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Coronaviruses (e.g., SARS, MERS and COVID-19)
Topic Collection
December 23, 2025

Topic Collection: Coronaviruses (e.g., SARS, MERS and COVID-19)

Healthcare facilities and emergency medical professionals need to be able to recognize and treat diseases such as Severe Acute Respiratory Syndrome (SARS), Middle East Respiratory Syndrome (MERS), and Coronavirus Disease 2019 (COVID-19) caused by novel respiratory pathogens. This Topic Collection (updated in 2024) contains resources that can help medical emergency planners and health care professionals: learn more about managing patients experiencing illness from novel respiratory pathogens; understand infection control principles in healthcare and community settings; and benefit from lessons learned from past outbreaks.

In addition to those listed in this Topic Collection, resources relevant to this outbreak may be found on our Infectious Diseases resource page and in the following Topic Collections:

Alternate Care Sites (including shelter medical care)

Continuity of Operations (COOP)/ Business Continuity Planning

Crisis Standards of Care

Ethics

Healthcare-Related Disaster Legal/ Regulatory/ Federal Policy

Hospital Surge Capacity and Immediate Bed Availability

Influenza Epidemic/ Pandemic

Mental/Behavioral Health (non-responders)

Responder Safety and Health

Virtual Medical Care

Each resource in this Topic Collection is placed into one or more of the following categories (click on the category name to be taken directly to that set of resources). Resources marked with an asterisk (*) appear in more than one category.

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Must Reads

Centers for Disease Control and Prevention. (2024). About Middle East Respiratory Syndrome (MERS). U.S. Department of Health and Human Services.
This web page contains links to information on MERS for the public, healthcare providers and laboratory professionals including a frequently asked questions resource. Preparedness checklists for providers and healthcare facilities are included.
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Cheng, V.C., Chan, J.F., To, K.K., and Yuen, K.Y. (2013). Clinical Management and Infection Control of SARS: Lessons Learned. Antiviral Research. 100(2):407-19.
The authors review the 2003 SARS outbreak and discuss lessons learned, particularly with regard to treatment and containment activities. Summaries of studies conducted to identify risk factors and infection control measures, as well as to describe nosocomial outbreaks for affected countries, are included.
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Milne-Price, S., Miazgowicz, K.L., Munster, V.J. (2014). The Emergence of the Middle East Respiratory Syndrome Coronavirus (MERS-CoV). Pathogens and Disease. 71(2):121-36.
The authors provide a review of the knowledge base pertaining to the current MERS-CoV outbreak, including detection, clinical features, and interventions.
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World Health Organization. (2014). Infection Prevention and Control of Epidemic- and Pandemic-Prone Acute Respiratory Infections in Health Care: WHO Guidelines.
This document provides recommendations, best practices and principles for infection prevention and control for acute respiratory infections in health care, particularly those that present as epidemics or pandemics. It includes information on PPE and aerosol-generating procedures. There are also summaries of literature and research reviews on physical interventions for infection control; risk of transmission from aerosol-generating procedures; and effectiveness of vaccination of health care workers to protect patients.
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Clinical Management and Research

