The anatomy of an outbreak — Breaking down Nipah

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This week, the subject picked itself. When there is an outbreak, the Health column writes itself. The last week has been a frenzy that characterises every outbreak, as initial reports of two people dying of Nipah Virus (NiV) came in, along with two other contacts of one victim also testing positive. In its fourth strike in Kerala, Nipah still sends a flutter throughout the community, neighbouring districts and States as well. With its multiple modes of transmission, including a propensity to spread as a nosocomial infection among healthcare workers, despite its rather low infectivity rate (R0 of 0.2-0.3 compared with R0 of over 1.5 in the case of SARS-CoV-2 virus), the virtual lack of a cure, and high mortality rate, plus the horror of the first 2018 outbreak a part of not so distant memory, naturally, people were anxious, more so in concentric circles closer to Kozhikode where Patient Zero came from, but people over a vaster radius had some concerns as daily news of Nipah dominated the headlines, in fact, whole news bulletins.

Nipah’s dance macabre among humans is a result of a phenomenon called a zoonotic spillover, a process by which the pathogen moves from animals to cause infection outside of the species it was hosted in. No secret here that anthropogenic activity in general, and consequential climate change in particular are causes for these zoonotic spillovers. Rapidly reducing original habitats for animals as a result of the expansion of constructed areas or farmlands are definite causative factors, research has revealed. As the world comes to the realisation of these crucial interdependencies, there is an increasing urge to ensure that a wholesome, unified approach governs nations’ handling of such crises. Apart from following the proper protocols in place for triaging, treating, isolating, contact tracing and infection control, it also behoves the state to take an expansive view of human health, one which studies the various aspects impinging on the health of humans, in order to prevent or predict such outbreaks, and also contain them, if there is indeed an outbreak.

Naturally, The Hindu’s coverage of Nipah went beyond the here and now, which was of course as in-depth as it was broad-ranging. In retrospect, it is now clear that the timeline of the crisis began as far back as August 30, when Mohammedali, 47, died in a private hospital in Kozhikode, at that time, doctors believed, felled by pneumonia. It was only on September 11, when Haris, who ostensibly had the same symptoms as Mohammedali (fever, respiratory issues), died at a private hospital in Kozhikode did alarm bells began to ring. For a State that has undergone three outbreaks earlier, Nipah was no more an unknown infection. Samples were sent for testing, isolation and contact tracing of contacts began in right earnest, systematically, in a State whose first handling of the outbreak (in 2018) resulted in inspired protocols, substantiated by evidence that has come to define care and containment. The flurry started soon enough.

Do look at our coverage of Nipah outbreak through the last week here, chronologically mapped:

September 13

Studies on the ecological dynamics of NiV and disease epidemiology crucial, by C. Maya.

September 14

Our editorial on Unified approach: Nipah Outbreak in Kerala.

Karnataka Health Department issues surveillance guidelines for Nipah.

Tamil Nadu following Centre’s guidelines to prevent Nipah from spreading to T.N., says Health Minister.

Central and ICMR teams equipped with BSL-3 labs reach Kozhikode for on-ground testing of Nipah virus, reports Bindu Shajan Perappadan.

Nipah scare leaves Kozhikode exotic fruit farmers in distress, records A. Mithosh Joseph.

September 15

India ups Nipah surveillance, reaches out to Australia for monoclonal antibody doses.

Public was not warned about probability of recurrence of the disease.

Health squads intensify efforts to track contacts of infected persons.

A deserted Kozhikode beach on Friday after restrictions were imposed by the district administration. | Photo Credit: K. Ragesh

One more tests positive for the virus in Kozhikode.

What lies behind the Nipah virus outbreak in India? Zubeda Hamid speaks to infectious diseases expert Dr. Subramanian Swaminathan.

Animal Husbandry department steps up surveillance, issues guidelines.

September 16

Nipah virus puts Kerala under siege again with fourth outbreak, records A. S. Jayanth.

Why Nipah virus outbreaks are occurring only in Kerala, explains R. Prasad. They are probably not being diagnosed elsewhere, as fruit bats at other areas in the rest of the country too have tested positive for Nipah.

Gathering of field data in progress.

Kozhikode in panic mode after Nipah reported in urban area, says Aabha Raveendran.

September 17

Efforts on to trace virus source of index Nipah patient in Kerala, reports A. S. Jayanth.

