomatic cases are the norm with most viral infections. With SARS, such patients may still be highly infectious. Infection control measures are needed to prevent similar clusters of infec- tions in the future. Acknowledgments We thank the staff of the Singapore General Hospital and Hsu Li-Yang and Brenda Ang for their support. Dr. Tan is member of the Royal College of Physicians (United Kingdom). He is currently working as an infectious dis- eases registrar at the Singapore General Hospital. The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the Centers for Disease Control and Prevention or the institutions with which the authors are affiliated. References 1. Lingappa JR, McDonald C, Parashar U, Simone P, Anderson L. Wresting SARS from uncertainty. Emerg Infect Dis 2004;10:167–70. 2. Poutanen SM, Low DE, Henry B, Finkelstein S, Rose D, Green K, et al. Identification of severe acute respiratory syndrome in Canada. N Engl J Med 2003;348:1995–2005. 3. Tsang KW, Ho PL, Ooi GC, Yee WK, Wang T, Chan-Yeung M, et al. A cluster of cases of severe acute respiratory syndrome in Hong Kong. N Engl J Med 2003;348:1977–85. 4. Lee N, Hui D, Wu A, Chan P, Cameron P, Joynt GM, et al. A Major outbreak of severe acute respiratory syndrome in Hong Kong. N Engl J Med 2003;348:1986–94. 5. Update: outbreak of severe acute respiratory syndrome—worldwide. MMWR Morb Mortal Wkly Rep [serial on the internet]. [April 2003]. Available from: URL: http://www.cdc.gov/mmwr/preview/mmw rhtml/mm5213a1.htm 6. Severe acute respiratory syndrome—Singapore, 2003. MMWR Morb Mortal Wkly Rep [serial on the internet]. [May 2003]. Available from: URL: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm 5218a1.htm 7. Drosten C, Gunther S, Preiser W, Van Der Werf S, Brodt HR, Becker S, et al. Identification of a novel coronavirus in patients with severe acute respiratory syndrome. N Engl J Med 2003;348:1967–76. 8. Preliminary clinical description of severe acute respiratory syndrome. MMWR Morb Mortal Wkly Rep [serial on the internet]. [March 2003]. Available from: URL: http://www.cdc.gov/mmwr/preview/ mmwrhtml/mm5212a5.htm 9. Peiris JSM, Lai ST, Poon LLM, Guan Y, Yam LYC, Lim W, et al. Coronavirus as a possible cause of severe acute respiratory syndrome. Lancet 2003;361:1319–25. 10. Wong CW, Leung KS, Hui M. Severe acute respiratory syndrome (SARS) in a geriatric patient with a hip fracture. J Bone Joint Surg Am [serial on the internet]. 2003 [date cited]. Available from: URL: http://www.jbjs.org 11. Garner JS. Guideline for isolation precautions in hospitals. Am J Infect Control 1996;24:24–52. 12. Tomlinson B, Cockram C. SARS: experience at Prince of Wales Hospital, Hong Kong. Lancet 2003;361:1486–7. Address for correspondence: Thuan Tong Tan, Singapore General Hospital, Outram Road, Singapore S169608, Singapore; fax: (65) 2221720; email: gimttt@sgh.com.sg 352 Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 10, No. 2, February 2004