Nipah amidst a pandemic
India is far from being anywhere near the finish line with regard to the coronavirus pandemic, even as fears of a Nipah virus outbreak have surfaced in Kerala with one confirmed death in Kozhikode. While confirmed cases of the viral infection have been reported several times since 2001 in West Bengal and Kerala, it was the outbreak in 2018, in Kozhikode, that made headlines after 17 deaths and 18 confirmed cases, underlining the high infection-associated fatality. Outbreaks fanned by exotic viruses are not foreign to India: a glance at the weekly reports compiled by the Integrated Disease Surveillance Programme shows the diversity of viral or bacterial outbreaks that flash by with barely a mention, unless they threaten India’s metropolises as outbreaks of dengue, H1N1, chikungunya or malaria sometimes do. However, the SARS-CoV-2 pandemic also draws attention to significant outbreaks that preceded it. Nipah in Kozhikode and Malappuram was the first outbreak where terms such as ‘contact tracing’, ‘RT PCR’, ‘antigen test’, and ‘PPE kits’ became part of the ordinary discourse in Kerala. The State’s public health system, earlier commended only for quality primary health care, earned appreciation for its ability to establish links between the infected and their contacts and to isolate them to prevent further spread.
There are now established protocols — at the national level — for the three key aspects of a potential pandemic: infection control, treatment and vaccination. When a contagion hits, the world now understands what can and cannot be controlled within each geographic region’s context. It is these lessons from the coronavirus pandemic that must inform future outbreaks. It had become routine for Uttar Pradesh and Bihar, at intervals, to report outbreaks of ‘mystery fevers’, when they were often easily diagnosable infections that were just a competent, accessible laboratory test away. Thus, while there is no knowing if the latest Nipah outbreak in India will peter out like in 2019 or be worse than in 2018, India must be heartened that the potential of an outbreak evokes national concern and an anticipatory response unlike the earlier and purely reactive approach. A standardised treatment for Nipah continues to be elusive and a spike in cases could spell disaster given the high mortality rate. However, some studies suggest that vaccines developed for the coronavirus, if adequately tweaked, may prove effective against the Nipah virus too. Another potential candidate vaccine is in early human trials. Because vaccination continues to be the best bet against the disease, the very fact that global attention and capital no longer need to be coaxed to developing vaccines for tropical infections is itself a key difference in how the world approaches outbreaks in the coronavirus era.