Just for a moment, tears fill 29-year-old Stanley D'Silva's eyes. They glitter over his green mask, as he puts away his dog-eared Bible. Then he composes himself. "When you return after a stint abroad, you get your family gifts, clothes and goodies. Only I got them SARS as well," he says, his voice choking.

ON THEIR OWN: The D'Silva family being led into the isolation ward at a hospital in Pune

D'Silva, a Jakarta sales manager now in quarantine in Pune, is not the first SARS victim in India-that painful primacy went to Goan marine engineer Prashant Vardhe, who caught it after a visit to Hong Kong and Singapore in March. The worry is that he may not be the last. As the examples of his mother Vimla and sister Julie show, SARS, or Severe Acute Respiratory Syndrome, is here to stay.

For a nation inured to millions of deaths from tuberculosis and malaria every year, over 250 deaths worldwide would not an epidemic make. In comparison, SARS-believed to be caused by a new type of coronavirus which is on their own: The D'Silva family being led into the isolation ward at a hospital in Pune

India's lax quarantine laws and inadequate surveillance could make SARS spin out of control.

Similar to the virus that causes the common cold-has infected only four Indians, none of them even remotely fatally. Yet there is every reason to watch the clock ticking. Last week, even as D'Silva was struggling to come to terms with his social ostracism, a 29-year-old Chinese woman, Tang Li, returned to Delhi after a visit home to China's Guangdong Province. As in D'Silva's case, she was not stopped at the airport. The next morning, she went to a private doctor with mild respiratory problems. When the National Institute of Communicable Diseases (NICD) in Delhi examined her blood, urine and sputum samples, she tested positive. If her second test also proves positive, she could well become another SARS statistic.

CASE STUDY: STANLEY D'SILVA

Pangs of Isolation

Not scanned for the virus when he came from Indonesia, D'Silva ended up infecting his family

Ostracised by his neighbours, unable to attend his sister's wedding, infected with the SARS virus-in less than a fortnight, Stanley D'Silva's world has come crashing down. And why it has done so is an abject lesson in how poorly primed our health system is for a disease like SARS. HOME ALONE: Stanley D'Silva, a forlorn figure, in quarantine at his Pune home The 29-year-old Jakarta-based supermarket sales manager had done his best to take precautions. On April 8, when he walked into the Jakarta airport for a flight home to Mumbai, he wore a mask. When a passenger at the tail-end of the aircraft was offloaded at Singapore complaining of breathlessness and respiratory trouble, the other passengers were moved to the front of the plane. So far so good. The half-hour halt at Hyderabad stretched to three hours while the plane was fumigated. When D'Silva finally landed in Mumbai, where his anxious family was waiting for him, he was ushered into a room with other passengers, where they duly filled forms about their medical history. But then instead of being tested or isolated by a medical crew, they were let off. Quickly. D'Silva is livid. "If the authorities knew the symptoms, they should have put us through the check at the airport itself. If I had been isolated then, my family would not have been infected. I would have told my parents not to meet me." He points to how his sister's case was handled as further proof. Fifteen minutes before Julie was supposed to be discharged to be able to attend her own wedding, health authorities asked her to call off the ceremony. "What prompted the authorities to change their minds?" asks D'Silva, as he shields his sister from the prying eyes of the media. "How do you expect her to feel? She and her husband couldn't even exchange the customary kisses after the wedding. All they did was exchange rings.'' Now quarantined in Kumar Park in Pune and deserted by fearful neighbours, the 11 members of the D'Silva family are trying to put up a brave front." I realise safety is an issue. It's no longer a D'Silva problem but one for the entire nation.'' They cannot go out and are under the constant supervision of two attendants from the Pune Medical College (PMC). Julie's groom, Shailesh Suryavanshi, has also been quarantined along with his family. So has Reverend A.S. Joglekar, who performed the ceremony-he is still waiting for the PMC to fumigate the church. As for many of the others who made contact with an infected D'Silva, they are still very much at large. Much like SARS.