* Assiri, A., Al-Tawfiq, J.A., Al-Rabeeah A.A., et al. (2013). Epidemiological, Demographic, and Clinical Characteristics of 47 Cases of Middle East Respiratory Syndrome Coronavirus Disease from Saudi Arabia: A Descriptive Study. The Lancet Infectious Disease. 13(9):752-761.
The Saudi Arabian Ministry of Health provided an analysis of 47 individuals with laboratory-confirmed MERS-CoV disease. Data suggest that the clinical presentation of MERS-CoV infection ranges from asymptomatic to severe pneumonia with the acute respiratory distress syndrome, septic shock and multi-organ failure resulting in death. At least two cases had a consumptive coagulopathy during the course of their illness.
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Centers for Disease Control and Prevention. (2015). Prevention and Control for Hospitalized MERS Patients. U.S. Department of Health and Human Services.
This document provides guidance to hospitals and other healthcare settings on personal protective equipment recommendations, source control, and environmental infection control measures when managing patients with MERS-CoV.
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* Centers for Disease Control and Prevention. (2024). About Middle East Respiratory Syndrome (MERS). U.S. Department of Health and Human Services.
This web page contains links to information on MERS for the public, healthcare providers and laboratory professionals including a frequently asked questions resource. Preparedness checklists for providers and healthcare facilities are included.
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Chen, M.I., Chow, A.L., Earnest, A. et al. (2006). Clinical and Epidemiological Predictors of Transmission in Severe Acute Respiratory Syndrome (SARS). BMC Infectious Diseases. 6:151.
The authors looked at factors contributing to SARS transmission in 98 index cases (22 with transmission; 76 without). They found several factors that seemed to contribute to transmission including delay to isolation; admission to a non-isolation facility; and higher lactate dehydrogenase levels of greater than 650 IU/L.
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* Cheng, V.C., Chan, J.F., To, K.K., and Yuen, K.Y. (2013). Clinical Management and Infection Control of SARS: Lessons Learned. Antiviral Research. 100(2):407-19.
The authors review the 2003 SARS outbreak and discuss lessons learned, particularly with regard to treatment and containment activities. Summaries of studies conducted to identify risk factors and infection control measures, as well as to describe nosocomial outbreaks for affected countries, are included.
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Donnelly, C., Malik, M., Elkholy, A., et al. (2019). Worldwide Reduction in MERS Cases and Deaths since 2016. Emerging Infectious Diseases. 25(9).
The authors analyzed case-based data on laboratory-confirmed cases of MERS-CoV from 2012 to October 1, 2018. They estimated that 1,465 cases and between 293 and 520 deaths may have been averted since 2016 due to improved understanding of transmission, enhanced surveillance, and implementation of effective infection prevention and control measures in hospitals.
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Kao, H.K., Wang, J.H., Sung, C.S. et al. (2005). Pneumothorax and Mortality in the Mechanically Ventilated SARS Patients: A Prospective Clinical Study. Critical Care. 9(4):R440-5.
The authors conducted this study to determine the effects of mechanical ventilation on pneumothorax and if pneumothorax in SARS patients increased mortality. They did not find any increase in mortality from pneumothorax. They found that patients who developed pneumothorax presented with significant respiratory involvement upon admission, and that these individuals required "meticulous" respiratory therapy and monitoring.
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Koenig, K. (2015). Identify-Isolate-Inform: A Modified Tool for Initial Detection and Management of Middle East Respiratory Syndrome Patients in the Emergency Department. Western Journal of Emergency Medicine. 16(5).
The authors report how the Identify-Isolate-Inform (3I) tool, originally conceived for healthcare providers to use with Ebola virus disease patients, can be adapted for real-time use for detection and management of patients under investigation for MERS.
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Lew, T.W. Kewk, T.K., Tai, D., et al. (2003). Acute Respiratory Distress Syndrome in Critically Ill Patients with Severe Acute Respiratory Syndrome. Journal of the American Medical Association. 16;290(3):374-80.
The authors describe clinical and epidemiologic data for 199 patients hospitalized with SARS. Nineteen of 24 ICU deaths occurred a week or later after ICU admission (and were linked to other complications, including acute respiratory distress syndrome (ARDS). The authors hypothesize that differences in the virulence of varied strains and viral load may be related to the likelihood of developing a severe ARDS and suggest aggressive early intervention.
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MedlinePlus. (2018). Coronavirus Infections. National Library of Medicine, Medlineplus.
This Medline encyclopedia article on coronaviruses includes information on SARS and MERS, prevention and risk factors, statistics, journal articles, and patient handouts.
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Milne-Price, S., Miazgowicz, K.L., Munster, V.J. (2014). The Emergence of the Middle East Respiratory Syndrome Coronavirus (MERS-CoV). Pathogens and Disease. 71(2):121-36.
