A Full-Blown Farce?
By Kalpana Sharma
04 May, 2003
The Front page photograph
of the Union Health Minister, Sushma Swaraj, mask firmly in place, declaring
that India is now free of the Severe Acute Respiratory Syndrome (SARS),
would have been considered hilarious if the story behind it was not
In two heady weeks, as print
and electronic media breathlessly reported each new "case"
of SARS, we have thoroughly exposed our inability to cope with a potential
epidemic. We have also exposed the pathetic state of our public health
information systems. Far from feeling reassured, we should feel worried
about any future such episodes because of the ease with which the "fog
of panic" overtakes even common sense.
According to the World Health
Organisation, the number of recorded cases of SARS worldwide between
November 1, 2002, and April 29, 2003, was 5, 462. The majority of these
were in China (3,303) and Hong Kong (1,572). Of these, 2,427 or roughly
under half, had recovered by that date. The total number of deaths recorded
was 353, with 148 in China and 150 in Hong Kong.
Without underplaying the
highly contagious nature of this virus, it is essential to place it
in perspective. No sooner had the SARS virus hit Hong Kong than the
media was declaring it as the "first global epidemic of the 21st
century". Global? By what measure? The numbers infected were minuscule
compared to the population of a country such as China. And in case,
the virus had spread to only 26 countries, with a concentration of cases
in two, and the mortality rate was 3 to 4 per cent, not much higher
than ordinary influenza.
By playing on people's fears,
no purpose was served. Instead, the panic obscured the reality of the
many diseases, infectious and otherwise, that are killing millions of
people in this country and worldwide every single day. None of this
merits more than a passing comment. Yet when a new virus emerges, at
a time when the cynics would say the Iraq news was slipping off the
front pages, suddenly all panic buttons are hit.
For instance, few people
realise that every year between 20,000 and 30,000 people die of ordinary
influenza in the United States, an infection that spreads but is also
In fact, just six months
before the first SARS case was reported, an estimated 27,000 people
in Madagascar were affected by a mysterious influenza and 800 people
died despite early intervention. This did not make the headlines.
As Robert Baker, a specialist
in infectious diseases at King's College Hospital, London, aptly pointed
out in The Independent, the panic that SARS generated was probably because
"it affects affluent Westerners rather than penniless African children".
There is the annual list of diseases and deaths that now barely cause
a flutter: two million children under five die every year of acute respiratory
infection, 1.3 million children die each year of diarrhoea and one million
of malaria. Children under five, who constitute 10 per cent of the world's
population, carry 40 per cent of the global disease burden. Granted
that not all these diseases are contagious like the SARS virus.
But even as new mutants of
viruses emerge and make their way from animals to humans, it is essential
to place them in the context of the disease map of the world, and of
our respective countries.
In India, the hype over SARS
stands out even more because of the extent of the spread of a highly
infectious disease like tuberculosis. Yet TB, despite its highly contagious
nature, fails to elicit anything but the most jaded response from the
The WHO acknowledges that
TB is one of the leading public health concerns not just because of
the ease with which it can spread in densely populated countries without
an adequate public health infrastructure but also because of the emergence
of new, drug resistant varieties.
It is also evident that neither
the authorities, nor the media that reported on the SARS here, drew
any lessons from the manner in which the infection had spread before
it entered India.
The pattern in Hong Kong
and China had already revealed that the majority of those who got infected
did so either through direct contact with an infected family member,
or as hospital staff treating a SARS patient.
Vietnam, for instance, took
quick measures to isolate potential cases and inform the general public.
As a result, despite its proximity to China and Hong Kong, it remained
relatively free of the infection.
Yet, in India we fumbled
and created panic. While Stanley D'Silva from Pune, who was diagnosed
as having SARS, was treated, steps were not taken to ensure that the
hospital staff treating him did not catch the infection.
And when they tested positive,
the information was given out to the press without the rider that they
were asymptomatic and therefore unlikely to spread the virus. The WHO
representative clearly said on television that a person is deemed to
have SARS not only when he is tested positive for coronavirus but when
he also shows clinical symptoms such as high temperature and respiratory
In the absence of accurate
information, SARS became a social disease overnight. Suspected SARS
cases were shunned. Housing societies demanded that they be expelled.
People living near a hospital
with just one suspected SARS case in Kolkata demanded that he be shifted
to the special Infectious Diseases hospital even though all necessary
precautions were being taken.
And of course, the Air India
pilots competed with this torrent of illogic by declaring that they
would not fly to SARS-affected countries or with the crew which had
transited through these countries. Everyone took this as an opportunity
to work off their pet peeve.
SARS is not the first, nor
the last, of strange new viruses that could emerge in India or enter
the country through some other route.
The lesson to be drawn from
this episode is the importance of adequate public health systems to
meet such contingencies. Two-thirds of health care in India is in the
private sector. Yet, the burden of dealing with major infectious diseases
rests with the public sector.
Also, it is the Government
laboratories that are called upon to confirm the emergence of diseases.
Repeatedly, we have seen that our facilities fall short at times of
emergency because they are not adequately supported during normal times.
If there is one thing the
Government and Ms. Swaraj should learn from this experience, it is the
importance of shoring up the public health system.
And if there is a lesson
for the media, it is the importance of doing their homework and placing
such diseases in a context rather than falling into the trap of spreading
SARS, Wars And
By Satya Sagar