One year after the outbreak, SARS survivors still had elevated stress levels and worrying levels of psychological distress. The situation of health care worker SARS survivors is particularly worrying. The long-term psychological implications of infectious diseases should not be ignored. Mental health services could play an important role in rehabilitation.

Health care workers who were at high risk of contracting SARS appear not only to have chronic stress but also higher levels of depression and anxiety. Front-line staff could benefit from stress management as part of preparation for future outbreaks.

S evere acute respiratory syndrome (SARS) is caused by a novel coronavirus (1) and has placed extraordinary demands upon health care systems worldwide. Unlike previous public health challenges, health care workers (HCWs) comprised a high proportion of the nearly 8000 infected persons across 29 countries: the percentage of infected HCWs ranged from 3% in the US, where most cases originated from international air travel (2), to as high as 22% in Hong Kong (3), 33% in Taiwan (4), and 51% in Toronto (5), with a mortality rate of 15% (6). Since early SARS resembles influenza (7), widespread avoidance of crowded places occurred in Hong Kong. HCWs were rapidly deployed to SARS wards. A qualitative study of 11