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India free of SARS, not SARS virus: Officials

Officials and WHO say it is the fine line between infection and the disease, that made the difference.

india Updated: May 03, 2003 13:27 IST

India has been declared free of SARS but the 20 cases that tested positive are SARS-infected, officials said on Friday.

It may sound baffling, but Indian health authorities and WHO say it is the fine line between the infection and the disease - similar to the difference between HIV and AIDS - that made all the difference.

And as experts grapple with the problem of defining and restraining the outbreak that has claimed nearly 400 lives worldwide, it all boils down to semantics.

"The definitions of the disease keep changing as more and more facts come to light," a senior Indian Council of Medical Research (ICMR) official said here.

"If we go by the SARS definition of today, there are no cases in India. But there can be suspect cases," he asserted.

Asked about the ostracism that a Pune family suffered on account of being declared "confirmed SARS cases", the official defensively passed some of the blame for the panic to WHO that had jumped the gun without going too deeply into the first few cases and then revised its definition.

On the other hand, WHO official in charge of infectious diseases N Kumara Ray reminded that SARS was a new disease and its laboratory testing kit was still being developed.

"So far, WHO does not consider the laboratory tests as a criterion for inclusion or exclusion of SARS cases. As per our criteria, the diagnosis of SARS is made purely on clinical and epidemiological grounds," said Ray.

SARS has infected 20 Indians since last month and scores have been quarantined as suspected cases but no deaths have been reported in the country from the disease that has infected 5,400 people across the world.

According to WHO, India could have seen only mild cases so far due to the higher immunity developed in India where hygiene and sanitation were low resulting in frequent infection of coronaviruses like the one that causes SARS.

"Many people might have developed immunity to these harmless viruses and as a result there is a higher immunity to SARS here," Ray said when asked why China, despite being similar in population density and several other aspects, had seen so many SARS deaths.

Another key reason SARS had not really taken a serious turn so far in India could be, according to experts, that the virus may have mutated once it entered India and become less virulent. It could, of course, become more virulent.

The ICMR official said out of the 20 cases, 10 had come from countries with a local outbreak and exhibited symptoms such as cough, cold and sometimes breathing difficulties that, however, did not develop into full-blown SARS.

The others were a-symptomatic cases that had come in close contact with a SARS-infected patient.

It could seem like a lot of hair-splitting to the layperson, but WHO now differentiates SARS cases into "suspect" and "probable" cases.

A suspect case shows fever, headache, muscle or joint pains, breathlessness and a history of contact with a case or travel to affected regions.

A probable case would be a suspect patient whose chest x-ray showed pneumonia of both lungs.

In India, all suspect cases showed mild clinical symptoms but none showed pneumonia.

The ICMR is currently trying to conduct tests on a set of monkeys to demystify the virus in its laboratories. The official said: "When we get permission to use them, expand the virus colonies and conduct serological tests, we can learn more about the infection and its cure."

First Published: May 03, 2003 13:27 IST