On the night of September 4, Sheena KP, a staff nurse at the Kozhikode Government Medical College Hospital (MCH), was on duty in the Covid ward when murmurs began on her WhatsApp account and those of her colleagues.
A potential case of Nipah virus infection had surfaced at a private hospital in the city. By midnight, the news broke on local TV channels — a 12-year-old boy’s samples, sent to the National Institute of Virology lab in Pune, had returned positive for Nipah. For Sheena and her fellow staff at the MCH, it brought back harrowing memories of the outbreak in 2018 which claimed 18 lives, including that of Lini Puthussery, a nurse at a taluk hospital in Perambra.
But unlike 2018, when the state’s health department struggled to find its feet in the initial days of the outbreak to fight a never-before-seen virus, this time officials knew exactly what to do.
“Steps were taken on a war-footing. By night itself, it was decided to convert the pay ward at the MCH that treated Covid patients into an exclusive isolation ward for Nipah suspects. Everyone worked together and by morning, we were able to remove the Covid triage and shift all the patients to an alternate facility. Within 24 hours, over 30 high-risk contacts of the Nipah-positive patient, including his family, were admitted in the same space. It was a laborious process,” said Sheena over the phone.
“The fact is, this time, nobody needed to tell us what had to be done. We knew what to do,” she pointed out.
And the results are clearly visible. Though the 12-year-old boy succumbed to the virus the next day, 10 days on, the outbreak currently remains restricted to him as over 140 persons, who came in contact with him including his close family members, have tested negative. A combination of the swift response to the index case, application of lessons learned from the 2018 and 2019 outbreaks and adherence to Covid-19 protocols have been critical in averting a major crisis.
Abdul Gafoor, president of the Chathamangalam panchayat in Kozhikode district, was preparing to go to sleep on the night of September 4 when he was warned by a top health official about the confirmation of a Nipah case in the local body he leads. The family of the 12-year-old boy resided in ward nine of the panchayat. Within hours, he was informed that the police had fortified a three-kilometre radius around the victim’s family, shutting off all roads and forming a containment zone.
“Naturally, when the news came that night, I was scared, unsure of how we would tackle this. But our health officials intervened and dispelled our fears,” said Gafoor.
The next morning, a Sunday when the state observed a complete shut-down as part of Covid-restrictions, the panchayat committee under Gafoor’s leadership met to take some hard and fast decisions, he explained. Rapid Response Team (RRT) volunteers at the ward-level were directed to supply essential provisions at the doorstep to the families in the containment zone. Around 400 food kits, costing Rs 1,000 each, were supplied to the most vulnerable families.
Arrangements were done to ferry cancer patients in the panchayat to the nearby MVR cancer centre. Loudspeakers fitted on jeeps and autos warned people from stepping out for the next one week. And the panchayat, in conjunction with local health officials, carried out an elaborate door-to-door survey across 2,200 houses to check for recent suspicious deaths, cases of fever and vomiting and illnesses in domesticated animals. Simultaneously, a team of the animal husbandry department collected samples from fruit bats, considered the natural carriers of the virus.
“As days went by and we got more and more negative results, we began to feel relieved. Right now, only ward nine is shut off. Relaxations have been given in other wards,” said Gafoor.
Dr Naveen, district programme manager of the National Health Mission (NHM), said while he is certain that the virus hasn’t spilled over into the community, the health department is sticking to an established protocol of observing a double incubation period of 42 days for fresh cases to emerge before formally declaring that the outbreak has been contained. That would mean another four weeks for the formal declaration.
He explained that the department’s success was founded on the lessons learned from the 2018 and 2019 outbreaks resulting in a detailed published action plan for future reference.
“We have a structure and we were able to activate it very quickly. There were three things we needed to do. One, prevent the virus from spreading from the positive patient to others. Second, trace primary and secondary contacts of the patient, isolate them and test them. Third, find the origin of the virus and confirm if the (12-year-old boy) was indeed the index case,” he said.
While the first two objectives have been realised, efforts are on to identify the origin of the virus. Surveillance of encephalitis cases and suspicious deaths in the Chathamangalam panchayat will also continue, said Dr Naveen.
According to officials, the use of masks, sanitisers and protective gear at government and private hospitals played a key role in breaking the chain of Nipah transmission, especially to health workers. “In 2018 (when we tackled Nipah), masks and protective gear were all very new to us. Until then, we had only learnt about it in theory. But two years of Covid have familiarised it for us. Covid protocols have definitely helped us,” said nurse Sheena.