The return of fear

Valanchery’s head Sulaiman never missed the Workers’ Day celebrations for more than 20 years. But this day is different.

Instead of joining his colleagues, Sulaiman drove his 42-year-old wife to clinics and hospitals, while her health faltered at every moment. By midnight, she was seriously ill in the emergency room of the EMS Memorial Cooperative Hospital in Perrin Salmanna.

In the early morning of May 2, she fell into a coma during the sterile silence of the intensive care unit (ICU). As Sulaiman and their three children wait in the frozen worries, the world of her loved ones begins to shrink to a terrible reality.

They stood still in the Thaniyappankunnu house in Valanchery, keeping silent, and since that day its doors were locked. In the porch, two plastic chairs sat in dust and were abandoned. The washed clothes tapped gently on the clothesline under the tarp, while Suleiman’s hero bike was idle behind the house. The 15 cents compound remains the same. The locked house and its creepy courtyard provide a thrilling reminder of suspending life.

On May 8, the day the woman tested positive for the deadly Nipah virus, the day the woman tested positive, announced nine wards with a three-km radius of her house, including the area of ​​the Valanchery municipality and the adjacent Panchayats in Marakkara, Edayur and Athavanad.

National Health Department and Health Minister Veena George personally rushed to Malappuram to officially announce the confirmation of the Nipah case.

Three cases within 10 months

In the 10 months since July last year, Malapuram has reported three Nipa cases. A 14-year-old boy succumbed to Nipah in Chembrassery near Panditcard in July last year, followed by a 24-year-old man from Naduvath near Wandoor in September. The Valanchery woman is the latest Nipah patient who fights for her life in the ICU and encephalitis puts her into a coma.

“We are all praying for her to come back,” said her neighbor K. Balakrishna and his wife Savithri. They seem to have no Nipa. The same goes for another neighbor, T. Bindu. “It could affect anyone; it happens to be her,” Balakrishna and Savithri shrugged.

They haven’t interacted with that woman since she had a fever and a headache on April 25. “We may be close, but we won’t visit as we used to. We’ll chat from the tree-shaded borders of the house,” Savithri explained.

The mystery of deepening

Neighbors reported that she rarely took risks, mostly staying indoors, and the mystery surrounding the woman’s Nipah infection deepened. “Whenever she goes out, she rides a bike with her husband,” Balacrishna said. The root of her infection remains unknown.

“We know that before she got sick, she had visited her siblings in Thiruvegapura in the Parakkad area where she exchanged fruits with them,” said Veerankutty, a municipal councillor representing Thaniyappankunnu Ward.

He has been at the forefront to help health and animal husbandry officials conducting surveys in the area and spread awareness of the health protocols to be followed, including isolation, and preventive measures against the spread of the virus.

Veerankutty warned: “When we are among people, we have to be a mask. It’s much safer.

The houses and surroundings of women affected by Nipa are typical of Malappuram, where lush trees thrive in the area. There are mango, jackfruit, papaya, guava and bilimbi fruit trees. A small bilimbi tree filled with fruit stood in the front right corner of her house. At the back, an unused acre belongs to another joint family, offering a veritable feast scattered with mangoes and jacks that may attract fruit bats to the area.

“We strongly suspect that the fruits bites by the bat are the source of her infection; but without evidence, it’s hard to say.”

Dr. Shubin, supported by District Medical Officer R. Renuka and his team, has played a role in discovering three NIPAH cases in Malappuram for the past 10 months. Dr. Renuka warned: “We should be prepared for further cases.”

Dr. Renuka and his team issued a preemptive warning about the potential outbreak of the deadly disease before the summer peaked. They advise people not to eat fallen fruits, especially those bitten by birds and bats. People are also warned to maintain strict hygiene when dealing with livestock.

Malappuram has monitored certain diseases, especially cases of encephalopathy since 2022. In addition to government hospitals, major tertiary hospitals in the region have also been trained to deal with brain disease cases, especially in Nepal’s risks.

After initial symptoms such as fever, headache, and vomiting, Nipah infection usually develops into acute encephalitis syndrome (AES). According to medical experts, monitoring AES cases helps detect early warning signals of outbreaks, allowing for timely treatment and intervention measures.