Apprehensions over Nipah subsiding in Kerala.

I write, here, a profile on the Nipah Virus: Deadly outbreak.

Central team to carry out field investigations in Kozhikode.

Probe on into spread of fake information about Nipah.

September 18

And since a note of optimism always helps, particularly in times of crises, when it is easy to be enveloped by tunnel vision, a look at our archives. Fifty years ago | Smallpox eradication: WHO chief’s optimism

Outside of Nipah, there was enough to keep the health team on their feet, for indeed what is health but a substantial part of life in the living! Apollo Hospital’s founder and chairperson Prathap C. Reddy whose pioneering efforts gave a boost to private health care in the country called for a reimagination of India’s health-care model. This can lead the country to becoming a powerhouse in AI-driven healthcare solutions and a leader in combating non-communicable diseases, he said, here: India is at a pivotal moment in its health-care journey.

As immunotherapy gains ground in the treatment process for cancers, here is information from a pilot study on ‘low dose immunotherapy’ claims effective results in the treatment of head and neck cancer patients. With a reported over two lakh cases of head and neck cancers detected every year in India, it is definitely a cause for cheer that this strategy of giving neoadjuvant therapy combining low-dose immunotherapy Nivolumab and the TPF regimen (docetaxel, cisplatin, and 5-fluorouracil) to patients works. Larger studies are of course required to establish the efficacy and safety of the treatment beyond doubt.

It does not come as a surprise, but doctors have now advised that socialisation can help prevent Alzheimer’s Disease - at an event held by the Buddhi clinic. The theme for this year for World Alzheimer’s Day, to be observed on September 21, is “Never Too Early, Never Too Late,” reflecting the need to identify risk factors of the disease and take steps to reduce the risk and prevent the onset of dementia.

This, ‘Patients’ rights and access to drugs could be hurt by proposed amendments in patent rules’, again is something we will retain eyes on. Some clauses in the draft Patents (Amendment) Rules, 2023 have triggered fears that important public health safeguards against patent evergreening and unmerited monopolies will be diluted. Civil society organisations, academics, and intellectual property and public health experts have voiced their concern that the Rules — released last month by the Department for Promotion of Industry and Internal Trade for stakeholder comments — will hurt people’s rights to file pre-grant opposition to patents.

A resident seen filling water from a well, every household tap connections provided under Har Ghar Jal scheme as part of Jal Jeevan Mission, at Luhari Village in Charkhari Block of Mahoba district in Uttar Pradesh, in the Bundelkhand region. | Photo Credit: Shiv Kumar Pushpakar

This story by Jacob Koshy, Har Ghar Jal initiative: liquidating the hand pump, is our tailpiece for the week, underlying as it does the unified approach that health care must take. If you look at these two things together: the Jal Jeevan Mission taking piped water to every village in India, and the importance of clean, healthy and easy-to-access drinking water, then this story is about how India slouches steadily towards a more comprehensive idea of health care for its citizens.

From the Health pages

If you have some time remaining, tarry on the following links for more coverage of health news:

ICMR to expand its network of BSL-3, BSL-4 laboratories.

Study shows COVID-19 variant XBB is highly infectious, favours booster dose to protect people.

The Indian Medical Association (IMA) asked the Centre to reduce cut-off marks for NEET-PG 2023.

For sickle cell patients, an elusive disability certificate.

Centre aims to open 10,000 new Janaushadhi Kendras across India by end of 2023.

Consortium of Accredited Healthcare Organisations advocates Patient Advisory Councils to promote patient involvement.

All hospitals to get organ harvesting units: Health Minister.

One-third of TB patients received no payment for nutrition support.

For regional coverage of The Hindu for the week, take a look below:

Karnataka

Tele-MANAS records highest number of calls seeking help for sleep disorders, reports Afshan Yasmeen.

Mental health review board acts against those violating rights of person with mental illness.

Kerala

Kerala will soon have a Centre for Disease Control to tackle infectious disease outbreaks, says Veena George.

Kerala High Court suggests that Centre formulate a protocol on employment of persons with Hepatitis B.

Puducherry

Implementation of Ayushman Bharat riddled with flaws, poor patients denied benefits of a flagship scheme, alleges Puducherry Congress chief Vaithilingam.

Vector control in full swing following dengue surge this season.

Puducherry Chief Minister launches distribution of nutrition kits for TB patients.