The Hindu : Fear over the nation

Online edition of India's National Newspaper
Sunday, May 04, 2003

Opinion

Opinion - News Analysis

Fear over the nation

The Union Health Ministry pressed the panic button, says Bindu Shajan Perappadan.

An abundance of caution... at a Pune hospital.

IT SEEMED as if fear had outrun the killer itself. And the reason for the panic over the Severe Acute Respiratory Syndrome was said to be India's lax quarantine laws and inadequate surveillance which could result in the disease spinning out of control. The absence of a fool-proof method to test for the virus and a possible cure or preventive vaccine made matters worse.

For its part, the Union Health Ministry pressed the panic button before understanding the basics of SARS. "India is at risk'', warned the Minister, Sushma Swaraj. "SARS is transmitted through cough droplets from an affected person and can spread on trains and buses. Symptoms may not show till almost 10 days after infection. A negative test does not rule out SARS and a patient given a clean chit may not be free from it. There is no way of being sure and we need to be constantly on guard." The message was loud and clear — "everyone is in danger". But there was good news too — the Government pumped in a few crores to upgrade the health care mechanism across the country.

The All-India Institute of Medical Sciences, the Safdarjang Hospital and the Ram Manohar Lohia Hospital in the capital were identified for treatment. Besides providing for ventilators and other equipment, isolation wards were prepared. A high-power committee comprising the Directors-General of Health Services of the various affected States and medical officers was constituted after a meeting of the Health Secretaries, convened by the Health Minister. A network was put in place across the country, enabling fast and reliable assimilation of information on any suspected case. The Government also designated two institutions, the National Institute of Communicable Diseases (NICD) and the National Institute of Virology (NIV) as the testing centres. SARS posters came up at the immigration counter of the Indira Gandhi International Airport and masks were provided to all the officials. As the NICD Director, N. K. Ganguly, says: "SARS is a new virus and we are still working on a cure or vaccine. Currently it is being treated with an anti-viral called ribavirin plus steroids."

Clearly, the facilities at the NICD and the NIV are inadequate. According to reports, a vast disease-prone country such as India has fewer than 10 BSL-3 laboratories, the international standard for identifying reasonably dangerous pathogens such as SARS. Even the NICD does not have such a facility and has temporarily upgraded a lab. "SARS is worrying because there is no fool-proof method to test it. The most common method is the DNA-based test called PCR or a cell-based immuno fluorescence test which shows best results 10 days later," says Dr. Ganguly.

What the public reads into the situation is best described by N. Kumara Rai, Director, Department of Communicable Diseases, WHO South East Asia Region. "For one, the world was dealing with an unknown disease. Second, conventional treatment to cure pneumonia does not work in the case of SARS. And we know that vaccine is not available. There was relatively high death rate among SARS cases, i.e. around 4 per cent and it spread fast. Within a month of global alert, five continents, including developed countries,were affected. Dealing with a new disease of unknown cause that can lead to death and with no cure or vaccine can trigger panic."

The situation worsened after a 42-year-old man, who was admitted to a Mumbai hospital on suspicion for SARS, was discharged. He stayed at the Oberoi Hotel before travelling to Delhi's Infectious Diseases Hospital. Fear was so rampant that the visiting Health Minister and officials wore masks as soon as they were in the compound of the hospital. What escaped the entire nation and the Ministry was the WHO directive on "whom to describe as a SARS patient''.

The WHO categorises the SARS cases as "suspect'' and "probable'' ones. Criteria for those who are "suspect" are: sudden onset of high fever, body ache, diarrhoea (in 10 per cent of the cases) and difficulty in breathing. And "probable" cases throw up symptoms similar to those of the "suspects" plus a chest X-ray showing pneumonia of both the lungs, according to Dr. Rai. "Of the nine cases with mild symptoms in India, none had an X-ray showing pneumonia".

The good news left the Health Ministry relieved but red in the face because of the confusion it had managed to create. But other real worries remain. "The SARS scare has taught us about the glaring inadequacy in our system. Lack of awareness, lack of coordination with the private sector, poor surveillance at the airports and sea ports, poor contact tracing, lack of testing facilities and the lack of awareness drives with the institutionalised populations are all important lessons that are to be learnt for the management of any disease," says C.M. Gulati, Editor, Monthly Index of Medical Specialities, India.

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