The authors provide a review of the knowledge base pertaining to the current MERS-CoV outbreak, including detection, clinical features, and interventions.
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Nebraska Medicine. (n.d.). MERS CoV Guidelines for Respiratory Care Services. (Accessed 1/8/2020.)
These guidelines identify respiratory therapy modalities to be used based on indications and patient treatment needs.
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New York City Department of Health and Mental Hygiene. (2014). NYC DOHMH Guidance Document for Development of Protocols for Management of Patients Presenting to Hospital Emergency Departments and Clinics with Potentially Communicable Diseases of Public Health Concern.
This document provides guidance for emergency departments and outpatient clinics to develop screening and isolation protocols for patients possibly infected with a highly communicable disease of public health concern. The document focuses on initial patient identification, initial infection control measures, notification and patient evaluation, and identification and management of exposed persons.
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New York State Depatment of Health. (n.d.). New York State Department of Health SARS Guidance Document, Chapter 4: Laboratory Diagnosis of SARS. (Accessed 6/9/2020.)
This chapter of a larger guidance document provides information on laboratory testing related to SARS, including which tests will be performed, safety precautions when handling specimens, and how to collect, test, and ship specimens.
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Occupational Safety and Health Administration. (n.d.). MERS Control and Prevention. (Accessed 1/9/2020.)
This webpage provides guidance to workers and employers to help prevent worker exposure to MERS-CoV.
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* Peiris, J., Yuen, K., Osterhaus, A., and Stöhr, K. (2003). The Severe Acute Respiratory Syndrome. New England Journal of Medicine. 349(25):2431-41.
The authors share a timeline of the SARS outbreak and include tables that highlight clinical components of the disease, laboratory abnormalities associated with the disease, radiographic results of patients with SARS, and other information that can help healthcare providers understand the 2003 outbreak and prepare for future outbreaks.
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* Public Health England. (2018). MERS-CoV: Clinical Management and Guidance.
This collection of resources provides guidance on investigation of MERS-CoV, public health management of suspected cases, and advice to travelers. Resources relate to diagnostic testing, the minimum data set for possible cases, specimen handling and processing, support for clinical decision-making, epidemiological protocols, risk assessment, infection prevention, and travel advice.
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Raj, V.S., Osterhaus, A.D., Fouchier, R.A., and Haagmans, B.L. (2014). MERS: Emergence of a Novel Human Coronavirus. Current Opinion in Virology. 5:58-62.
The authors discuss what is known about the current MERS-CoV outbreak. They emphasize the importance of rapid identification and isolation of cases in the absence of effective treatments and clear understanding of how the virus is primarily being transmitted (i.e., human-to-human, or animal-to-human spread).
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* Sandrock, C.E. (2008). Severe Febrile Respiratory Illnesses as a Cause of Mass Critical Care. Respiratory Care. 53(1):40-53.
The author reviews the agents that could necessitate the need for mass critical care of patients with severe febrile respiratory illness, as well as associated infection control protocols and personal protective equipment requirements, including those for procedures that could result in a high rate of disease transmission. Planning considerations are included, as are general treatment principles and research supporting lung ventilation protocols.
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* Tang, J., Nicolle, A., Pantelic, J., et al. (2013). Different Types of Door-Opening Motions as Contributing Factors to Containment Failures in Hospital Isolation Rooms. PLoS One. 8(6):e66663.
The authors conducted experiments with different types of doors to assess which allowed the most air into and out of rooms to determine the type of door(s) that hospitals should use for isolation rooms. The effect of human movement on air flow when operating the doors was also examined. The authors contend that sliding doors are the most effective.
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* World Health Organization. (n.d.). Middle East Respiratory Syndrome Coronavirus (MERS-CoV). (Accessed 2/2/2021.)
This web page contains links to information on MERS for healthcare providers and laboratory professionals. It also provides updates on the various outbreaks occurring around the world.
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World Health Organization. (2019). Infection Prevention and Control During Health Care for Probable or Confirmed Cases of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) Infection.
This interim guidance document provides principles of infection prevention and control strategies and precautions for healthcare workers managing patients with confirmed or probable MERS-CoV infection.
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Education and Training

