It is not that we don’t know about the dangers of unknown, strange viruses causing large scale death and morbidity. Among others, it was Bill Gates, who had forewarned that we are staring at a possible calamity when he had famously declared that, the Ebola epidemic in West Africa has killed more than 10,000 people. If anything good is coming from this continuing tragedy, it is that Ebola awakened the world to a sobering fact: We are simply not prepared to deal with a global epidemic.
In fact, the response to the Ebola crisis in West Africa shines a light on the weak health systems in these countries which have been affected by years of under-investment. Today, after having handled far too many Ebola patients, the surviving staff are in need of support, better protection and reinforcements. The above warning is felt even more direly when we look back further to 1918, when the Spanish flu killed more than 30 million people. Imagine what it could do in today’s highly mobile world.
In the case of the Nipah virus, we were indeed lucky that it happened in a state where the healthcare sector is better prepared than others. In any such breakout, it is important for the surveillance system to work, infected people to be quarantined immediately and panic not allowed to set in. That is what we have seen in Kerala.
However, the battle is not won yet. It is only the beginning as we now need vaccines and therapeutic drugs to fight this disease that could return anytime. This has happened before, in recent history with SARS, Zika, and of course Ebola. Malaria is another apt case in point, a persistent killer which takes nearly half a million lives a year even now. Despite a long history, awareness of the pathogen and treatment protocols developed, we still see epidemics break out, with India and Africa impacted the most.
Despite all the past information and dread coming from such large-scale morbidity, we are not yet at a point of effective preparedness to manage such a situation. While Kerala did manage to contain the impact of the virus, I worry to think how another state with less effective health systems would have dealt with a similar outbreak.
Doctors going into panic and blame being apportioned to various actors are common occurrences in a country as large and diverse as ours. Kerala could manage this situation better, but we have news trickling in of more deaths even as the days pass by. Travel advisories have been issued and business has already got affected as some countries like the USA have stopped importing fruits and vegetables from the state.
According to the WHO, the Nipah virus NiV is “a newly emerging zoonosis that causes severe disease in both animals and humans.” It is an infectious disease spread by secretions of infected bats. It can spread to humans through contaminated fruit, infected animals, or through close contact with infected humans. The outbreak of Nipah was first recognised in Asia, in Malaysia, in 1999. The same year, 11 workers in one of two Singaporean abattoirs developed Nipah virus associated encephalitis or pneumonia, resulting in one fatality. In the south-eastern region, the first identification of Nipah virus as a cause of encephalitis outbreak, happened in Bangladesh in 2001. Since then, outbreaks of Nipah virus encephalitis have been reported almost every year in select districts of Bangladesh.
In India, this is the third outbreak. As with many such pathogens, it is quite likely that outbreaks happen all of a sudden, and sometimes could happen after the virus mutates into a deadlier form. It is important therefore to identify cases early and isolate them. In fact, in 2009, a roadmap to combat zoonoses (like Nipah virus) was launched with the Indian Council of Medical Research, and under the aegis of the Public Health Foundation of India. It was based on a three-fold principle of promoting multi-sectoral and cohesive strategies, advocating a risk-centered approach, and steering a response in line with the nation’s priorities. This time around, Kerala thankfully could identify and isolate with the one family that was infected. However, the alert is still important as the infection could continue to trickle down.
Questions will have to be asked: How quickly did the National Centre for Disease Control react? Had it at all predicted such an outbreak? Does it have the capacity to work against such outbreaks in the future? Do we have enough sanitation protocols for vulnerable groups such as those who are culling animals which may be carriers of the infection? Are health-workers being trained to effectively tackle such outbreaks?
In this outbreak, the tragedy was the death of the nurse who handled the early patients. While her sacrifice is immense and deserves the world’s admiration, it is also a pointer to how important it is to ensure prevention and safety of the staff dealing with it. It is indeed a wake-up call for disease control and for all neglected diseases in the country. Even as the recent Lancet report shows that India is not prepared to handle TB, this new episode once again reminds how important it is to strengthen our public health and disease control systems across states.
The writer is a Health Economist and a Professor at Maulana Azad National Urdu University, Hyderabad. Views expressed are his own.