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SARS — 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 so tragic.

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 treatable.

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 media.

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 infection.

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 panic.

Also see

SARS, Wars And The Farce
By Satya Sagar