“Since last year, we have identified all three Nipa cases reported by Malappuram. No cases without AES or acute respiratory distress syndrome (ARDS) cannot be reported, either in the current surveillance system, whether in private or government hospitals,” Dr. Shubin said. “Our private hospitals are cooperative in reporting cases quickly.”

Malappuram’s major tertiary private hospitals are equipped with ICU isolation facilities, allowing them to effectively manage virus outbreaks like Nipah. Shubin asserted: “Treatment of Nipah suspects is no longer a reason for the attention.”

Enhanced surveillance

Experts warn that eliminating NIPAH may be impossible due to the complexity of the factors that lead to the outbreak. However, enhanced surveillance of AES cases can promote early detection and rapid isolation of contact and potentially prevent transmission.

Research has put fruit bats, especially pterosaurs or flying foxes, as natural reservoirs of Nipah virus. Although the exact route of transmission to humans is unknown, it is suspected that contaminated fruit bitten or licked by bats may play a role in spreading the virus. The possibility of mediation hosts facilitating dissemination is still under study.

Sreehari Raman, Assistant Professor at Kerala Agricultural University, bat researcher Sreehari Raman identified six dietary bats among the 48 bat varieties found in Kerala. “In addition to the spread of fruits bitten by bats, it’s also a possibility,” Sreehari said.

Another potential transmission pathway is through the consumption of bats, which is still observed in some indigenous tribes in Kerala. “I met several people during the research process, but after the Nipah outbreak and the publicity campaign, the practice seems to have declined,” he said.

Some unusual observations

His encounter with bats leads to abnormal observations, such as bats eating fruit in stores. “I captured footage of bats that feed on bananas in a fruit shop. After showing the video to the store owner, he quickly covered potential entry points with a large net to prevent further access from fox hunting,” he said.

Human activities (such as urbanization and deforestation) are considered the main cause of virus spillover. According to research, expelling bats by destroying perched trees can lead to changes in their habits. “Viral load seems to be the highest point in the breeding season. But that must be said,” Sreehari said.

According to health officials, preventing the spread of bat virus requires two-p jurisdictional methods: rapid outbreak response and alert bat population monitoring. The World Health Organization (WHO) recognizes a healthy approach that integrates human, animal and environmental health as part of controlling zoonotic diseases such as Nipah. “It promotes a balance between humans, animals and nature,” said Health Minister Veena George.

Cats, birds’ death

In Valanchery, livestock officials took measurements within a 500-meter radius of Nipa patient’s house and joined the Anti-Nipa Avenue. They collected animal samples for antibody testing. Recent cat and bird deaths in the area remained the cause of concern as fever monitoring by health officials increased.

“We are doing a field investigation part of a health concept. If the virus is traced back in the early stages of the animal, it can easily include the virus,” said TN Anoop, regional planning manager for the National Health Mission.

Research by the Indian Medical Research Council National Virology Commission Pune found Nipah antibodies in bats in 10 states including Kerala, Tamil Nadu and Maharashtra. However, Kerala, especially Malabar, often reports of Nipa outbreaks, sparking curiosity about the root causes of such regional concentration.

According to Anoop Kumar, when Nipah first identified the intensive care specialist for the deadly virus in Kerala outbreak in 2018, Nipah cases may not be found in other states due to limited testing. He believes that the frequent Nipa case in Kerala may be due to vigils and routine screening in the state.

The degree of virility

The high mortality rate of Nipah virus (70% and above) has caused it to be of major concern. Studying whether the current strain retains the same virulence as the 2018 outbreak is critical to understanding the potential severity of the outbreak and guiding public health responses. “I think it’s not that powerful right now. That’s why the latest drop in the mid-term infection rate is down,” said Mohammed Ismail, a former deputy district medical officer.

But Dr. Arnop disagreed. “We have a reliable surveillance system and a clear plan of action. Unless research proves this, we can’t say that the virus has lost its virulence,” he said.

Sulaiman and his children take turns outside the hospital’s ICU all day, hoping that medical experts are working overtime to help her fight the crisis as soon as possible. The villagers also kept her prayers in prayer to see her return to a healthy life.