Every crisis is an opportunity. Kozhikode and its people can stand testimony to this as they fought off — alongside the government, the medical community, and the media — a grave public health challenge that manifested in the form of the Nipah outbreak.
There was a sense of mystery as the tragedy unfolded in mid-May at Sooppikkada, a hamlet in Changaroth grama panchayat, near Perambra, around 40 km from the city. Two brothers died in a span of two weeks in similar circumstances, exhibiting similar symptoms, and two more of the family were hospitalised. The apprehensions of two alert doctors of a private hospital in the city proved correct when the results of the second brother’s body fluid samples confirmed the presence of the deadly virus, at a lab in Manipal.
Sensing trouble, Health Minister K.K. Shylaja rushed to Kozhikode to take stock of the situation. At a late night press meet at the government guest house on May 19, her first attempt was to allay the fears of the people as social media was agog with rumours of an unheard of virus out to hunt people. “We are awaiting the test results from the National Institute of Virology, Pune. Until then, we cannot say for certain what is the cause of the deaths. We are ready to face any eventuality,” she said.
No bid to cover-up
Late next day, R.L. Saritha, Director, Health Services, confirmed that the deaths were indeed caused by Nipah. By then, there were more deaths and more persons were admitted to hospitals. There was no attempt at a cover-up of the real magnitude of the situation. It was already international news as a team from the National Centre for Disease Control (NCDC) termed it the “third major outbreak in the country”, “unusual” and “a cause for concern”.
The government machinery swung into action. Help was sought from private hospitals and all other branches of medicine. The Government Medical College Hospital, Kozhikode, soon became the hub of activity as people with Nipah symptoms, mainly those from Kozhikode, were admitted there. Other district hospitals were instructed to set up isolation wards to address any possible eventuality as three of the victims were from Malappuram and suspected cases were reported from across the State. Personnel from departments such as Animal Husbandry and Forests and virology experts were called in to ascertain the source of the infection.
Link among victims
Almost a week into the outbreak, a pattern set to emerge. The victims and those who were suspected to have the symptoms of the infection were found to have certain links. The second and third victims belonged to the same family. Those who succumbed later had all been with them at the taluk hospital in Perambra and later the Government Medical College hospital, Kozhikode, as patients, helpers or visitors. Some others, like a nurse at the Perambra hospital, had attended to the Nipah-infected patients.
However, the tragedy had already had a huge impact on the social psyche of Kozhikode. People wearing masks became a common sight as it was known that the infection would spread through body fluids. Very few vehicles plied on the road. It was just a few days into the Ramzan season, when the social life of Malabar comes alive normally in the evening. Iftar parties and house visits suddenly dropped. Not many came home from the Gulf. Business was down — sale of fruits was hit hard as the carrier of the virus was suspected to be fruit-eating bats. Bishops advised the clergy to exercise caution at Sunday services and other rituals.
Bus services to Perambra and areas such as Kuttiyadi were cancelled as people were scared of travelling.
The otherwise throbbing business centres such as S.M. Street wore a deserted look for many days. Those from other parts of the district avoided travelling to Kozhikode and Malappuram following a government advisory to people to avoid travelling to Malappuram.
All this while, the Health Department apparatus was working undeterred by the fear gripping the region. A State Nipah Cell started functioning at the government guest house, Kozhikode. From the ground-level staff to the higher authorities, all were engaged in containing the infection and trying to stop it from spreading among the community. Leading from the front were the Health Minister and Additional Chief Secretary (Health) Rajiv Sadanandan. A long list of people and health professionals who might have had any contact with the dead and the infected people was prepared. They were kept under surveillance. A helpline was opened at the guest house for people to clear doubts and seek assistance in case of health emergencies. Health staff were trained to face psychological trauma. Ribavirin, an anti-viral drug, was administered to the critically ill patients, and human monoclonal antibody was procured from Australia.
Activities reviewed
All these activities were reviewed by Ms. Shylaja and Ministers T.P. Ramakrishnan and A.K. Saseendran, Mr. Sadanandan, Dr. Saritha, and MCH authorities, among others. All the information related to the Nipah cases came only through the Health authorities who made it a point to address the media regularly. Except a few aberrations, the coverage of the issue by the media too was restrained, devoid of sensation. As happens in such situations, social media became a source for information and misinformation alike. Action was taken against those who spread rumours and canards through the social media to suit their vested interests. The NCDC changed their prognosis about the outbreak to announce that “it was just a local occurrence”. Just when everyone thought that the situation was under control, there were three more deaths in the last week of May, taking the toll to 17. The authorities were on a high alert once again as debates centred on a possible “second wave” of infection. However, it soon turned out that the three persons too had a link with the earlier victims through government hospitals, including the Balussery taluk hospital.
There have been no new deaths or positive cases so far this month. Two persons who had earlier tested positive for the virus infection, are on the path of recovery and their blood samples have tested negative for Nipah. The number of people under observation at the MCH too is dwindling, prompting Ms. Shylaja to declare in the Assembly that the “situation was under control” though “the alert would continue” till the month-end. The source of the infection, however, remains unclear and veterinary experts have called for a detailed epidemiological study. Meanwhile, life is coming back to normal in Kozhikode. The feeling was summed up by a senior citizen on a bus to the medical college hospital on Friday.
“Everything will return to normal by the day of Id-ul-Fitr. Very soon, the football World Cup will start too.”
