Swine flu was first reported in Mexico, SARS and bird flu in China, but India surprisingly escaped being ground zero for any.
China: SARS in 2002-2003 and bird flu in 1996, both in the southern provinces. Malaysia: the Nipah virus in 1998 — encephalitis in humans via pigs, from fruit bats. Probably Mexico: swine flu or Mexican flu this year, a hybrid of human, swine and avian viruses which the WHO politely rechristened Influenza A(H1N1), using the technical terminology, a few days ago. Pair up these widely feared pandemics — there have been many others in history — with their supposed places of origin and one fact is prominent for its absence: India. Doesn’t India incubate any such dangerous viruses?
To start with, the reason these viruses are such a threat is that they are totally new in humans, and therefore we have no immunity to them. Since the body has no defence, even a relatively mild pathogen can become a severe hazard, even a killer.
The reason such viruses are new is that they evolved at first in animals other than humans, typically vertebrates like pigs, birds, cats, dogs, horses. Each of these species, like humans, is a reservoir of hundreds of specific pathogens which are perfectly adapted to them. The animal, or the human, does not even need to be apparently sick to be harbouring, or indeed spreading or “shedding” the pathogens.
Clearly these are animals with which people live and work. In poorer parts of the world, humans may even share living space with some of these animals. Such extended proximity explains why what starts out as an animal virus can eventually evolve enough to make the jump from one species to another — to humans. In the case of the ongoing influenza, which probably originated in pigs (physiologically not dissimilar to humans), scientists think that the pigs were a mixing bowl in which avian and human respiratory viruses came together with a swine virus, to make a hybrid virus which could attack human cells and, thanks to the avian element, could reproduce speedily. Such a virus can be a quick learner and a quick adapter — and therefore more virulent. The human-to-human transmission of Influenza A(H1N1) comes from such adaptability, and this is what has health professionals so worried now.
So why has this not happened in India? After all, the conditions that made a cross-species jump possible in south China or Malaysia are not so different from conditions in parts of India.
“It’s the heat that has killed the virus,” speculates medical historian Mridula Ramanna, who has closely studied the Indian career of the 1918-19 pandemic of “Spanish flu”, which is estimated to have killed between 35 and 100 million people worldwide in the immediate aftermath of World War I. “The number of deaths was almost 17 million in India in 1918,” says Ramanna. “The colonial power attributed [the flu] to India, but it appears to have come from outside by ship.” Many epidemiologists (experts on the transmission and control of disease) and historians think the 1918 influenza started in southern China and probably, like the ongoing “swine” flu, combined avian and swine with human traits — although at a much higher level of virulence. (Even so, only a small proportion of those who contracted it actually died.) Spanish flu is the spectre in the minds of modern epidemiologists.
The unseasonal April heat in India is one reason medical opinion cites, because the influenza virus does not last long in hot weather outside the host’s body; but it is not always hot here. Peak influenza season (when people have coughs and colds), moreover, is cool weather, yet no outbreak of an emerging virus has started in India even in winter.
Not surprisingly, medical professionals are extremely wary of speaking about the influenza situation in India.
“We don’t know that they don’t occur in India. They probably do, and we don’t know.” say Kalpana Swaminathan and Ishrat Syed, authors of a substantial new book on mass disease and history, and both paediatricians. “If 10 people die one after another in a jhuggi cluster, who notices? Next time you’re travelling across the city, look and you will see lots of swine and humans around living in close proximity, living together in some cases.”
And it’s a misconception, they point out, that doctors always know what they are treating: “Most of these new emerging diseases which are viral or present mainly as fevers — all you can do is make sure the person stays alive until his own body can overcome the pathogen. These diseases are killers because we don’t know anything about them.”
Given the constraints they are so familiar with, these doctor-authors are full of praise for China during SARS, once the government realised that concealment was counterproductive: “China is like us — sprawling — so when you look at what China did to control SARS, it’s really marvellous. Would we be able to do it?”
For the moment, Influenza A(H1N1) appears to be less potent than doctors originally feared. The number of confirmed fatalities, while tragic, is not large. Yet such viruses don’t vanish — they continue to exist in various reservoirs, and may come into play again in cooler weather. The more widely they spread, the greater the risk they pose. It’s just possible that India has not given the world such a virus — yet — but the future is wide open.
