The Nipah virus crisis in Kerala required many to step up to control the disease. But perhaps no one was under more pressure than the doctors and hospital staff themselves. While the non-indigenous virus caught everyone by surprise, dealing with it taught many important lessons as well.
TNM spoke to Dr Arun Kumar, head of the Manipal Centre for Virus Research (MCVR), who was the first person to identify that the virus that struck the Moosa family at Changaroth panchayat in Kozhikode as Nipah. The tests which his lab at MCVR conducted proved crucial in the early identification of the virus and sounding an alert in Kozhikode district.
These were his takeaways, and what he thinks will help us prepare better for future crises.
Expect the unexpected
“The biggest takeaway is the importance of being prepared. Because we were expecting the unexpected we were adequately prepared. Nobody was expecting Nipah in Kerala because so far, cases were reported only in West Bengal and the neighbouring country, Bangladesh,” Dr Arun says.
Dr Arun explains that he was already working on a project to test samples for Nipah from states like Tripura and Assam due to their proximity to Bangladesh. “Because of these the tests were ready, our laboratory was trained well and we were prepared. That’s how we could use it in Kerala,” he says.
Dr Arun’s research showed them that they needed to be prepared to tackle pathogens that are not indigenous to the region. “These past few years we have been preparing our laboratory for diagnosing emerging viruses including Nipah. The experience has showed that we need to be prepared for even other pathogens which is not found in India and which theoretically cannot come to India,” said Dr Arun.
What could have been done better
Despite his belief that they were able to handle the situation reasonably well, Dr Arun says that there are things that could be put in place to help them prepare better.
The first, he says, is a mobile laboratory. “It would have helped if we could have set up a mobile lab of high containment in Kozhikode itself. To be able to immediately test and certify a case as positive or negative would have relieved so much stress. The waiting time would have been reduced and the isolation could have been quicker and more efficient.” said Dr Arun.
This – testing and ascertaining the infection on the spot – is Point of Care Testing (POCT), Dr Arun says. “Taking care of all safety, you can inactivate the specimen, inactivate the virus and then carry out the test,” he says.
During the Nipah outbreak Dr Arun and his team roped in MolBio Diagnostics from Bengaluru, and even co-developed one POCT for Nipah. Fortunately, the virus was contained and they did not have to use it. He also says that since it is not possible to have a lab in every district and village, POCTs and mobile clinics become even more important for quick detection.
The second thing Dr Arun stresses on is the need to improve disease surveillance. He argues that the encephalitis surveillance which is currently happening is insufficient. “Good surveillance is needed especially when there is an unusual death. When a young boy died without a known cause, it should have warranted an immediate investigation,” he points out.
Although the Kerala Public Health Department does have a system for collecting information and disease surveillance, most of its data are not relevant in real time.
Dr Arun explains, “The trends can be monitored real time with good surveillance. Deaths happen every day. But when deaths are interrelated or there are subsequent serious cases coming to the hospital; when there is an unusual increase in these instances in one place – these things need immediate data collection and analysis. Clustering can be immediately identified thus.”
And finally, Dr Arun stresses on the need for real time analysis of the data collected as well so that it does not become redundant. “Computers are already programmed today and can easily identify disease clustering or if a particular syndrome is coming up… if particular age group or area are affected,” he says.