- With fanfare the Union Health Ministry announced that
the government was fully geared to meet any eventuality arising out of
the entry of Severe Acute Respiratory Syndrome (SARS) into India.
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- A close examination of the ground reality shows that
except for its ability to handle a very few isolated cases of SARS in a
handful of large metropolitan cities such as Delhi and Mumbai, the Government?s
?preparedness? is restricted to lot of slogan shouting with little substance.
Look at some of the ground realities:
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- Possibility of pandemic: The chances of SARS becoming
pandemic cannot be ruled out because whole populations around the globe
have no immunity against the disease. Every day new cases are coming to
light with more deaths being reported. Additional countries are joining
the list of SARS-infested. There is no sign of the disease disappearing.
Suppose the disease turns nasty, the way it did in China and we have a
pandemic? How many isolation rooms are available not just in Delhi or Mumbai
but across the nation? We simply do not have adequately trained doctors
and paramedical staff to handle large number of cases.
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- Lack of awareness: With some 60 per cent population illiterate
and three-fourths in over half a million villages, not many people have
heard about SARS. The government has not taken a single step to create
mass awareness. No epidemic can be controlled unless people have basic
information. As things stand, most people in rural and semi-urban areas
will dismiss suspected SARS cases as nothing more than cold, cough or influenza
thus spreading the infection.
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- Lack of coordination with private sector: An estimated
81 per cent of the population is dependent on private healthcare. No steps
have been taken to involve this sector in SARS control and treatment. The
state sector, already understaffed and over-burdened, will collapse should
SARS spread. Very few government hospitals have facilities such as ventilators
required to treat SARS patients. How does one handle a suspected SARS case
in small towns at sub-district levels? Especially where there is no medical
college hospital? How and where the patient will be treated? Do people
have funds to undertake expensive journeys and stay for weeks in large
towns? Do hospitals even in big towns have the capacity to deal with large
numbers of SARS patients? The Government has doled out crores of rupees
to private hospitals in the past but has failed to use their facilities
even during epidemics, to which it is legally entitled.
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- Lack of training to doctors: Out of approximately 400,000
medical practitioners in private practice, just over 250,000 are general
family doctors. They form the backbone of the healthcare system in the
country. No training is being given to them to diagnose and treat suspected
SARS cases.
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- Some very basic, fundamental steps needed to control
the spread of SARS are not in place. Some examples:
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- Surveillance at ports: The staff has been told to look
for passengers showing signs and symptoms of ?cold and flu? at international
airports. It is not being appreciated that the most infective stage of
SARS is during the incubation period when infected persons have no signs
and symptoms. Not only do such actions lead to a false sense of security
but highly infective persons can enter the country unchecked and are not
followed up till they show signs of illness. By then they may infect others.
Urgent steps are needed to pro-actively follow up all passengers who have
visited SARS-infected areas for 10 days after their entry to India. The
coverage needs to extend to all points of entry including seaports.
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- Contact Tracing of SARS patients at the moment lacks
depth and is limited to relatives and known contacts. What about other
contacts? For example if an infected person returns to India by air he
must have come in contact with other passengers, particularly those seated
near him. Then he may have traveled by taxi to his place of residence,
gone to shops, cinema houses etc. and come in contact with other people.
At the moment there is no procedure in place to locate such contacts. It
is not difficult for the government to order that all passengers disembarking
at Indian ports remain in touch with designated officials for 10 days -
the time taken by infection to show signs and symptoms.
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- Lack of testing facilities: Currently there are just
two laboratories ? one in Delhi and the other in Pune ? that can undertake
confirmatory blood tests of suspected SARS cases. Forget about other towns,
even other metropolitan cities with huge populations such as Mumbai, Kolkota,
Chennai, Bangalore and Ahmedabad do not have testing facilities. Can one
control SARS in a country of 100 crores with such poor infrastructure?
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- Institutionalized populations: No special arrangements
have been made to deal with special institutionalized populations such
as residential schools, army barracks etc. The chances of SARS spreading
rapidly in such situations are much higher. Suppose a student of a residential
school has returned from a SARS-infected area? If infected, do we wait
till he has infected others? No advice has been given to heads of such
institutions.
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- Mode of transmission: The current strategy to deal with
SARS is based on the assumption that infection spreads through droplets
only. This has not been established so far. There is a possibility that
apart from aerosol droplets, there could be other means of transmission
such as through contacts with contaminated objects (handles, utensils,
toilet seats etc). The possibility of insects such as cockroaches carrying
the virus is also under investigation. In such an eventuality, facemasks
alone will not be adequate. The government has no plans to deal with other
modes of transmission, particularly through insects.
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- The experience with other viruses in the past shows that
even if the current epidemic dies down, SAARS virus is here to stay because
either it will remain dormant in humans (like Chickenpox virus) or remain
alive in animal reservoirs. Therefore long-term measures will need to be
put in place to deal with this new disease in years to come. To begin with
the government should at least make SARS a legally notifiable disease so
that cases do not go unreported.
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- (The writer is the editor of Monthly Index of Medical
Specialities (MIMS) India.)
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- http://www.hindustantimes.com/news/181_237364,00300006.htm
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