Kerala Health Minister Veena George on Monday, 18 September, said that the situation regarding the latest Nipah outbreak in Kerala was completely under control, and more than 200 samples from the high-risk contacts of the “index case” had tested negative.
“A very positive thing is that all four patients under treatment are now stable, and the condition of the nine-year-old boy, who was on ventilator support, is improving clinically. He is now out of ventilator support and is being given minimal oxygen support,” George said.
“So far, we have six positive cases, and all the samples tested for the last three days were negative,” the minister said. The statement came after a sense of fear gripped Kerala over the recent outbreak.
On Tuesday, 12 September, the news broke that a case of Nipah had been detected in the state. By Friday, the overall count of individuals infected with the virus in the state had increased to six, with two fatalities.
Also read: Why Kerala is first to detect and report exotic viral strains
The fear outside
Consequently, a sense of panic gripped not only Kerala but also neighbouring states, prompting them to enact their own guidelines to address the situation.
In response, the Karnataka government issued several guidelines, including discouraging unnecessary travel to the affected areas in Kerala and intensifying fever surveillance in districts along the state’s borders.
A circular dated 14 September from the Commissionerate of Health and Family Welfare and Ayush emphasised the need to step up surveillance activities in districts bordering Kerala.
The Tamil Nadu Health Department, too, diligently followed the guidelines and protocols issued by the Union government to prevent the spread of the Nipah virus from Kerala.
Tamil Nadu Health Minister Ma Subramanian confirmed this and explained that staff from the Department of Public Health and Preventive Medicine had been conducting screenings of individuals arriving from Kerala to Tamil Nadu via six districts that shared borders.
These measures by the neighbouring states of Kerala struck much more fear in the hearts of the people.
Speaking to South First, experts explained how the fear manifested, festered, and in some cases was exacerbated.
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The fear within
Kochi-based Dr Rajeev Jayadevan said that the fear primarily stemmed from three key factors.
The firsthand experience of the pandemic made people correlate the current Nipah virus outbreak to the losses already suffered due to Covid-19. Many had lost their loved ones to that disease.
“It is only natural for the layperson to fear that the Nipah virus could set off a similar sequence of events; Covid-19 and its devastating global impact became a frame of reference for everyone,” Jayadevan told South First.
He added that it made even lay people aware of the seriousness of viral outbreaks and acknowledge that a virus transmitted from person to person could indeed result in deaths on a large scale.
The second factor contributing to this fear was the Nipah virus’ lethality. This virus has a case fatality rate that ranges from 40 to 70 percent, according to the Indian Council of Medical Research (ICMR). Some experts extend the range to 90 percent.
“This places Niph among the most lethal viruses known to humankind. While some degree of fear is justified, it is important to note that this is still a relatively rare event, akin to fearing a meteor striking a random village. The event might be rare, but the outcome is deadly. This rarity can be difficult for people to comprehend fully, leading to varying degrees of fear among individuals,” explained Jayadevan.
Third, fear is highly subjective and manifests differently in various people. Some remain fearless in the face of almost anything, while others are anxious even about the slightest risks.
“This spectrum of fear responses underscores the complexity of human psychology. Clear communication helps alleviate this,” noted Jayadevan.
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Fear coming from authorities
An ordinary individual tuning to news channels and perusing the newspaper encounters a situation where the government and authorities are setting up barriers in containment zones, health authorities are conducting thorough border checks, and government officials are convening meetings.
Meanwhile, the health minister is addressing the virus mutation, while news outlets are broadcasting images from hospitals depicting patients in their beds.
“Communication is key during these situations, but over-communication creates fear and panic. It occurred during the Covid-19 pandemic as well,” a health official from Kerala told South First.
“In December 2022, when the cases of the BF.7 variant of Covid-19 were reported in China, we all panicked on being shown visuals of the hospitals, while our government held four to five meetings per day. The key here would have been for one top health scientist of the country to come once and address the public, but we were seeing health ministers of every state talking about surveillance at airports,” added the official, who did not want to be identified.
In an Interview with South First, CMC Vellore virologist Dr Gagandeep Kang flagged similar concerns.
The official pointed out that governments, as elected representatives responsible for their citizens, were compelled to act when a serious disease gained nationwide attention. Their actions were motivated by a desire to be seen as responsive and protective of the public interest.
Failing to take any action could have severe consequences, both politically and in terms of public health, she noted. The government’s actions were often more for the sake of visibility than practicality.
Also read: Kerala government working to identify area, source of index case
Random checks not required
“A Nipah virus diagnosis primarily relies on a compatible clinical scenario, which the Kerala government has already addressed by creating a comprehensive contact checking list,” the health official from Kerala said.
He added that there was no logical reason to subject a random person who was travelling to unnecessary scrutiny at an interstate border. “This approach lacks sound reasoning. Building awareness and preparedness within the healthcare system is the right thing to do,” he said.
The predictive value of fever as an indicator of Nipah virus infection is exceedingly low, akin to searching for a needle in a haystack when the odds are one in 10 million. Screening such a vast number of people for such a rare event is not only impractical but also a gross misuse of resources.
The official added that if the government refrained from taking any action and a Nipah case were to emerge, it could potentially be detected due to heightened awareness.
For instance, a knowledgeable and astute medical professional might identify cases more effectively. The virus is present in various regions due to the ubiquitous nature of bats — its suspected carriers.
“In such a scenario, the government might face criticism for not taking visible actions, such as roadblocks and fever screenings. However, these actions do not contribute substantially to public safety or virus detection. They might offer a false sense of security but lack real preventive or diagnostic value,” added the official.
The government’s pursuit of visible actions like roadblocks might be more about maintaining public confidence than actual scientific efficacy. While these actions may provide a semblance of immunity from criticism, they do little to address the real challenges posed by Nipah virus containment.
The virus
The Nipah virus is a zoonotic virus, which means it can be transmitted from animals to humans. It was first identified in 1998 during an outbreak in Malaysia and Singapore that primarily affected pig farmers and those in close contact with pigs. The virus is named after the village in Malaysia where the outbreak occurred.
Transmission: The virus is typically transmitted to humans through direct contact with the bodily fluids (such as saliva, urine, or blood) of infected animals, particularly bats and pigs.
Human-to-human transmission has also been documented, primarily in healthcare settings or among close contacts of infected individuals.
Symptoms: Nipah virus infection can cause a range of symptoms, including fever, headache, dizziness, nausea, muscle pain, and respiratory problems. In severe cases, it can lead to encephalitis (inflammation of the brain), seizures, and coma.
Incubation period: The incubation period for Nipah virus infection can vary, but symptoms typically appear within a couple of weeks after exposure.
Geographic distribution: Nipah virus outbreaks have occurred primarily in South and Southeast Asia, including Malaysia, Singapore, India, and Bangladesh. These regions have fruit bats (flying foxes) as natural reservoirs of the virus.
Prevention: There is currently no licensed vaccine for the Nipah virus. Prevention efforts often involve avoiding direct contact with infected animals, practising good hygiene, and implementing infection control measures in healthcare settings during outbreaks.
Treatment: There is no specific antiviral treatment for Nipah virus infection. Supportive care, including management of symptoms and complications, is a critical aspect of patient care.
