Just hours after the 11 September death of the second victim of the latest Nipah outbreak in Kerala’s Kozhikode, the biosafety level-2 lab at the Government Medical College Hospital in the city identified the virus in the swabs — which included those of the first victim, who died on 30 August — sent to it for analysis.
The swabs were then sent on a six-hour road trip to Kochi, from where they were put on a flight to their ultimate destination — the National Institute of Virology (NIV) in Pune, which confirmed the presence of the Nipah virus by late afternoon on 12 September. (Kozhikode does not have direct flight to Pune.)
It was only after this confirmation that the Kerala government officially declared the return of the deadly virus to the state — more than 24 hours after it was first identified at the local hospital.
Dependence on NIV
Health experts point out that the confirmation from the NIV took many additional hours. If the government had acted on the findings of the Kozhikode lab, speedy remedial measures might have been in force earlier.
Why, despite having three state-of-the-art virology laboratories, is Kerala dependent on the NIV in Pune to confirm zoonotic diseases such as Nipah, and to initiate individual-specific treatment facilities officially?
The answer was provided by Health Minister Veena George: It is mandatory to send samples to the Pune lab under the protocol established by the Indian Council of Medical Research (ICMR) to confirm and declare epidemic outbreaks.
The samples, she said, were only being sent to the NIV lab for “technical declaration”.
Of course, within the next 48 hours, the NIV had set up its own mobile lab in the city, manned by its own experts.
The local labs
Apart from the biosafety level-2 lab at the Government Medical College Hospital in Kozhikode, Kerala has two other state-of-the-art virology labs — one in Thiruvananthapuram, and another in Alappuzha — and they are capable of detecting Nipah and similar viruses by testing swabs.
In addition, the Rajiv Gandhi Centre for Biotechnology in Thiruvananthapuram — which functions under the aegis of the Union government — too has a biosafety level-2 mobile lab, which can deliver results in just three hours.
Speaking in the Assembly, Health Minister George contended that the the labs in Kerala are fully equipped to test and confirm virus outbreaks.
The virology institute at Thonnakkal in Thiruvananthapuram was established three years ago — with ICMR authorisation — amidst the Covid-19-related challenges.
The lab boasts of the most modern equipment and several experts, and can reportedly diagnose more than 70 viral diseases, including Covid-19, the Nipah virus, and monkeypox.
When the issue came up for discussion in the Kerala Assembly, Chief Minister Pinarayi Vijayan claimed that the lab at Thonnakkal was fully equipped to conduct all advanced tests and it has the potential to earn further acclaim.
Inaugurated by Vijayan in 2020, it is the first virology institute in the country to be linked to the Global Virus Network.
Now, the state government has said that it has approached the Union government seeking permission to empower the Thonnakkal and Kozhikode labs to declare the results of their test samples.
Experts weigh in
With the Nipah virus making its shocking return to the state after a hiatus of five years — with Kozhikode again as the epicentre — public health activists are demanding priority for the Kozhikode lab to test and declare the presence of the virus.
After the issue came up in the Assembly, the Thonnakkal institute conducted its first Nipah test on a dental student from Thiruvananthapuram, who thought he had eaten a fruit that had bat bites. Though test results turned negative, the samples were dispatched to NIV fort confirmation — which also returned a negative verdict.
“It is quite perplexing to see that the state has no right to declare disease confirmation even though it has a foolproof system to test it,” said public health expert Dr SS Lal.
“The labs in the state can get this right only if the government issues a certificate by appointing an expert committee,” he told South First.
“It is reported that the reason for not providing the certificate is the reluctance of the concerned people in the Health Department who are not yet ready to take responsibility in case of any outbreak,” contended Dr Lal.
Alappuzha lab: Awaiting an upgrade
The Alappuzha lab has a ₹25-crore building on 5.5 acres of land at Kuravanthodu, near Punnapra. Though it was envisaged as a satellite of NIV, Pune, steps are yet to be taken to upgrade it to a level-3 lab despite it having all the equipment and experts.
The lab is currently sanctioned to test samples for only the novel coronavirus, chikungunya, and dengue. Like Kozhikode, Alappuzha is also an epicentre for epidemics that return to Kerala regularly.
“It’s quite worrying that a state with three advanced virology labs depends heavily on the NIV in Pune. Flights connecting directly with Pune are rare from Kerala airports, and that is one big handicap in sending swabs in time,” said public health activist Dr NM Arun.
“As the NIV has a huge workload, we must strengthen a decentralised testing facility nationwide. The state and Union governments must remove the technicalities involved urgently to facilitate quick testing of swabs at the easily accessible testing labs,” he told South First.
Highly placed sources in the Kerala Health Department informed South First that getting the Union government’s nod for empowering the local labs should be a smooth task.
However, they added that some key officials preferred the testing being done at the NIV in Pune to absolve themselves of responsibilities.