* Abrahamson, S.D., Canzian, S., and Brunet, F. (2006). Using Simulation for Training and to Change Protocol During the Outbreak of Severe Acute Respiratory Syndrome. Critical Care. 10(1): R3.
The authors trained 275 health care workers in two weeks on how to don personal protective equipment and perform resuscitation procedures for a patient in cardiac arrest using a high-fidelity simulator. Lessons learned from this initiative have implications for health care worker training, as well as care of patients with infectious respiratory diseases.
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ASPR TRACIE. (2020). Highly Pathogenic Infectious Disease Training and Exercise Resources Webinar.
The National Ebola Training and Education Center (NETEC) and ASPR’s Technical Resources, Assistance Center, and Information Exchange (ASPR TRACIE) are partnering on a series of joint webinars featuring NETEC’s suite of free, fully customizable, Homeland Security Exercise and Evaluation Program (HSEEP)-compliant exercise materials, trainings, and other resources. This webinar highlights a new course, exercise templates, and other ASPR TRACIE and NETEC resources.
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Department of Emergency Health Services. (2018). Emerging Infectious Diseases Videos for Prehospital Providers. University of Maryland Baltimore County.
This instructional series, comprised of nine modules (listed at the top of the page), includes an introduction to infectious diseases, basic infection control concepts, considerations for personal protective equipment (including donning and doffing), personnel decontamination, patient transport, and transfer of patient care for patients with Ebola and other highly infectious diseases.
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Harvard University. (2020). Mechanical Ventilation for COVID-19. edX.
This online course prepares licensed non-intensive care unit clinicians to support hospital critical care teams. The course covers: principles and physiology of mechanical ventilation, initial ventilator setting and adjustments, troubleshooting the ventilator, and ventilating patients in special circumstances.
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Massachusetts General Hospital. (2020). Strict Isolation PPE Doffing.
This video demonstrates the personal protective equipment doffing process under Massachusetts General Hospital's strict isolation policy. It uses a combination of airborne isolation, contact isolation, and eye protection to protect healthcare workers caring for patients known or suspected to be infected with highly pathogenic organisms transmitted by the airborne route or direct or indirect contact with the patient, environmental surfaces, or contaminated equipment. Diseases covered under this policy include SARS, MERS, avian influenza, and 2019 Novel Coronavirus.
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Massachusetts General Hospital. (2020). Strict Isolation PPE Donning.
This video demonstrates the personal protective equipment donning process under Massachusetts General Hospital's strict isolation policy. It uses a combination of airborne isolation, contact isolation, and eye protection to protect healthcare workers caring for patients known or suspected to be infected with highly pathogenic organisms transmitted by the airborne route or direct or indirect contact with the patient, environmental surfaces, or contaminated equipment. Diseases covered under this policy include SARS, MERS, avian influenza, and 2019 Novel Coronavirus.
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Event-Specific Lessons Learned

