The Hindu : Who says we have SARS?

Online edition of India's National Newspaper
Monday, May 05, 2003

Opinion

Opinion - Editorials

Who says we have SARS?

IS INDIA FREE of the Severe Acute Respiratory Syndrome (SARS)? Yes, if you go by the norms laid down by the World Health Organisation (WHO), which has declared that a patient must exhibit certain clinical symptoms (example: high fever, cough and breathlessness) to be classified as a SARS-afflicted person. No, if you go by standard or accepted laboratory tests, which have recorded positive findings from samples of patients from various parts of the country. The WHO's declaration that India is SARS-free may set at rest both fear and speculation that a major outbreak of the disease is imminent in the country. However, the official certification, which has been greeted with palpable relief by the Indian health establishment, still leaves the country with something of a puzzle. What should it make of the fact that all those who have tested positive for the disease have exhibited extremely mild and atypical symptoms? The truth is that we do not know, or at least fully. India is not the only country where people with SARS have atypical symptom and such cases are now being reported from various parts of the world. Explanations for such symptoms have included the theory that the cause lies in genetic mutations of the coronavirus. Some medical scientists have speculated that because of the large number of mutations, some versions of the virus may be causing less severe illnesses, which are sometimes so mild that they do not show up as probable SARS cases even in laboratory tests.

An alternative view, which seems to have found support amongst some members of the medical community in India, is that a higher immunity is responsible for situations where lab tests show up positive results even when patients are not clinically sick. Could people in the subcontinent, unlike those in the two dozen or so SARS-afflicted countries, have developed antibodies to counter the virus? Could this, in turn, explain why countries such as India, Pakistan, Bangladesh and Sri Lanka have been free from `full-blown' SARS? Vast variations in the recovery rate, among other things, have led some people to speculate that the Syndrome, or at least its absence, is somehow tied up with racial or cultural characteristics. But there is no proof for this extraordinary hypothesis and, even more important, it provides no basis at all for hoping that India will successfully defeat SARS because of the strong immunity of its people. The last thing one needs when battling a disease that has killed about four per cent of those afflicted and spreads easily through close contact is a complacency that is based on a speculative theory about a virus that the medical world still has to learn a considerable amount about.

As the result of the WHO's clean chit to India, the Government's periodic announcements, of positive test results of samples taken from patients from different parts of the country, may appear to some people as if they were alarmist and uncalled for. Far from it. It is absolutely essential to be totally transparent when combating a disease with epidemic potential such as SARS and, as a general rule, the damage from withholding such information is likely to be much worse than the possible misapprehension caused by sharing it. The world has been made painfully aware of the cost of official secrecy, suppression and misinformation, which characterised the Chinese response to SARS and which was directly responsible for promoting the spread of the disease at home and abroad. The Government's recent decision to sack the Health Minister and the Mayor of Beijing are obviously attempts to signal to the world community that China is finally prepared to reveal the true dimensions of the incidence of SARS. India's approach to the problem must continue to be characterised by openness and transparency. It must also remain vigilant — the WHO's SARS-free certification is hardly a reason to drop one's guard.

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