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Fear of the Nipah virus that shook India in May had all the ingredients of a medical thriller like: Outbreak : A country of 1.3 billion people and one encounter with one of the most
But the deadly virus finally inspired a Bollywood clip dancing and singing.
Traces of India with Nipah go back to the small village of Soopikada in the Changaroth region. Dr. R. Gopakumar, the health officer of Kozhikode Municipality, who led a task force to curb the spread of the virus. It is 28 miles from Kozhikode, the third largest city in the state of Kerala in South India.
In an interview with NPR, Gopakumar describes the last weeks of May as "the most difficult and heartbreaking days of his career". health. But the story of the Battle of India with Nipah is also a reflection of the preparation of Kerala public health institution to the virus
Nipah is a scary disease to fight because the Virus attacks the brain and has the potential to send a healthy youth into coma within 24 hours. The World Health Organization (WHO) has classified the Nipah virus as a "priority disease" in 2017, due to its potential to cause serious epidemics on an international scale
. in Malaysia, in 1999, farmers were struck by a mysterious disease transmitted by contact with the pigs they were treating, themselves contaminated by fruits contaminated with saliva and the urine of bats, vectors of the virus. Nipah has little effect on bats. The virus can be fatal for piglets and cause severe symptoms in adult pigs.
People contracting the virus deteriorate rapidly, suffering from acute respiratory distress syndrome and encephalitis, causing brain inflammation, neurological symptoms, swelling and seizures. The Malaysian epidemic had a mortality rate of about 40% in humans. To stop Nipah in 1999, the government ordered the slaughter of more than one million pigs. Years later, new outbreaks resurfaced in India and Bangladesh – with a mortality rate of about 70%.
India has experienced Nipah outbreaks at least twice before – both times in West Bengal in 2001 and 2007. affected, 50 died.
The story of Nipah 2018 begins when two young men became ill. They were Muhammad Salih, 28, and Muhammad Sabith, 26, sons of Valachuketti Moosa. Their father had recently bought a house in Soopikada and neighbors reported that the two brothers had cleaned an abandoned well, infested with bats in the compound. The two young men became ill soon after.
Sabith died at Kozhikode Medical College Hospital (KMCH) on May 5th. The cause of death was unknown.
On the eve of May 17, Dr. G. Arunkumar, virologist and head of the microbiology department of the Manipal Center for Virus Research, was working in his laboratory in the state of Karnataka, at nearly 300 km away, when he received a call from the treating physician Salih.
Arunkumar had often treated and analyzed public health emergencies in the past, and the local doctor wanted his advice. "[The treating doctor] was concerned because several members of the same family were affected," says Arunkumar. "And the clinical symptoms of his patient were different from anything he had ever encountered before."
Salih, admitted to Baby Memorial, a private hospital in Kozhikode, showed signs of acute encephalitis – an inflammation of the brain caused by an infection or when the body's immune system begins to attack brain tissue. In patients with encephalitis, blood pressure and heart rate are generally low, but Salih's blood pressure was very high and his pulse fluctuated rapidly.
Arunkumar felt that it was essential to investigate quickly. He asked the team to deliver the cerebrospinal fluid, blood, urine and samples from the patient's throat to his laboratory. He received the samples on the morning of May 18th. Salih died later in the day
Meanwhile, Dr. V. Jayasree, Kozhikode District Physician, accompanied a team of local epidemiologists to Changaroth's family home. "At first we wondered if mosquitoes were the cause of the infection," she says. "We examined the area, passed the bat-infested well, trapped mosquitoes and collected food and water samples for testing." Arunkumar was conducting angry tests at the Manipal Virus Research Center
In 2014, as part of a training program launched by the US Global Health Security Program, laboratories at the Manipal Research Center on viruses and at the National Institute of Virology in Pune were ready to identify Nipah outbreaks. "This training really helped us," says Arunkumar. "I ruled out other causes of encephalitis and I suspected that it was Nipah right away." On the evening of May 18, less than 12 hours after receiving the patient's tissue samples, his laboratory confirmed his suspicion.
The next day, Mr. Miriyam, the boy's aunt, died. worried, "says Arunkumar." You can contract [Nipah] from animals – in direct contact with the urine or saliva of bats or from direct contact with infected pigs like in Malaysia – in case of human-human transmission through direct contact with bodily fluids, patients in overcrowded hospitals in India would be a huge challenge. "
Salih tissue samples were sent to a second laboratory – the National Institute of Virology in Pune – to confirm the results.