* Abrahamson, S.D., Canzian, S., and Brunet, F. (2006). Using Simulation for Training and to Change Protocol During the Outbreak of Severe Acute Respiratory Syndrome. Critical Care. 10(1): R3.
The authors trained 275 health care workers in two weeks on how to don personal protective equipment and perform resuscitation procedures for a patient in cardiac arrest using a high-fidelity simulator. Lessons learned from this initiative have implications for health care worker training, as well as care of patients with infectious respiratory diseases.
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ASPR TRACIE. (2021). Creating a COVID-19 Specialty Hospital.
During a pandemic, patients have specific critical care and isolation needs and many hospitals across the country were not prepared or built to treat the significant patient surge in 2020. Erica Kuhlmann, DO, COVID ICU Medical Director, M Health Fairview (MN), shared her experiences transforming the system's Bethesda facility to a dedicated COVID-19 hospital in 2020.
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ASPR TRACIE. (2021). Reconfiguring Spaces: How NorthShore University HealthSystem Met the COVID-19 Challenge.
COVID-19 challenged every aspect of healthcare facilities across the country. From patient care to engineering, environmental health & safety, public safety, and food & nutrition--every department and specialty was affected somehow by the virus. ASPR TRACIE interviewed Michael Fiore, CIH, Corporate Senior Director for Environmental Health and Safety and Clinical Operations for NorthShore University HealthSystem in Illinois. In this role, he oversees the environment of care, including nonclinical areas that support clinical operations that promote a safe, comfortable and healing environment.
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* Centers for Disease Control and Prevention. (2003). Cluster of Severe Acute Respiratory Syndrome Cases Among Protected Health-Care Workers-Toronto, Canada. Morbidity and Mortality Weekly, 52(19);433-436.
Despite apparent compliance with recommended infection-control precautions, a cluster of healthcare workers became ill with SARS during the 2003 outbreak. One table shows how these workers were exposed, by their occupation and type of exposure.
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* Chen, W.Q., Ling, W.H., Lu, C.Y., et al. (2009). Which Preventive Measures Might Protect Health Care Workers from SARS? BMC Public Health. 9(81).
The article describes a retrospective study of health care workers infected with SARS during the 2003 outbreak in China that sought to identify measures that might have protected them from becoming ill. Measures found to be preventive included the use of double gloves; high-air flow ventilation on the wards; and avoidance of face-to-face contact with SARS patients.
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* Cheng, V.C., Chan, J.F., To, K.K., and Yuen, K.Y. (2013). Clinical Management and Infection Control of SARS: Lessons Learned. Antiviral Research. 100(2):407-19.
The authors review the 2003 SARS outbreak and discuss lessons learned, particularly with regard to treatment and containment activities. Summaries of studies conducted to identify risk factors and infection control measures, as well as to describe nosocomial outbreaks for affected countries, are included.
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Hawryluck, L., Lapinsky, S.E., and Stewart, T.E. (2005). Clinical Review: SARS - Lessons in Disaster Management. Critical Care. 9(4):384-9.
The authors review their experience during the 2003 SARS outbreak and present lessons learned to assist health care facilities plan for future infectious disease outbreak.
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Jefferson, T., Foxlee, R., Del Mar, C. et al. (2008). Physical Interventions to Interrupt or Reduce the Spread of Respiratory Viruses: Systematic Review. BMJ. 336(7635):77-80.
The authors report findings from a literature review on physical interventions to reduce or interrupt the spread of respiratory viruses, such as isolation, quarantine, social distancing, barriers, personal protection, and hygiene. They found that handwashing more than 10 times daily; wearing gowns, gloves, masks, and/or N-95 masks were effective. They also found that hygiene measures directed at children helped contain viral spread in the community.
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Lee, S.S., and Wong, N.S. (2015). Probable Transmission Chains of Middle East Respiratory Syndrome Coronavirus and the Multiple Generations of Secondary Infection in South Korea. International Journal of Infectious Disease. 38 :65–7.
Authors described possible cause of MERS-CoV transmission in South Korea resulting in 185 secondary infections as of July 14, 2015. These secondary infections were attributed to three overlapping generations of cases who have contracted the virus almost exclusively in the healthcare environment. Fomite transmission may explain a significant proportion of the infections occurring in the absence of direct contact with infected cases. The analysis of publicly available data collected from multiple sources, including the media, is useful for describing the epidemic history of an infectious disease outbreak.
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Leider, J.P., Lim, S., DeBruin, D., et al. (2023). Using a Web Platform for Equitable Distribution of COVID-19 Monoclonal Antibodies: A Case Study in Resource Allocation. Frontiers. 11.
The authors of this article sought to incorporate ethical considerations into distribution of monoclonal antibodies (mAbs) for COVID-19. The centralized access platform (state website) assessed patient criteria compared with the mAbs emergency use authorization and created a scoring system to prioritize eligible patients in times of scarcity.
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Metersky, M., Rodrick, D., Ho, S., et al. (2024). Hospital COVID-19 Burden and Adverse Event Rates. JAMA Network Open. 7(11):e2442936.
The authors describe a cohort study of more than 40,000 Medicare hospital admissions between September 1, 2020, and June 30, 2022, to determine whether increased hospital strain due to the COVID-19 pandemic was associated with the rate of adverse effects in hospitals. They found a statistically significant increase in adverse effects in both patients with and without COVID-19 during periods of high hospital COVID-19 burden.
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* Peiris, J., Yuen, K., Osterhaus, A., and Stöhr, K. (2003). The Severe Acute Respiratory Syndrome. New England Journal of Medicine. 349(25):2431-41.
The authors share a timeline of the SARS outbreak and include tables that highlight clinical components of the disease, laboratory abnormalities associated with the disease, radiographic results of patients with SARS, and other information that can help healthcare providers understand the 2003 outbreak and prepare for future outbreaks.
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* Reynolds, M.G., Anh, B.H., Thu, V.H., et al. (2006). Factors Associated with Nosocomial SARS-CoV Transmission Among Healthcare Workers in Hanoi, Vietnam, 2003. BMC Public Health. 6: 207.
The authors conducted a small cohort study to determine factors for nosocomial transmission of SARS among health care workers, and which job categories had the highest rates of infection. Nurses working on general wards and who cared for SARS patients had the highest attack rates. Non-clinical staff experienced a 19% attack rate. These findings have implications for hospital infection control plans.
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Schull, M., Stukel, T., Vermeulen, M., et al. (2007). Effect of Widespread Restrictions on the Use of Hospital Services During an Outbreak of Severe Acute Respiratory Syndrome. Canadian Medical Association Journal. 176(13).
The authors examined the effects of restrictions on non-urgent use of hospital services during the SARS outbreak in Toronto and found substantial decreases in elective use and also some decreases in emergency use, suggesting that some patients may have forgone care for urgent conditions.
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Tai, D. (2006). SARS: How to Manage Future Outbreaks? Annals of the Academy of Medicine, Singapore. 35:368-73.
Using lessons learned from the 2003 SARS outbreak, the author provides planning recommendations for future outbreaks, and notes that this planning is valuable for bioterrorism or pandemic influenza response, even if SARS does not reemerge.
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Tan, C. (2006). SARS in Singapore--Key Lessons from an Epidemic. Annals of the Academy of Medicine, Singapore. 35(5):345-9.
This article reviews lessons learned from the SARS outbreak in Singapore in 2003, and focuses on the containment and monitoring measures utilized. Large-scale home quarantine and telephone surveillance helped identify probable cases quickly, but required a significant effort to find a small number of cases comparatively. Daily temperature monitoring of health care workers led to early identification of SARS cases, but monitoring of children and travelers at the airports did not.
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* Toner, E. and Nuzzo, J. (2011). Acting on the Lessons of SARS: What Remains To Be Done? (First page only.) Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science. 9 (2).
The authors share the lessons learned from the SARS outbreak, including how hospitals "amplified" the disease by performing specific procedures (e.g., endotracheal intubation and airway suctioning) that can aerosolize respiratory droplets. The authors then highlight successes (e.g., the use of "respiratory etiquette") that have come about as a result of implementing the lessons learned.
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Wang, L.M., Chen, Y.C., Tung, S.P., et al. (2006). The Rationale of Fever Surveillance to Identify Patients with Severe Acute Respiratory Syndrome in Taiwan. Emergency Medicine Journal. 23(3):202-5.
The article describes a cohort study conducted in 2003 to develop a predictive score for SARS infection in patients presenting to emergency departments at several hospitals in Taiwan with fever. The score is based on 10 evaluation items that include symptoms; travel history; contact history; blood count data; and chest X-ray findings. The authors contend that the scoring system was more sensitive and specific than the World Health Organization case definition criteria.
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General Information

