Lightning is unlikely to strike the same place twice, but the Nipah virus is again wreaking havoc in Kozhikode, the fourth outbreak of the disease in Kerala over the last five years. Caused by a zoonotic spillover, the transmission of pathogens from animals to humans, the closest reservoir of the virus is fruit bats. With two persons dying of Nipah this week in Kozhikode, and three more persons, two of them relatives of one of the victims, testing positive, and being hospitalised, disturbing memories from the terrifying outbreak of 2018, in which 21 of 23 infected people died, have surfaced. The situation remains very much the same, in terms of treatment options: there is no cure, and supportive care remains the only way to handle Nipah infection even in a hospital setting. Kerala’s Health Minister Veena George said hundreds of people on the contact list of the deceased had been put under medical observation. One of them, a nine-year-old child, is on ventilator support. A control room has been opened in Kozhikode to monitor the situation, and all the hospitals in the district would be asked to follow infection control protocols. Sixteen teams have been formed to take forward appropriate containment protocols. A central team has also been sent to Kerala to assist the State government. Neighbouring States have taken preparatory steps to ensure that porous borders do not bring the infection across from Kerala. The State’s Chief Minister assured the people via a video message that the State was taking the issue very seriously.
While experiences from the prior outbreaks (2018, 2019, 2021) have given medical teams a toolkit of protocols, across the sectors — management, isolation, containment, and treatment — constant vigil can be the only guard against such outbreaks. The biggest lesson though, from global outbreaks, is likely unlearnt yet. Research has shown that anthropogenic activity has a definite hand to play in zoonotic spillovers. In the case of Nipah, rapid expansion of agricultural activity in original habitat zones of the fruit bats has repeatedly shown up on post-factor analyses. As governments mount strategic efforts to control outbreaks and deaths due to infectious diseases, it is increasingly clear that the State needs to initiate a One Health approach on the way forward. The COVID-19 pandemic has led to a deeper appreciation of the One Health concept, which is an integrated, unifying approach to balancing and optimising the health of people, animals and the environment, with the conviction that humans live in symbiosis and that the health of one impacts that of another significantly.