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Coronaviruses (e.g., SARS, MERS and COVID-19)
Topic Collection
March 27, 2026

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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Clinical Management and Research

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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* 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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* 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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Education and Training

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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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

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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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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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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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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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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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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Nosocomial Transmission

* 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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* 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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Plans, Tools, and Templates

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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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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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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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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