Toner, E., Veenema, T., Adalja, A., et al. (2021). Masks and Respirators for the 21st Century: Policy Changes Needed to Save Lives and Prevent Societal Disruption. Johns Hopkins Bloomberg School of Public Health, Center for Health Security.
This report summarizes the history of masks and respirators available to healthcare workers, other workers, and the general public; acceptance and willingness to use them; and ways to encourage the development and use of new devices. The authors offer eight recommendations for federal action.
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Health Care Worker Safety

* Centers for Disease Control and Prevention. (2003). Cluster of Severe Acute Respiratory Syndrome Cases Among Protected Health-Care Workers-Toronto, Canada. Morbidity and Mortality Weekly, 52(19);433-436.
Despite apparent compliance with recommended infection-control precautions, a cluster of healthcare workers became ill with SARS during the 2003 outbreak. One table shows how these workers were exposed, by their occupation and type of exposure.
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Centers for Disease Control and Prevention. (2023). Isolation Precautions Guideline. U.S. Department of Health and Human Services.
This document provides infection control guidelines for healthcare settings across the continuum of care. It is intended to inform the development, implementation, and evaluation of infection control and prevention programs in healthcare settings.
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* Chen, W.Q., Ling, W.H., Lu, C.Y., et al. (2009). Which Preventive Measures Might Protect Health Care Workers from SARS? BMC Public Health. 9(81).
The article describes a retrospective study of health care workers infected with SARS during the 2003 outbreak in China that sought to identify measures that might have protected them from becoming ill. Measures found to be preventive included the use of double gloves; high-air flow ventilation on the wards; and avoidance of face-to-face contact with SARS patients.
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* Cheng, V.C., Chan, J.F., To, K.K., and Yuen, K.Y. (2013). Clinical Management and Infection Control of SARS: Lessons Learned. Antiviral Research. 100(2):407-19.
The authors review the 2003 SARS outbreak and discuss lessons learned, particularly with regard to treatment and containment activities. Summaries of studies conducted to identify risk factors and infection control measures, as well as to describe nosocomial outbreaks for affected countries, are included.
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* Fusco, F.M., Schilling, S., Puro, V., et al. (2009). EuroNHID Checklists for the Assessment of High-Level Isolation Units and Referral Centres for Highly Infectious Diseases: Results from the Pilot Phase of a European Survey. Clinical Microbiology and Infection. 15(8):711-19.
This article describes a series of three checklists developed to assess hospital capabilities in infection control and health care worker safety related to the treatment of patients with highly infectious diseases. Checklists focus on hospital resources, hospital procedures, and health care worker safety.
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Memish, Z.A., Al-Tawfiq, J.A., Makhdoom, H.Q. et al. (2014). Screening for Middle East Respiratory Syndrome Coronavirus Infection in Hospital Patients and Their Healthcare Worker and Family Contacts: A Prospective Descriptive Study. Clinical Microbiology and Infection. 20(5); 469–474.
The article discusses a descriptive study wherein 5,065 individuals were screened for MERS-CoV, including suspected cases, health care worker contacts, and contacts of laboratory-confirmed cases. The authors cite the data collected as part of this study, as well as data from studies undertaken in several countries, as proof that current infection control recommendations work. They state that the risk of transmission to health care workers is low.
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National Academies of Sciences, Engineering, and Medicine. (2019). Reusable Elastomeric Respirators in Health Care: Considerations for Routine and Surge Use. The National Academies Press.
This report examines strategies for and pros and cons related to stockpiling and reusing elastomeric respirators during an influenza pandemic or other large aerosol-transmissible outbreak.
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Nickell, L., Crighton, E., Tracy, C., et al. (2004). Psychosocial Effects of SARS on Hospital Staff: Survey of a Large Tertiary Care Institution. Canadian Medical Association Journal. 170(5):793-8.
The authors studied the psychosocial effects associated with working in a hospital environment during the SARS outbreak. They found significant negative effects on employees' families and lifestyles as a result of this experience.
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* Reynolds, M.G., Anh, B.H., Thu, V.H., et al. (2006). Factors Associated with Nosocomial SARS-CoV Transmission Among Healthcare Workers in Hanoi, Vietnam, 2003. BMC Public Health. 6: 207.
The authors conducted a small cohort study to determine factors for nosocomial transmission of SARS among health care workers, and which job categories had the highest rates of infection. Nurses working on general wards and who cared for SARS patients had the highest attack rates. Non-clinical staff experienced a 19% attack rate. These findings have implications for hospital infection control plans.
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Tran, K., Cimon, K., Severn, M., et al. (2011). Aerosol-Generating Procedures and Risk of Transmission of Acute Respiratory Infections: A Systematic Review. Canadian Agency for Drugs and Technologies in Health (CADTH).
The authors performed a literature review to assess evidence for the risk to health care workers of contracting an infectious disease from aerosol-generating procedures. They found the data to be limited, and describe the findings of each of the 10 included studies in detail. They note that aerosol-generating procedures do seem to increase the risk of infection for health care workers, but that good infection control and proper training of workers can limit disease spread.
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Nosocomial Transmission

* Assiri, A., Al-Tawfiq, J.A., Al-Rabeeah A.A., et al. (2013). Epidemiological, Demographic, and Clinical Characteristics of 47 Cases of Middle East Respiratory Syndrome Coronavirus Disease from Saudi Arabia: A Descriptive Study. The Lancet Infectious Disease. 13(9):752-761.
The Saudi Arabian Ministry of Health provided an analysis of 47 individuals with laboratory-confirmed MERS-CoV disease. Data suggest that the clinical presentation of MERS-CoV infection ranges from asymptomatic to severe pneumonia with the acute respiratory distress syndrome, septic shock and multi-organ failure resulting in death. At least two cases had a consumptive coagulopathy during the course of their illness.
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* Centers for Disease Control and Prevention. (2003). Cluster of Severe Acute Respiratory Syndrome Cases Among Protected Health-Care Workers-Toronto, Canada. Morbidity and Mortality Weekly, 52(19);433-436.
Despite apparent compliance with recommended infection-control precautions, a cluster of healthcare workers became ill with SARS during the 2003 outbreak. One table shows how these workers were exposed, by their occupation and type of exposure.
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Raboud, J. Shigayeva, A., McGeer, A., et al. (2010). Risk Factors for SARS Transmission from Patients Requiring Intubation: A Multicentre Investigation in Toronto, Canada. PLoS One. 5(5):e10717.
The authors conducted a retrospective cohort study to identify risk factors for transmission of SARS-CoV during intubation from confirmed SARS patients to healthcare workers. They found that close contact with the airway of severely ill patients and failure of infection control practices to prevent exposure to respiratory secretions were associated with transmission of SARS-CoV.
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* Tang, J., Nicolle, A., Pantelic, J., et al. (2013). Different Types of Door-Opening Motions as Contributing Factors to Containment Failures in Hospital Isolation Rooms. PLoS One. 8(6):e66663.
The authors conducted experiments with different types of doors to assess which allowed the most air into and out of rooms to determine the type of door(s) that hospitals should use for isolation rooms. The effect of human movement on air flow when operating the doors was also examined. The authors contend that sliding doors are the most effective.
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* Toner, E. and Nuzzo, J. (2011). Acting on the Lessons of SARS: What Remains To Be Done? (First page only.) Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science. 9 (2).
The authors share the lessons learned from the SARS outbreak, including how hospitals "amplified" the disease by performing specific procedures (e.g., endotracheal intubation and airway suctioning) that can aerosolize respiratory droplets. The authors then highlight successes (e.g., the use of "respiratory etiquette") that have come about as a result of implementing the lessons learned.
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World Health Organization. (2014). Infection Prevention and Control of Epidemic- and Pandemic-Prone Acute Respiratory Infections in Health Care: WHO Guidelines.
This document provides recommendations, best practices and principles for infection prevention and control for acute respiratory infections in health care, particularly those that present as epidemics or pandemics. It includes information on PPE and aerosol-generating procedures. There are also summaries of literature and research reviews on physical interventions for infection control; risk of transmission from aerosol-generating procedures; and effectiveness of vaccination of health care workers to protect patients.
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Plans, Tools, and Templates

