By Ranjit Devraj
NEW DELHI, Mar 18 2003 (IPS)

Indian experts who have experience with the 1984 pneumonic plague scare in the western port city of Surat say the World Health Organisation (WHO) may be overreacting to the mysterious atypical pneumonia that has killed five people and affected hundreds in western China, where it is thought to have originated.

Called Severe Acute Respiratory Syndrome (SARS), the causative organism behind the pneumonia has yet to be isolated. However, China reported 305 cases, including five fatal ones, in Guangdong province more than a month ago.

Internationally, SARS is said to be responsible for four other deaths and a total of 400 infections.

Over the weekend, WHO pronounced the illness a ”worldwide health threat” in an unusual emergency warning. The Centres for Disease Control (CDC) at Atlanta in the United States has now been called in by baffled Chinese authorities to help with investigations.

This contrasted with Beijing’s earlier news blackout on the disease and refusal to let authorities from the CDC investigate the outbreak.

”I met with the Chinese officials about 10 days ago, and I asked them at that time to allow CDC to go in and work with them. We were not able to successfully negotiate that at that time, but subsequently we have been able to,” said Tommy G Thompson, U.S. health secretary, at a telebriefing on Monday.

In this country, China’s neighbour to its south, authorities are tending to downplay the seriousness of the outbreak while considerable scepticism is being expressed by experts who say the ‘base definition” is scanty and suspect the hand of pharmaceutical transnationals behind what they suspect is a motivated scare.

Prodded by WHO’s global warning, India’s health ministry called a meeting Tuesday that was attended by the body’s South-east Asia Region representative S R Abdullah, and experts from the National Institute of Communicable Diseases (NICD) and the All-India Institute of Medical Sciences (AIIMS).

S P Aggarwal, India’s director general of health services, told reporters at the end of the meeting that the situation did not warrant issuance of a health alert – in this country at least. ”There is no need for panic as no case has so far been reported in India.”

But in the absence of any certain knowledge about the disease or its cause, Indian authorities are dutifully following the ‘case definition’ issued first by the CDC, and later by WHO. This case definition talks about a fever higher than 384 degrees Celsius, shortness of breath, coughing and breathing difficulty in anyone who has been in Asia recently.

”With a case definition like that, thousands of Indians could be suffering from SARS,” said Dr. Mira Shiva, an internationally-known campaigner for rational drug policies who works with the non-government Voluntary Health Association of India.

Shiva said she is intrigued by the fact that the disease had broken out in Guangdong, the same Chinese province where a particularly virulent form of dengue (haemorrhagic brain fever) surfaced a few years ago, reportedly from mutant varieties. ”This calls for thorough investigation,” she said.

Shiva said outbreaks of mysterious diseases usually benefited the manufacturers of antibiotics and diagnostic kits, as happened during the 1984 outbreak in Surat. That outbreak was initially suspected to be pneumonic plague, but was disproven later by rigorous scientific investigation carried out by leading medical scientists.

Speaking to IPS, Dr Kalyan Banerjee, former director of the National Institute of Virology, agrees that the CDC/WHO case definition was not specific enough and that there is so far no evidence to link the reported deaths to a new organism or even a mutant variety of a known pathogen. ”Too many diseases carry similar symptoms.”

”All this hype is reminiscent of the 1984 outbreak of a mystery disease in Surat, which was erroneously attributed to plague,” Banerjee said.

The plague controversy was finally settled in a scientific paper written jointly by Banerjee, N S Deodhar, former director of the All-India Institute of Hygiene and Public Health and V J Yemule, former director of the Haffkine Institute in southern Mumbai and published in the U.S. Journal of Public Health Policy in 1997. But the supposed plague, which claimed 47 lives, spread terror in Surat, from where people fled in thousands to other cities. It also led to several countries cancelling flights from India.

Economic losses from the plague scare exceeded a billion dollars, including the cancellation of flights and hotel bookings and an overhaul of Surat’s public health system – although many said this was long overdue.

”Maybe some good can come out of the present pneumonia scare? It will draw attention to basic hygiene such as covering one’s mouth and nose while coughing and sneezing and maintenance of clean, sanitary surroundings,” Shiva said.

She said the outbreak could also help focus attention on the need to have robust national surveillance systems that could go a long way in checking sudden outbreaks of disease, especially in times of increased international travel.

WHO officials argue for the strengthening the global disease surveillance system, which they say has helped contain in recent years explosive epidemics of unidentified and re-emerging diseases.

Some of these diseases are old foes like cholera, plague, typhoid and meningitis. Others are new, like Creuzfeldt-Jakob disease, the Hong Kong bird flu and a virus carried by pigs. ”If a global disease surveillance system had not been in place, the outcome could have been disastrous,” said a WHO document.

But doctors like V K Vijayan, director of the prestigious Patel Chest Institute that functions at Delhi University, said WHO’s response to the present pneumonia outbreak has so far has been lacking because it has not been able to isolate a causative organism, let alone prescribe any treatment regimen.

Commented Banerjee: ”It is surprising that one month after the outbreak of this infectious pneumonia, some of the world’s finest institutes located in places like Hong Kong and backed by WHO’s expertise have no clue as to what the organism might be.”

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