Health services switched to action. They published public interest messages telling people with flu symptoms to go to KMCH a government-run program. A hotline has been set up so that the public can call to report their symptoms.
"We have not allowed suspected Nipah people to be treated in private hospitals." On May 20, the National Institute of Virology in Pune confirmed the diagnosis – but because of the Arunkumar's foresight, the measures to prevent its spread were already in place. The next day, on May 21, a 31-year-old nurse, P. Lini, who was caring for infected family members, died of Nipah. She was the mother of two sons, aged 5 and 2.
With each new victim, health professionals encountered a difficult situation: How to manipulate the body of the deceased without exposing the family members to bodily fluids, which could infect them virus
The two brothers are from a Muslim family. According to Muslim tradition, bodies are washed and wrapped in white. The head of the deceased is turned to Mecca, a prayer is said and then the burial takes place
This had to change because of the risk of infection.
When Moosa, the father of the boys, passed away on May 23, Gopakumar oversaw the burial, fulfilling the last sacraments and acting as one of the porters. He and the other staff members were dressed in full protective gear – gloves, gowns, eye protection, masks and shoe covers.
"We followed the same protocol [used] for the Ebola outbreak," he says. The body, packed in two sealed plastic bags, was buried deeper than usual, lowered into a 10-foot pit filled with 11 pounds of bleaching powder
Gopakumar oversees the funeral of 12 victims, performing the last rituals of death. two of them entirely alone. Another Muslim patient was buried and the others were cremated as required by the Hindu norm. "We wanted the victims to have a dignified funeral," he says.
The case of B. Rasil, 25 years old, weighed heavily on him. Rasil died while his mother was in an isolated neighborhood of Nipah. His father was too distressed to perform the last sacraments. "She could not even see him one last time, it was a tragic situation," he says.
Since the news that Salih had been tested positive for Nipah was made public, rumors were spreading about WhatsApp and social networks. 19659037] As rumors spread about Nipah, the contagious – and deadly – nature of the disease meant that many people stayed inside. While the companies were still operating, the schools were closed. For V. Jipsa, a 27-year-old nurse who was visiting her mother, the sight of a deserted beach on the weekend in Kozhikode was surreal. "Then I realized the depth of fear," she says.
And the sale of fruit, even in neighboring countries, failed – even though, as Kumar notes, "the only way to contract Nipah fruit after a fruit bat bit into it," he says. infecting with saliva – a rare event. "
Three weeks after Nipah was identified as the cause of the epidemic, on June 10, Kerala's Minister of Health, KK Shylaja, stated that the state was Nipah-free. Of the 19 cases, two patients healed
There have been no new cases since the last death – the 17th accident – May 30th.
Surveillance at the national level ended on June 30.
Well that the two brothers had cleaned to see if they were wearing Nipah.
Arunkumar believes that heightened awareness and surveillance of the symptoms of encephalitis should continue among health practitioners in India. "There is a possibility that it can happen again," he says. "Fruit bats are endemic in India and in other parts of Southeast Asia."
But with caution about the future, there was a festive mood.
When it was announced that Kozhikode was free of Nipah, musicians and filmmakers decided to make a video to celebrate.
On June 14, they released "Bye Bye Nipah."
"It was a work of love," says composer Sai Balan video in an hour. "It's our way of saying that anguish and suffering are behind us now."
"The song was an effort to recover and celebrate our public spaces after the threat of the epidemic almost shut the city up for fear," says Shaji Kumar, who wrote the lyrics. "We also wanted to honor the efforts and sacrifices of our health professionals." The video shows smiling images of doctors, nurses and local health workers, giving a thumbs up.
With scenes of shopping malls, the beach, the emerald green backwaters, the main streets and restaurants, video is a slice of everyday life in Kozhikode. "We shot pictures of current residents walking around with health and hope," says Kumar.
"Do not forget that it's Kozhikode," say the lyrics. "We will overcome the contamination with force and determination, we will not collapse, we will never get tired Bye Bye Nipah!"
Kamala Thiagarajan is an independent journalist based in Madurai, India, who wrote for ] The New York Times International, BBC Travel and Forbes India. You can follow her @kamal_t .
Copyright NPR 2018. 9(MDAyNzUwMDI2MDEyNTA3MTU5NzcyNTQyNA004))
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