Alabama Department of Public Health. (n.d.). Hospital Template for Serious Infectious Disease Procedures. (Accessed 3/17/2021.)
This eight-page template is for the use of hospital administration and planning personnel to identify and communicate key elements of the policy and procedures for screening, identification, and initial management of a suspected serious infectious disease patient. It is intended to be used as a tool to assist in the effective preparation for, implementation, and execution of facility serious infectious disease response plans.
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ASPR TRACIE. (2023). EMS Infectious Disease Playbook.
This playbook (updated in 2023) synthesizes multiple sources of information in a single planning document addressing the full spectrum of infectious agents to create a concise reference resource for emergency medical services (EMS) agencies developing their service policies. The information can be incorporated into agency standard operating procedures and reviewed by the EMS medical director.
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  • Bridget Kanawati Thank you for your interest in this resource. Unfortunately, funding restrictions preclude our being able to provide printed versions of our resources so all of our products, including this one, are only available electronically. ASPR TRACIE Team
    3/26/2020 2:12:42 PM
  • Frances Thorpe I agree with Tracy, is there a way to order this publication in hard copy format? The information contained in this publication highlights agency infection control policies and is a great resource to have in the department library.
    3/26/2020 12:21:37 PM
  • Tracy Miller Is there any way to order a printed and bound version?
    8/9/2018 5:16:09 PM
California Emergency Medical Services Authority. (2014). Incident Planning Guide: Infectious Disease.
Hospitals can use this Incident Planning Guide in conjunction with their Incident Command System and emergency management plans. It provides a scenario and planning factors to consider pertaining to infectious disease outbreaks. Note: Click on the Word or PDF version provided under the Infectious Disease category.
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California Emergency Medical Services Authority (2014). Incident Response Guide: Infectious Disease.
This is an Incident Response Guide for hospitals to use in conjunction with their Incident Command System and emergency management plans. It describes actions by response role for identifying, triaging, isolating, treating, and tracking a surge of potentially infectious patients and staff.
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* Centers for Disease Control and Prevention. (2024). About Middle East Respiratory Syndrome (MERS). U.S. Department of Health and Human Services.
This web page contains links to information on MERS for the public, healthcare providers and laboratory professionals including a frequently asked questions resource. Preparedness checklists for providers and healthcare facilities are included.
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* Fusco, F.M., Schilling, S., Puro, V., et al. (2009). EuroNHID Checklists for the Assessment of High-Level Isolation Units and Referral Centres for Highly Infectious Diseases: Results from the Pilot Phase of a European Survey. Clinical Microbiology and Infection. 15(8):711-19.
This article describes a series of three checklists developed to assess hospital capabilities in infection control and health care worker safety related to the treatment of patients with highly infectious diseases. Checklists focus on hospital resources, hospital procedures, and health care worker safety.
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Minnesota Department of Health, Association for Professionals in Infection Control and Epidemiology - Minnesota, and Health Care Coalitions of Minnesota. (2019). High Consequence Infectious Disease (HCID) Toolbox for Frontline Health Care Facilities.
This toolbox includes a variety of resources to assist frontline facilities in their readiness activities related to patients with high consequence infectious diseases. Included are planning and training tools, exercise templates, and the components (e.g., screening guide, checklists, posters) to create a readiness binder.
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National Ebola Training and Education Center. (n.d.). NETEC Exercise Templates. (Accessed 9/9/2024.)
This web page includes links to various Homeland Security Exercise and Evaluation Program-compliant templates to assist healthcare coalitions, frontline facilities, assessment hospitals, state-designated Ebola treatment centers, regional Ebola and special pathogen treatment centers, and their respective response partners in the planning and conduct of exercises on the identification, assessment, treatment, management, transport, and transfer of high risk patients. The site includes templates for drills, tabletops, functional, and full-scale exercises. There is also a beginners guide to assist users new to exercise planning.
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National Emerging Special Pathogens Training & Education Center and ASPR TRACIE. (2025). Estimating PPE Needs: Using the DASH Tool for Special Pathogen Readiness.
In this webinar, NETEC and and ASPR TRACIE demonstrate the Disaster Available Supplies in Hospitals (DASH) Tool and highlight the National Special Pathogen System framework, real-world use cases of DASH for Level 2 and Level 3 care, and how PPE needs change over 24-hour and multi-day scenarios.
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National Emerging Special Pathogens Training and Education Center. (2024). EMS Procedural Guidelines for Special Pathogens.
These model procedural guidelines, created by NETEC's EMS/Patient Transport Work Group, are designed to help EMS agencies develop standard operating procedures for the transport and management of patients suspected or confirmed to have a high-consequence infectious disease. The guidelines address personal protective equipment (PPE) donning and doffing, EMS provider down, PPE breaches, biohazard spills, waste management, ambulance modification, and ambulance cleaning and disinfection. They complement ASPR TRACIE's EMS Infectious Disease Playbook (https://files.asprtracie.hhs.gov/documents/aspr-tracie-transport-playbook-508.pdf).
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Nebraska Medicine. (2019). MERS-CoV ED Screening Protocol.
This screening algorithm is intended to assist emergency department staff in screening potential MERS-CoV patients and implementing effective infection prevention and control measures.
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New York City Department of Health and Mental Hygiene. (n.d.). Mystery Patient Drill Toolkit. (Accessed 3/5/2025.)
This toolkit is intended for use by hospital emergency departments, and tests how long it takes for a potential patient with a highly infectious disease to be identified and for staff to begin exposure mitigation procedures; how long it takes for a patient to be transferred to an isolation room; and the capability of the facility to make notifications internally and to the health department. The Toolkit includes scenarios for Ebola Virus Disease, Middle East Respiratory Syndrome, and Measles, but may be modified to suit healthcare facilities of any nature and any type of disease outbreak.
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New York City Health + Hospitals. (2019). Frontline Hospital Planning Guide: Special Pathogens.
This planning guide from New York City Health + Hospitals provides high-level planning information for frontline hospital multidisciplinary teams to support planning and training for the initial care of suspected special pathogen patients while determining whether and when they will be transferred to another facility for further assessment and treatment.
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* Peiris, J., Yuen, K., Osterhaus, A., and Stöhr, K. (2003). The Severe Acute Respiratory Syndrome. New England Journal of Medicine. 349(25):2431-41.
The authors share a timeline of the SARS outbreak and include tables that highlight clinical components of the disease, laboratory abnormalities associated with the disease, radiographic results of patients with SARS, and other information that can help healthcare providers understand the 2003 outbreak and prepare for future outbreaks.
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* Public Health England. (2018). MERS-CoV: Clinical Management and Guidance.
This collection of resources provides guidance on investigation of MERS-CoV, public health management of suspected cases, and advice to travelers. Resources relate to diagnostic testing, the minimum data set for possible cases, specimen handling and processing, support for clinical decision-making, epidemiological protocols, risk assessment, infection prevention, and travel advice.
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Rebmann, T. (2009). Assessing Hospital Emergency Management Plans: A Guide for Infection Preventionists. (Abstract only.) American Journal of Infection Control. 37(9); 708–714.e4.
The author conducted a literature search to develop a checklist for infection preventionists to use to assess their hospital's emergency management plans. Infectious disease response considerations are addressed.
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San Francisco Department of Public Health. (2011). Infectious Disease Emergency Response Plan.
This plan contains the following sections: command; plans section (by unit); operations section; logistics; and finance. Four annexes that focus on different threats are included, as are sample forms and other appendices.
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* Sandrock, C.E. (2008). Severe Febrile Respiratory Illnesses as a Cause of Mass Critical Care. Respiratory Care. 53(1):40-53.
The author reviews the agents that could necessitate the need for mass critical care of patients with severe febrile respiratory illness, as well as associated infection control protocols and personal protective equipment requirements, including those for procedures that could result in a high rate of disease transmission. Planning considerations are included, as are general treatment principles and research supporting lung ventilation protocols.
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* World Health Organization. (n.d.). Middle East Respiratory Syndrome Coronavirus (MERS-CoV). (Accessed 2/2/2021.)
This web page contains links to information on MERS for healthcare providers and laboratory professionals. It also provides updates on the various outbreaks occurring around the world.
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Agencies and Organizations

