Peace in exchange
Sir — There is never a dull moment in the drama involving India and Pakistan. Our neighbour’s latest move appears to be a demand for a hands-off policy from India vis-à-vis Afghanistan in exchange for cutting down its patronage to terrorist outfits in Jammu and Kashmir (“Afghan piece in Kashmir puzzle”, April 28). If Pakistan’s demand is not outrageous enough — it was hardly expected to extend the olive branch India’s way — the eagerness of the United States of America to fall in line with it surely is. There is no doubt that Pervez Musharraf wants India to distance itself from Afghanistan because he wants the war-ravaged country to serve as his backroom. Whether India lends a hand to Hamid Karzai in rebuilding his country or not, cross-border terrorism in Kashmir will not become a thing of the past in a hurry, though there could be a minor and temporary de-escalation to show the rest of the world. Kashmir, after all, is much more important than Afghanistan to Musharraf and his country. The only regret is that a country in ruins must be made a pawn in this sordid game.
S.P. Tyagi, Patna
Sir — The report, “All that you should know about SARS” (April 28), gives a bird’s-eye view of the severe acute respiratory syndrome. However, there is some confusing information in the article. It has been stated that the family of “coronaviruses” (the same virus that causes SARS) causes common cold. Common cold is caused by a host of different organisms. Although some members of the “coronaviruses” family cause a milder form of upper respiratory tract infections like the common cold, these viruses are by no means involved with each and every incidence of common cold. It should also be noted that the common cold-causing “coronaviruses” are genetically quite different from the “coronaviruses” that cause SARS.
Regarding the treatment of SARS, it has been stated that doctors “worldwide” have been treating SARS patients with Ribavirin, an antiviral drug, and steroids. Although some centres in different parts of the world have empirically used Ribavirin with or without steroids for this new disease, there is absolutely no proof till date that such therapy is effective against the SARS viruses. Ribavirin is generally indicated in selected cases of respiratory syncitial virus (a virus widely different from the “coronaviruses”) induced severe lower respiratory tract infections in children. Ribavirin has also shown some success against viruses like influenza A and B, chronic hepatitis, measles, and Lassa fever. In a recent update from the Center for Disease Control, it has been claimed that the concentration of Ribavirin that inhibits other Ribavirin-sensitive virus infections, does not appear to have any effect on “coronaviruses”. On the other hand, Ribavirin is a known teratogen (a substance that causes developmental malformation) and has other severe adverse effects like hemolytic anaemia. It is also not true that doctors “worldwide” use Ribavirin to treat SARS. Most of the SARS patients in the United States of America have recovered without the use of any Ribavirin, as regularly reported by the CDC. Indeed, neither the CDC and nor the WHO treatment guidelines for SARS patients recommends the routine use of Ribavirin. Indian physicians will be well advised to consult the CDC and WHO recommendations for the treatment of SARS. They also need to be aware of the harmful effects before starting to use Ribavirin for SARS.
Kunal Saha, Columbus, US
Sir — I am a frequent visitor to Bangladesh. This time, while returning from Dhaka, I watched the elaborate arrangements at the Dum Dum international airport to isolate passengers coming in from the SARS-affected countries. I would like to draw the attention of the health officials and the government of West Bengal to the group of young men in their mid-twenties frequently visiting Hong Kong and Singapore via Bangladesh. They are called “delivery boys” and they bring a variety of items from these countries through legal and sometimes illegal ways. They enjoy excellent rapport with the airport personnel. Their baggage is hardly checked and they get preferential treatment. But these persons are coming from the “danger zones”, and because they are not screened properly, there is every chance that SARS may sneak into this country silently through these airport-friendly men.
N. Sen, Calcutta
Sir — The incident of the Beliaghata Infectious Diseases Hospital releasing Calcutta’s first SARS patient at the insistence of his family members is deplorable. The interim period between his release and his admission to the Advanced Medical Research Institute might have already spread the virus among many. But the airport authorities are to be equally blamed. There was nothing that could have possibly kept them in the dark about the fact that he was returning from a trip to China and southeast Asia. So he should have ideally been quarantined and tested immediately. Vaccines to combat the virus are still being developed and even proper masks to be worn as precaution are not available in the city. Health officials and the government should step up action to restore faith in the public.
S. Ram, Calcutta
Sir — The first known SARS case in Calcutta brings to the fore the absolute lack of responsibility and incompetence of the officials concerned towards public health. Developments in the past few days have been reported with regularity. However, more needs to be done to make people aware of all the symptoms and necessary precautions to be taken. This is especially needed for the thousands living in rural areas as well as the slums of Calcutta for they hold the maximum chance of spreading the disease should they get infected.
Sir — SARS has become so dangerous that we have no other option but to keep an eye over frequent fliers and suspected patients coming from these countries. Some shopowners in the Kidderpore area are frequent visitors to Bangkok, Singapore and Hong Kong. They buy goods there and sell them in Calcutta. It would be better to check them immediately on their arrival at the airport itself rather than allow the infection to spread.
Govind Das Dujari, Calcutta
Sir — The tall claims of West Bengal’s SARS-readiness have proved to be hollow. More surprising was the remark of the health minister that there is no need to panic. Like a true politician who can only count numbers, he has promised to provide more doctors. Why can’t we learn from those who are doing it best' Like Singapore. The WHO has commented that if Singapore could not contain SARS, no one can. What the West Bengal government can do is adopt the following measures: make a high-level cross-functional ministerial committee to monitor the day-to-day situation; give press briefings from one source only; create a cell for people to contact and for ensuring that home-quarantined persons cannot go out of their homes; designate ambulances for SARS suspects; make it mandatory for people travelling abroad or in close contact with SARS patient to give health declarations; create the infrastructure to transfer all medical staff attending SARS patients to the infectious diseases hospital or quarantine them for 10 days; create public awareness about SARS; send circulars to all hospitals and nursing homes about the necessary steps to take in case they have a SARS suspect; check the sewage system and the possibility of SARS contamination as in Hong Kong; adopt contingency plans, for possible SARS epidemic in slum areas.Above all, one must take precautions for oneself. Last but not the least, one must look at the whole thing realistically. Only six per cent SARS affected people are dying, a percentage much lower than AIDS. If we can live with AIDS, there is no reason why we cannot live with SARS.
Anindya Ghosh, Singapore
Sir — The report, “Virus victim turns medical reject” (April 29) mentions that anti-viral filter masks are not available in Bengal.We beg to differ. Ours is a joint venture company of Mine Safety Appliances Company, and Exide Industries Limited, India. We do have masks for protection against SARS with filter class N95, which are available from our works based in Calcutta. Our address: MSA India Limited, P-25,Transport Depot Road, Calcutta 700 038. Telephone: 24492206/1657/1707.
Sudipto Bhattacharya, Calcutta
Sir — Please note that VENUS Safety & Health is manufacturing WHO approved masks and is promoting them through its network of dealers in Calcutta.
Jayati Chakravorti, Calcutta