-Nidhi Taparia

Some of those statistics are worrying. SARS, which has claimed 100 victims each in China and Hong Kong, has a 5 per cent mortality rate. The DNA test used in India is only 50-60 per cent sensitive. The eight suspected cases in India that did not test positive were allowed to go free, without being quarantined-as were all of Vardhe's and D'Silva's co-passengers, whom the Government insists it is tracking. To top the list of woes, there is no cure yet for SARS, although combinations of anti-virals like ribavirin and steroids have been known to work.

TRACKING THE VIRUS

Abraham Varghese, an infectious diseases specialist at the University of Texas' Health Sciences Center, San Antonio, US, says SARS may well just be to the new millennium what the Spanish influenza epidemic of 1918 was to the previous century-although SARS is much less infectious than the flu. China's graveyard silence on an epidemic raging since November under the gaze of 24-hour news channels is equally alarming. By the time the Chinese Government admitted in March that SARS had been in its midst for six months, there had been over 330 cases in Beijing alone. The cover-up cost health minister Zhang Wenkang and Beijing mayor Meng Xuenong their jobs, but not before 18 people had died in Beijing.

Yet, what we know about SARS is less alarming than what we do not know. In Canada, which has recorded 17 SARS deaths so far, there is no unanimity about what causes the disease in the first place. Francis Plummer, scientific director of the National Microbiology Laboratory, Winnipeg, Canada, says the link between SARS and the virus is quite weak. Only 40 per cent of Canadian SARS patients have the suspect virus in their tissue samples and conversely, some people who test positive for coronavirus have no SARS symptoms.

Even Larry Anderson, a leading SARS virologist at the Atlanta-based Center for Disease Control in the US, says it is difficult to predict anything about SARS, except that it "appears to spread relatively slowly, slower than other respiratory viruses we are familiar with, but persistently". He expects the global epidemic to continue-and the virus to evolve. Initially, SARS victims were elderly people, those with low immune systems. Now victims are younger and healthier, indicating an increased level of lethality.

NO ENTRY: Staff at the international airport at Delhi check passengers. A little more caution could have saved Stanley D'Silva from infecting his family and perhaps his friends.

There is still a lot to learn. "Four cases is not enough to make a judgement about its behaviour and pathogenicity," says A.K. Mishra, director, National Institute of Virology (NIV), Pune. Tests are not failsafe. "A positive DNA test is a confirmed positive, but if a test is negative you can't say that you don't have SARS," says N.K. Ganguly, director-general, Indian Council of Medical Research. Diagnosing SARS depends on a combination of clinical symptoms and laboratory tests, which is a problem as the symptoms can vary widely. For instance, the World Health Organisation (WHO) defines a SARS patient as one who shows signs of pneumonia on an X-ray, yet all four confirmed SARS patients in India showed clear X-rays.

What's more, even as a vaccine takes months to develop, the only way to control the virus may well be to limit exposure, almost impossible in nations like China and India. All it needs is for an infected person to cough in a crowded bus or train in Mumbai-and a minor epidemic is afoot. Varghese voices these very real anxieties: "My fear is that it will take some time to realise SARS' spread in India as it was the case of China-the background noise of endemic diseases is so high."

NO PANIC STATIONS

The Government is doing its best to control panic. As soon as the who announced an alert on March 15, it made sure all the externals were in place, such as a SARS poster at the immigration counter at Delhi's international airport-"The reason there is still no major panic among air travellers," says Civil Aviation Minister Shahnawaz Hussain, "is because we have taken the issue extremely seriously." The Government has also identified nodal hospitals for treating the virus and designated two institutions-NICD and NIV-as the two testing centres. A DNA-based test for diagnosing SARS, initially imported, has been refined indigenously.

