The month of May was one of anxiety, fear and isolation for Kerala. What started off with the death of a young man Mohammad Sadik due to unknown causes on May 5, spiraled into an outbreak of a deadly virus in the subsequent weeks.
‘Nipah’, a word unheard of in Kerala until then, soon became one that sparked fear across the state. As the death toll rose in the following days, health professionals and administrative teams worked round the clock to bring the Nipah outbreak under control.
It was on June 10 that Kerala Health Minister KK Shyalaja finally declared that Nipah has been contained, with death toll standing at 17 and no more infections reported from May 17. With two confirmed patients who had been under intensive care having made full recovery, the spell of fear and isolation on Kerala was broken.
TNM brings you the experience of three key personnel at the administration level whose expertise contributed significantly in containing Nipah Virus.
Rajeev Sadanandan, Additional Chief Secretary, Health and Family Welfare, Government of Kerala
Rajeev Sadanandan was responsible for taking swift decisions at the state level on screening, prevention and treatment. He efficiently coordinated state and national bodies to tackle the disease. In order to procure the Human Monoclonal Antibodies (M 102.4), the only known effective antibody against the Nipah Virus developed at the University of Queensland Australia, he also coordinated with the WHO and the Australian government.
Rajeev’s biggest takeaway is remembering the basics. “The topics you had ignored in your medicine classes like infection control, basic epidemiology - they are all important. It is necessary to go back to elementary things like proper surveillance, infection prevention systems in the hospital, basic epidemiology of tracing how the virus could have spread,” he says.
Rajeev also stresses on being prepared for foreign pathogens. “I wish I had taken a course on Ebola. I had always assumed that viruses like Ebola would not come to Kerala. If I had taken that course, I think I would have been better prepared in handling Nipah. We did ultimately contain it, but if we had prior knowledge we would have been better prepared,” he admits.
Dr V Jayasree, District Medical Officer, Kozhikode
Dr V Jayasree is in-charge of the Kozhikode district. She was one of the several administrative personnel who coordinated logistics to handle the Nipah crisis at the district level.
Dr Jayasree says that though they did not have prior experience with Nipah, the coordination between State Department of Health and medical colleges, which usually work separately, was crucial. “When this outbreak happened, everyone came together. We needed protective gear and the Kerala Medical Service Co-operation ensured that supplies were provided promptly, and didn’t run short. There was tremendous inter-departmental cooperation,” she shares.
“As days progressed, we all felt that our ability to handle the crisis was increasing. We started genuinely believing that the outbreak can be controlled,” she narrates.
Dr Jayasree says that the public too was cooperative and took their advisories seriously, even if it was out of fear. “I know people who have postponed marriages in the family. People understood the gravity of the situation and were doing all they could to prevent the spread of the disease,” she notes.
There was also peaceful cooperation amongst religious communities when it came to laying those they lost to Nipah to rest. “There were confirmed as well as suspected deaths in Hindu, Muslim and Christian communities because of the virus. However, they did not protest about cremating their dead even when it went against their traditional last rites. They immediately understood the seriousness of the situation,” Dr Jayasree notes.
The experience of handling Nipah crisis has also boosted their confidence – Dr Jayasree feels that with the level of coordination that helped them contain Nipah in a timely manner, they would be able to handle, if there were, such outbreaks in the future as well. “Every step was taken in the right direction and in the right time. So, in retrospect I don’t have thoughts on how things could have been done better,” she added.
Dr KG Sajith Kumar, Superintendent, Kozhikode Medical College Hospital (KMCH)
Under the leadership of Dr KG Sajith Kumar, Kozhikode Medical College Hospital rose to the occasion for containing Nipah.
Dr Sajith Kumar tells TNM that their main hurdle was the lack of proper isolation wards. That the virus was only known through literature prior to the outbreak also posed a challenge. “Our priority was to treat patients while keeping the hospital staff protected.”
KMCH primarily caters to five districts in North Malabar viz Kasargod, Kannur, Kozhikode, Wayanad and Malappuram. “Our usual patient load is three times the capacity of the hospital. So when the outbreak happened, we were faced with a tremendous challenge of preventing disease spread through contact,” Dr Sajith shares.
However, they acted quickly. “We immediately arranged an additional triad system away from the common casualty area so that people don’t mix together and thus prevent the virus from spreading.” One of the biggest achievement for him was that they were able to set up an isolation ward which complied with the WHO criteria. “In future, if there are similar outbreaks, we will be able to set up such isolation wards in an efficient and timely manner without much strain,” Dr Sajith says.
Dr Sajith concludes, “We would like to believe we carried out our duties reasonably well. So now when I think back, there is nothing I wish could have been done better.