For the fourth time since 2018, Kerala is confronting the deadly virus Nipah. The zoonotic disease is revisiting the North Kerala district of Kozhikode for the third time since then.
The lessons from the previous bouts of the infection, coupled with two consecutive years facing the Covid-19 pandemic in 2020 and 2021, have helped Kerala take the virus head-on in its fourth foray into Kozhikode villages.
The outbreak of 2018, which claimed 17 lives out of 18 confirmed cases, had caught the state health department off-guard. The government had no past experience of handling a disease with such a high fatality rate. At the time, the disease was identified only after the virus had already started spreading among human, and claimed a few victims.
What the state then followed was the protocol for Ebola virus disease (EVD), which had been reported mainly in sub-Saharan Africa. Social distancing, contact tracing and isolation became new concepts to Kerala society. Images of health workers in PPE kits filled the TV screens for the first time.
Still, during the first outbreak, the health department had only limited knowledge to fall back on to fight the alien virus. But a co-ordinated effort was launched for the virus’s containment. Apart from the health department, the revenue district administration took up the lead in coordinating with various stakeholders. Route maps of confirmed cases were published to identify contacts and make people self-report. All contacts were put under home quarantine, then unprecedented in Kerala.
At one point of time, 3000 persons had been under quarantine. A call centre was launched in Kozhikode to give psychological support for all those under quarantine. Isolation wards were opened at the government medical college hospital, which took care of all patients and suspected cases. Several ad-hoc committees were formed. Slowly a procedure was in the making at the war-room of Kozhikode, wards of the medical college hospital and fields of the affected villages.
In early June, 2019, the health department issued a short Nipah virus infection control guideline. Later in that month, when a case was reported in Ernakulam, the health department, with the support of various other departments, streamlined surveillance activities, contact tracing, quarantine, isolation, and treatment. A medical board, treatment protocol, use of monoclonal antibody protocol and point of care testing were framed.
It was the back-to-back confirmation of Nipah in 2018 and 2019 (then one case in Ernakulam) that forced the health department to work out a systematic approach to deal with any future outbreaks.
Thus, even while tackling the virus in 2019, during its second revisit to Kerala, the health department was already engaged in building structures and processes. A resource group of senior doctors held several brainstorming meetings for preparing guidelines, capacity building, and co-ordinated fight against the Nipah. At one stage, WHO representatives were also involved in protocol preparation and mock drills were held. The guidelines covered diagnosis, surveillance, treatment and sample collection. These guidelines have been revised twice since they first came up and have been very valuable.
In fact, on 30 January, 2020, when Kerala reported the country’s first coronavirus case in Thrissur, the experience of handling Nipah for the past two years held Kerala in good stead. From the day one of coronavirus, the state could roll out its Nipah guidelines, including contact tracking, publication of route map, isolation, treatment and containment at grassroots level.
Story By: HT Online