April 09, 2003
India, South Africa Reporting Suspected SARS Cases

Very few SARS cases have been reported in India so far. However, if SARS becomes established in India it will be very hard to stop.

"Our health system is very inadequate and it will be extremely tough to control the disease if it arrives," Anil Bansal, president of the Delhi Medical Association, told Reuters.

The very limited health case system in India makes the news about SARS coming from India very important. Therefore every suspected SARS case in India is watched very closely.

Not all suspected SARS cases in India have turned out to be SARS. For instance, Maria, the first suspected SARS case in New Dehli, may have a different kind of infection.

"She has been provisionally detected of having acute pharyngotonsilitis, said Dr R.N. Salhan, the hospital medical superintendent.

Also, a 23 year old American woman suspected of having SARS in Bombay turned out to have a less dangerous illness. However there are at least two other suspected SARS cases in India including a 48 year old Indian national recently arrived via Singapore.

A 48-year-old software worker was admitted to hospital in Hyderabad on Tuesday after he arrived from Australia via Singapore with high fever, a cough and cold -- symptoms of the virus that has killed more than 100 people worldwide.

Surely the government of India can afford to quarantine and treat a few thousand sufferers. India is making efforts to be prepared to do so.

Facilities have been created for treatment of SARS cases in isolation in the Central Government hospitals as also in other Infectious Disease Hospitals. Health care facilities at International Airports and Ports have been strengthened by deploying additional doctors and evolving a standard operating protocol.

But the problem for India is that there are hundreds of millions of poor people who have little or no access to medical doctors and medical tests. If a single SARS sufferer reaches India and if that sufferer happens to be very infectious the results could be disastrous.

A single SARS sufferer is all it would take to rapidly cause a large SARS outbreak in a primitive country. "Hyper-infectors" (a.k.a. "super-carriers") of SARS may have been responsible for the big SARS outbreak in the Toronto Canada area.

Canada's SARS outbreak has been fuelled by three "hyperinfectors" who each passed on the disease to 20 or more other people -- a phenomenon never before seen with a virus, experts said yesterday

It is noteworthy that all three of the hyper-infectors in Canada died. Could it be that the more severe form of the disease is more infectious? Perhaps the people who have the severe form cough more and therefore generate more airborne particles which contain active virus.

It is unusual for a virus to be highly infectious.

Individuals who are inordinately infectious have been seen with certain types of bacteria, but not viruses, said Dr. Low.

Africa has the same vulnerability to SARS that India has. Therefore SARS cases in Africa are incredibly important to watch for. A Pretoria South African man who travelled from Hong Kong to South Africa on March 27 is hospitalized and suspected of being a SARS case.

A 62-year-old South African man is being treated at a Pretoria hospital as a "probable SARS" case, according to officials.

One factor that is doing a lot to reduce the chances of SARS spread is the great reduction in air travel. Given India's greater vulnerability to SARS Air India's 60% reduction in flights between Hong Kong and Bombay (Mumbai) is good news.

It further curtailed its services to Hong Kong, and will now operate only two flights a week (on Mondays and Fridays) as against the scheduled five flights a week.

While voluntary decisions to not travel are playing a role in efforts to reduce the risk of further spread of SARS government decisions can block off means of spread by more dramatic means. In order to reduce its risk of getting SARS cases from China the government of Malaysia is no longer granting tourist visas at its diplomatic facilities in China.

Malaysia has taken the draconian step of banning all tourists from mainland China to try to stop the spread of the deadly Sars virus.

India and Africa have greater need to take such a dramatic action than Malaysia does. If tourist travel was cut off other types of travel could still be allowed but under much more stringent rules. In the extreme, countries could allow passengers to travel from other countries but then force them into quarantine for 7 to 14 days upon arrival. This would provide a way for people who plan longer term changes in residence to still move around to take different jobs.

Update: On April 17, 2003 a confirmed case of SARS was found in Goa India.

Goa's chief minister, Manohar Parrikar said that a 32-year-old marine engineer had tested positive for the virus and was being treated at the Goa Medical College. The man is said to have arrived in Goa earlier this month after travelling in Singapore.

The worry has to be that this fellow may have already passed on SARS to other people after he returned to India. SARS may now be on the loose in India. If that is the case the odds of containing it there are low. If SARS becomes pandemic in less developed countries the effect on the world economy would be to cause world recession.

Update: India reports 2 new cases of Sars on Saturday April 26.

CALCUTTA, April 26 (Reuters) - A 42-year-old Indian man has tested positive for SARS, authorities said on Saturday, the country's sixth case of the virus that has killed at least 289 people and infected about 5,000 worldwide.

Share |      Randall Parker, 2003 April 09 03:53 PM  Dangers Natural Bio


Comments
Krishnakali Sinha said at April 19, 2003 8:37 PM:

SARS in India would be world's worst nightmare !
SARS has to be treated in a warfare manner. Unlike
some dignitaries who says " we have to learn to live with SARS" as said at Hong Kong, compounding public fears futher by opening the schools, it should have been treated with house arrest, vigilance by the community and timely proactive action with a tranparency on health situation.

Foreigners from affected area must not be allowed to get in India. Indians must be banned from travelling to affected area. If any Indian found to have travelled to the affected area after the ban comes to effect, he/she should be kept under quarentine until established they are free of the infection. Non-resident Indians should be strongly discouraged from returning from affected area unless there is no options left . They should then have a health check upon arrival, and sign a declaration to the state that they would "keep themselves isolated for 12 days ( instead of visiting spree ) until it is established that they are free of the virus.
Their houses should be aired at all times, house cleaned with bleach and hands washed with rubbing alcohol constantly. Close contact with the community, house hold staff should be absent, keeping the distance of at least four feet in order to avoid contact with all including family members and spouse ( when spouse is an Indian resident) ." At the end of 12 days a clean health chit from the doctor should be given to health office of airport, any party failing to do so will be tracked by the police and proper explaination will be sought for this failure.
Action will be taken if any non-resident found to have spread the infection within the country.

If above approaches are achievable and can be enforced then we can further implement next step of preventive actions.

Thanks/regards

Sinha

Randall Parker said at April 19, 2003 11:26 PM:

Sinha,

I agree, drastic measures should be taken to keep SARS out of India. India is ill-equipped to try do deal with it.

I think India should cut off all flights from China, and Hong Kong and possibly from other areas as well.

What is really needed is a fast test that can be given to all air travellers. Then anyone testing positive could be kept off of airplanes.

Ranesh Kumar said at April 22, 2003 10:40 PM:

What will be the effect of SARS on Imports from China ?

In the near future, will workers at different SEA or AIR PORTS refuse to handle cargo coming from China ?

Randall Parker said at April 23, 2003 12:43 AM:

Ranesh,

Coronaviruses can not survive outside of a body for all that long. They probably can survive for a few hours at most. Therefore cargo is very unlikely to serve as a method of transport for the virus. The big danger comes from airplane flights carrying people.

What would do the most to slow the spread of SARS between countries would be a fast test for SARS so that everyone who wants to fly to a different country could be tested before being allowed to board an airplane.

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