National 5 (Spotlight Weekly)

Battle With The Bug

Nepalese officials are under pressure to come up with a strategy to confront SARS, as rumors fuel panic among the people

By KESHAB POUDEL

Caught in a two-day Nepal bandh amid continuing student protests this week, Kathmandu valley residents encountered the chilling news of three cases of Severe Acute Respiratory Syndrome (SARS) infections. As news appeared in the media, people thronged medial stores to buy surgical masks.

A hospital in far-west : Is it aware?

While the majority of the rural people remain unaware about the implications of the virus, the urban population - who have access to the Internet and international television channels - have been gripped by a wave of panic.

On Sunday evening, medical workers at the Sukraraj Hospital (for Infectious and Tropical diseases) in Teku were baffled when three foreign citizens who arrived from Hong Kong were referred to the hospital by medical teams at Tribhuvan International Airport (TIA) on suspicion of SARS infection.

As panic spread across the hospital and its vicinity, the medical officer denied the three admission. The hospital subsequently dismissed the media reports. "We did not have any referral from the airport. This is just a false rumor and there is no question of our denying treatment to the three people," said a senior hospital staff on condition of anonymity.

Some eyewitnesses, nevertheless, confirmed that a minor fracas had erupted when the foreigners demanded urgent attention and were rebuffed.

A few weeks ago, the government set up a medical camp at the TIA to monitor passengers coming from SARS-affected regions. Each passenger coming from Hong Kong and mainland China is required to fill in a form detailing his or her health report of the previous week.

The three Canadians were referred to the hospital when the medical teams at the airport detected some symptoms of SARS. Had these tourists been infected by SARS, they would have spread the virus around them.

Fortunately, Nepal has not reported a single patient with the SARS virus. The country's existing health system is in no position to stop the epidemic. Recognition of this reality has played an important part in fuelling the rumors.

"I saw medical staff going outside taking his mask and glove. They asked us to take precautionary measures," said a man whose patient was being treated at the hospital, on condition of anonymity.

The panic in the hospital was understandable, as the casualty level among the medical staff was very high in Hong Kong and mainland China. At a time when the government is yet improve the hospitals' capabilities to treat SARS patient, no one is in a position to take risks.

"We have not received any directions on how to treat the SARS patients and there is no special system to put the person in quarantine," said a paramedical staff. "Since the hospital does not have any respiratory equipment, how can we treat them here?"

Government officials, however, insists that proper measures have been taken. "The government has already allocated some beds at the Teku Hospital to treat the SARS patients," said Dr. Beni Bahadur Karki, director of the Department of Health. Despite his claim, the hospital management said x-ray and blood testing equipment were removed from the hospital.

Regardless of the government's claim, the hospitals and nursing homes in the valley are yet to get proper directions on the treatment of the SARS virus. Since the disease is very complicated, delay in identification, like in any other viral infection, could prove fatal.

Since the last few weeks, Hong Kong, Beijing and the southern Chinese province of Guangdong are regarded as a breeding ground for SARS virus. Considering the geographical proximity, Nepal, too, is vulnerable. There are more than 50,000 Nepalese living in China and there is frequent interaction between the countries. Royal Nepal Airlines flies three flights week to Hong Kong.

The World Health Organization (WHO) has already issued an unprecedented warning against travel to the hardest hit regions of Guangdong, Beijing and Hong Kong and has urged airlines to cut the flights to affected zones.

Researchers averred that while the disease was contagious, it chiefly required close contact with an infected patient to be spread, most likely through respiratory droplets spread into the air by a cough or sneeze. The virus is easily passed from person to person through the air by droplets and small particles excreted when infected individuals cough or sneeze. According to the WHO bulletin, the respiratory illness caused by influenza is difficult to distinguish from illness caused by other respiratory pathogens based on symptoms alone.

Investigators have considered several transmission theories for the outbreak, the most disturbing being that the SARS virus is airborne, meaning it can move through ducts.

Prompt action by local health authorities can nip an outbreak in the bud, saving lives and millions of rupees. "When the country confronts a new disease, the government has to do everything to try to stop the transmission," said a doctor.

If officials seek to downplay the disease to avoid panic and bad publicity, the virus will slip into the general population. Far from being contained, the disease seems to be gathering steam. The countries in the region are implementing tough quarantine methods to contain the disease. Whenever new cases are discovered, there require tracking down not only the patient's immediate families, friends and neighbors but also their office colleagues.

The WHO had already decoded the entire genetic sequence of the new corona virus now conclusively believed to cause SARS. In the last two months, scientists have found better diagnostic tools amid hopes of a treatment and perhaps even a vaccine. One highly accurate test kit can detect SARS in less than three hours.

Identifying the virus, however, is just the first step in a long battle against the disease. AIDS, SARS and the common cold are caused by viruses. They are notoriously hard to kill. There are many medicines to fight against most of the bacterial infections, but a viral invasion is difficult to control.

According to medical practitioners, the bacteria are living organisms. Antibiotics can control bacterial infections by attacking enzymes and allowing the body's immune system to mop them up. Viruses, however, are parasites incapable of producing on their own. They are inactive until they burrow into a host cell, talking over its factions in order to replicate and thereby destroying the host. Despite the efforts of scientists, it will take more than a year to develop a vaccine.

According to researchers, at present, about one in every 20 SARS victims dies, usually due to swelling in the lungs, a result of the body's immune system response. The doctors in Hong Kong are now using anti-viral drugs to inhibit the virus combined with cortosteroids to check the virus. Scientist are exploring other anti-viral such as interferon, which boosts the immune system or even HIV drugs such as protease inhibitors, which block an enzyme the virus needs to replicate. Unlike HIV virus, the corona virus seems to be more stable than HIV, and researchers are confident that SARS specific antiviral and vaccines can be developed over time.

What are corona-viruses?

Until SARS appeared, only two human and 12 animal corona-viruses were known. The human viruses are responsible for one-third of all common colds. In animals, the viruses change frequently through a process called recombination, whereby two viruses exchange genes. If that happen, the new viruses can be passed on to new hosts.

Each corona-virus contains its own genetic code. At some point, two viruses simultaneously infect cells by attaching themselves to receptors on the cell membrane. According to Time magazine, after the viruses enter the host cell, their genetic code is coupled and swapped. New pathogens may have characteristics different from those of their parents. The newly formed corona-virus can then successfully invade a new host.

Nepal would almost certainly see cases of the SARS virus and public attention is focused on how soon the government would prepare a strategy to contain the disease. The first few days' incidents have exposed many glaring weaknesses.