"It is because our measures are effective that we have so few cases of SARS in India today," says Union Health Minister Sushma Swaraj, who convened an unprecedented meeting of health secretaries of various states. In practice, however, there are gaping holes the size of several Chinas. At airports, screening of passengers is far from adequate. Orientation of doctors is still somewhat askew-Vardhe was calmly sent home from hospital when his symptoms subsided, and put back into quarantine only when his blood tests showed a positive reading.

"We are treating SARS with the seriousness it deserves." SUSHMA SWARAJ Union Minister for Health

The dangers to the economy are only too real. The whims of a creature smaller than a full stop has brought some of the world's most powerful economies to its knees. Hong Kong has already announced a $1.5 billion (Rs 7,500 crore) package for revitalising its devastated economy. India so far has been spared too much pain. The main tourist season in India is just over though outbound summer travel could be significantly affected. Travel agents being professional optimists are looking at the bright side. With the Gulf and South-east Asia now out of bounds, Indians may just discover India. "Much to the benefit of the Indian tourism industry, we foresee an increase in domestic travel," says Ankur Bhatia, director, Amadeus India. Exporters have been the most severely hit. Two mega fairs for exporters held in April in Hong Kong every year have been cancelled-causing Indian handicraft and gift exporters a loss of around Rs 700 crore. After a growth 0virtually no increase this year.

But industry at large has not yet started donning the mask. Ranbaxy Laboratories, which gets close to Rs 650 crore from South-east Asia and Latin America, has three manufacturing facilities in Malaysia, Vietnam and China employing around 1,000 people in the region. "Life goes on. The work so far has not been affected. Our executives continue to travel if work demands," Paresh Choudhary, director, corporate communications, Ranbaxy. "We seem to be hyping it up."

SWADESHI SARS

The origins of SARS make it especially frightening in Indian conditions. It is believed to have emerged from a deadly combination of human and animal flu viruses, possible because of the close proximity in which animals live with human beings-a way of life in India and China. "Such recombinations happen all the time in viruses,'' says Shahid Jameel of the International Centre for Genetic Engineering and Biotechnology, Delhi. So could a "Swadeshi SARS" make an appearance? And if it emerges, would India be able to detect it? Already there have been sporadic epidemics in India. In October last year, more than 50 children died of a mysterious fever in Saharanpur, Uttar Pradesh-later reported as the Herpes simplex virus. In 2001, 37 people lost their lives in a mysterious epidemic in Siliguri, West Bengal. Even now, the cause is uncertain, though the deadly Nipah or Hendra like viruses are suspected.

AN UNKNOWN COMMODITY: At the National Institute of Virology in Pune, a senior doctor tests blood samples for SARS

But it brings into question India's disease surveillance system. "NICD was not even aware of the Saharanpur development till the media reported it. Many such fevers go unreported," says Pranay Lal of the Centre for Science and Environment, Delhi. Lack of infrastructure makes it impossible. A vast disease-prone country like India has fewer than 10 bsl-3 laboratories, the international standard for reasonably dangerous pathogens like SARS. Even NICD, one of the two nodal laboratories, does not have such a facility, and has temporarily upgraded a lab for the purpose. The nation does not have a single civilian bsl-4 laboratory, the highest security laboratory for dangerous diseases-NIV will have one set up only by the end of the year at a cost of Rs 12 crore. Trained manpower matters almost as much as infrastructure. "We need more thorough maintenance of records,'' says N. Gupta of Delhi's Ram Manohar Lohia Hospital. For more than 90 per cent of viral fevers, currently, the causes are not investigated.

In 1997, India survived the Asian flu that damaged the region's economies. In a far more interconnected world, will it be as lucky with the mother of all flus? It is not a battle which needs a giant technological leap. All it needs is for India to review its disease surveillance system, follow strict quarantine rules, and be informed. Eternal vigilance is the price of good health.

-with Sayantan Chakravarty, Malini Goyal, and Anil Padmanabhan in New York