Centers for Disease Control and Prevention. Middle East Respiratory Syndrome.
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Centers for Disease Control and Prevention. COVID-19.
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Institute for Diseases and Disaster Management. Tools and Resources. NYC Health + Hospitals.
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National Emerging Special Pathogens Training and Education Center.
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World Health Organization. Middle East Respiratory Syndrome Coronavirus.
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World Health Organization. Severe Acute Respiratory Syndrome.
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This ASPR TRACIE Topic Collection was refreshed in 2024. It was originally comprehensively reviewed in September 2015 and is being updated regularly to include information relevant to the emerging 2019 Novel Coronavirus, with assistance by the following subject matter experts (listed in alphabetical order): Eric Alberts, BS, FPEM, CHS-V, CDP-1, CHPP, CHEP, SEM, CFRP, FABCHS, Manager, Emergency Preparedness, Orlando Health, Inc. (Hospital System); John Hick, MD, HHS ASPR and Hennepin County Medical Center; Brad Learn, Regional Healthcare Preparedness Coordinator, Kentucky Department for Public Health; Connie Savor Price, MD, Chief Medical Officer, Denver Health and Hospital and Professor of Medicine, Division of Infectious Diseases, University of Colorado School of Medicine; Mary Russell, EdD MSN, Emergency Services, Boca Raton Regional Hospital; and Xiaoyan Song, PhD, MBBS, MSc, Director, Infection Control/ Epidemiology, Children’s National Health System and Associate Professor of Pediatrics, George Washington University School of Medicine and Health Sciences.
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