The doctors from a corporate hospital in Kozhikode district were quick to note the atypical symptoms of a patient and foresee an unknown virus outbreak.
Had they not taken cognisance of this, the Nipah virus would have caused a large number of casualties. Acknowledging their contribution, Kerala Chief Minister Pinarayi Vijayan said to be able to ascertain the pathogen in the second patient itself was a huge achievement.
The doctor largely responsible for this, Dr A S Anoop Kumar, Head of Critical Care, Baby Memorial Hospital in north Kerala’s Kozhikode district, refuses to take any individual credit, saying it was a team work that involved his colleagues Dr Ajith K Gopan and Dr Ganga Prasad; and neurologists Dr C Jayakrishnan and Dr Ummer K.
The virus was identified within 36 hours of admission of the second victim, said Dr Kumar. (The first victim was treated at the state-run Medical College Hospital). During earlier Nipah outbreaks in India and elsewhere, it took months to identify the virus, resulting in large number of casualties as the disease is highly contagious.
This is the third outbreak of the disease in India. It was detected in 2001 and 2007 in West Bengal’s Siliguri and Nadia districts respectively. The virus had reportedly infiltrated into India via Bangladesh and claimed 50 lives.
Fighting against odds
Explaining how they were able to identify the pathogen, Dr Kumar said one Mohammed Saleh from Perambra town of the district, the epicentre of the disease, was hospitalised with suspected viral encephalitis on 17 May.
“But I found that his clinical symptoms were not typical of the acute Encephalitis disease, for which he was being treated. His blood pressure and heart rate were shooting up whereas in the case of Encephalitis the blood pressure and heart rate fall. So I consulted my colleagues and specialists of the neurology department. Before we could come to any conclusion, the patient succumbed.
“However, we were keen on knowing what afflicted Saleh. Clueless, we contacted his family and found out that his younger brother had also died of similar symptoms on May 5 at the Medical College Hospital. Mohammed Sabith was the index, or the first victim of Nipah virus (NiV). His father Moosa and an aunt, who were showing signs of infection were also admitted to the hospital, but they too succumbed.”
Encephalitis does not spread like this. So the needle of suspicion pointed to Nipah virus, said the critical care specialist, who was recently conferred the Dr B C Roy award for 2018.
“I contacted my good friend Dr Arunkumar, director Manipal Centre for Virus Research
(MCVR) and got a relative of the deceased to deliver Saleh’s blood and fluid sample to the Centre, which is a good 300 km away in Karnataka,” he recalled.
Normally the samples are sent by courier but that would take time, Dr Kumar said adding that the relatives gave their full cooperation. They also allowed the doctors to conduct a pathological autopsy on Saleh as they struggled to find out what he was exactly suffering from.
Notable feat
The virologist received the sample by 8 am on 19 May and within 12 hours it was confirmed that the mystery virus was indeed Nipah. The sample was cross-checked by National Institute of Virology in Pune and after completing legal formalities, the Nipah virus outbreak was officially announced 20 May, said Dr Kumar.
This enabled the state health department put in place measures to isolate others suspected of carrying the virus and saved many lives. It also earned Kerala WHO’s appreciation, Kerala Health Minister KK Shylaja said.
The feat was lauded by none other than renowned scientist, Dr Robert Gallo, co-founder of globally-acclaimed Baltimore institute of the US. The institute presented an award to Kerala government for its efforts in successful containment of the virus.
Close contacts affected
Only persons who came in close contact with the victims contracted the virus. Sabith wasinitially taken to the Taluk Hospital at Perambara town in the district and then shifted to Kozhikode Medical College. During his stay in Perambra Hospital, a nurse attending on him, Lini Puthussery, fell prey to the virus.
At the Medical College Hospital too, people who came in contact with Sabith got infected.
He was persistently coughing while being wheeled into the CT scan room and some people waiting in the corridors possibly got infected. Out of the 18 confirmed cases, 17 were directly in contact with the index case, said Dr Arunkumar. Altogether 16 people, including the index victim, his brother, father and an aunt, died. Only two persons who tested positive recovered.
There is no known cure for the disease nor vaccine, only intensive supportive care. Nearly 2,000 people, who had any contact with the victim, were kept under surveillance and provided free food, according to district collector U V Jose.
Culprit fruit bats
Dr Arunkumar, who also bagged Dr B C Roy award for his efforts, said the first person who died due to NiV was infected by a bat. “It is proven across the globe that fruit bats are responsible for the outbreak of NiV.”
