SARS: How India tackled previous coronavirus outbreak

Like novel coronavirus, SARS coronavirus outbreak had happened during winters in China. But unlike Covid-19 pandemic, India largely remained insulated from coronavirus outbreak back then. A story to think it over

HIGHLIGHTS

• SARS outbreak happened in 2002-03 in China and spread to many countries
• SARS was the first major coronavirus outbreak anywhere in the world
• India had managed to keep the country insulated from raging SARS coronavirus

Novel coronavirus is the seventh member of its family to attack humans. Except the two SARS and one MERS coronaviruses, none have caused an outbreak. The SARS outbreak of 2002 was the first serious health crisis posed by the coronavirus, believed to have come from bats.

The current virus, SARS-CoV-2, has been named so due to its similarity with SARS. Incidentally, both the coronavirus outbreaks originated during winters in China - both in November. Some researchers, however, say SARS-CoV-2 outbreak could have begun in September.

On both occasions, China was found reluctant in acknowledging the outbreak. During the SARS outbreak, China recognised it only in February. This time around, China reported on December 31 and took another three weeks to confirm that the virus could transmit from human to human.

Still, the SARS outbreak did not assume the scale SARS-CoV-2 or Covid-19 pandemic has attained. Covid-19 has killed more people than SARS had infected.

India had remained largely unaffected by SARS outbreak. India reported three "probable cases" of SARS - one each from West Bengal, Karnataka and Gujarat. The probable cases were those who had tested positive in the PCR (polymerase chain reaction) test, as per WHO's existing guidelines.

There were 10 more "suspected" cases of SARS infection - three from Karnataka, two from Maharashtra, and one each from Delhi, Tamil Nadu, Chhattisgarh and Rajasthan. Only one "probable" case was diagnosed to have pneumonia.

With the way SARS infection was spreading then in some of the worst-affected countries such as China, Canada, Singapore and others, India was worried over the possibility of community spread of the disease. Not having a vaccine or known drugs for the virus had sent the health authorities in a tizzy.

India responded by ensuring that the virus did not enter the country. It was easier back in 2002 to have surveillance over international passengers coming into India.

The number of international passengers arriving in India in early 2003 was 1.20 lakh a week. This was the time of SARS outbreak, which for some reason did not spread as fast as its newer cousin. In January-March 2020 period, average daily inbound international passengers were over 85,000 or about 6 lakh a week.

Back then, the passengers arriving at Indian airports were screened for SARS that was more like the current Covid-19 self-declaration proforma.

Those with a SARS compatible illness were sent to designated hospitals for treatment in isolation. Healthy passengers were asked to self-monitor their symptoms for next 10 days and report to local health authorities if SARS signs were observed.

Another step that was undertaken was to expand a five-year-old pilot project by the National Surveillance Programme for Communicable Diseases (NSPCD) from five districts in 1997 to over 100 districts.

This is how India found all its probable and suspect cases of SARS. All the three probable and nine of the 10 suspect cases of SARS were people who had to India from other countries. The other suspect case had never gone out of India. The authorities traced and quarantined 60 of her contacts. No further cases were reported.

At a global level, SARS created a lot of panic particularly among healthcare professionals. For the first few months, they were the ones to be infected most. The situation came under control only after it was realised sometime in March 2003 that PPE (personal protection equipment) can prevent healthcare workers from SARS.

In India, the panic led to a unique response from Air India pilots. They refused to fly to SARS-affected countries.

Writing for the National Medical Journal of India, published by the AIIMS, then director general of health services in the health ministry SP Agarwal warned, "The SARS coronavirus is neither the first nor the last virus to emerge as a major threat to public health The SARS epidemic, therefore, should be considered as an opportunity to improve public health systems."

Yet, 17 years later, India -- along with the world -- is waking up to same realisation after being challenged by the newest member of the coronavirus family. Incidentally, it was another BJP-led government at the Centre when the previous SARS coronavirus hit India.