Why then, were bats from the infested well, tested later, found to be negative? “The virus is present only in one or two bats among a colony of bats. A thousand bats need to be tested to ascertain the presence of the virus,” he pointed out.
Reportedly, Moosa had bought a piece of land and was planning to shift there. His sons had gone to clean a well in the land that was infested with bats and that spelled their doom.
Normal life out of gear
The virus outbreak caused a dramatic change in the rhythms of daily life in the Malabar region in particular and the state in general. Once the Nipah virus was confirmed, all government machinery moved in tandem to contain the spread, said Jose. Advisories were issued against travelling to the northern districts of Wayanad, Kannur, Mallapuram and Kozhikode. Later the travel ban was lifted from non-affected districts of Wayanad and Kannur.
All public meetings were discouraged. No iftar parties or prayer meetings, except mandatory ones, were held. No weddings, engagement, house warming ceremonies were allowed. Streets, churches, temples, malls and markets wore a deserted look.
Though the virus was confined to the northern districts, the impact was felt in the entire state and across various sectors. Even in the Capital city of Thiruvananthapuram, people were exercising caution and refraining from consuming juicy fruits like mangoes. People restricted travel and ventured out only if required. Summer holidays of schools and colleges were extended.
All employees of government offices were supplied face masks and gloves. The general public, auto and taxi drivers, vegetable and fruit vendors all wore face masks. “The roads resembled a huge operation theatre, with almost everyone in masks and protective gear,” commented university student Rohit Nair.
Virus plays spoiler
The NiV played a spoiler. It was holiday season, the Holy month of Ramadan and time for family reunions but many people, especially those working in the petro-rich Gulf nations, could not come home. Bahrain, UAE, Saudi Arabia and some others had issued advisories against visiting India. An estimated over 1.5 million people from the state work in the Gulf region, the modern El Dorado.
Many young men and women, who had planned wedding celebrations during the time, were in for disappointment. Many relatives could not reach Kerala and even if they did, several religious groups, conscious of their social responsibilities, did not allow such functions, where people congregate in large numbers to avoid spread of infection.
Housewife Jameela Mohammed, who was awaiting her son’s return from the United Arab Emirates after two years away, was disappointed. “Also, with no Iftar parties, we were not getting a feel of the festival,” she said.
The fear of infection, fuelled by rumours over social media and messenger applications, caused unprecedented panic. Fear was palpable as the virus has no known cure and a high mortality rate of 70 per cent.
Business down
The footfalls at shopping malls and cinemas too drastically reduced. Most Malayalam film producers reportedly withheld releases in Kerala till situation improved. Manoj Diwakar, general manager of Focus Mall in Kozhikode city, spoke of a fall in business.
“We used to get a good crowd with footfalls upwards of 14,000 per month, but that has dropped to 11,000.” Seeing the dismal situation, doctors of Medical College Hospital visited shopping complexes and told people not to avoid shopping, just maintain personal hygiene and keep washing their hands but in vain, said Diwakar.
Even busy S M Street market in Kozhikode city, which is generally teeming with people, wore a forlorn look. An eerie silence prevailed over the streets, which used to bustle with activity in the evenings with the tantalising aroma of meat and other exotic food wafting in the air during Ramadan season.
Muhammed Basheer, general secretary, Palayam Footpath Labourers’ Union, said fake messages over social media were amplifying the fear and they were running huge losses.
Fruits like mangoes and bananas had no takers and prices plummeted by 50 per cent or more. People were not ready to risk consuming these fruits, said supplier Guna Ramachandran. He said exporters to West Asia faced huge losses as countries such as Bahrain, the UAE and Saudi Arabia banned fruits and vegetables from Kerala. The state reportedly suffered a loss of Rs. 90 lakh in daily revenue.
Kerala with its mesmerising backwaters and mouth-watering seafood cuisine, is a favoured tourist destination. But the state’s tourism industry, a mainstay of the economy, was badly hit with cancellations following travel ban advisories by Gulf nations, said Johny George, a member of the Tourism Advisory Committee.
Not only businesses, even private transport providers like buses, autorickshaws and taxis faced the crunch with people not venturing out unless required. However, losses and discomfort notwithstanding, people heaved a sigh of relief when Shylaja announced on 1 July that spread of virus has been thwarted. Kozhikode and Malappuram districts are being temporarily declared as free of Nipah infection.