Mystery deaths: Can our healthcare prevent them?

By Jisha Krishnan

Published on 18, June, 2018

Idiopathic. Meaning occurring without known cause. From itchy skin rashes and water retention problems to scarring of lungs and calcification of ligaments, there are numerous conditions whose genesis medical science fails to fathom. However, when something as lethal as the Nipah Virus - that claimed 16 lives in Kerala last month – shows up, we need robust disease surveillance systems and protocols in place to contain the attack. 
Yes, the doctors, nurses, hospital staff, and public healthcare officials in Kerala did a fine job of managing the viral outbreak, albeit the cause is yet to be ascertained. Which begs the question: Does the Indian healthcare system have the resources and the will to prevent these mysterious deaths? 
Writing on the wall 
In 2013, a research report by scientists at the National Institute of High Security Animal Diseases (NIHSAD) had called for enhanced surveillance and a state of readiness to deal with the Nipah Virus epidemic in the near future. Yet, we were caught napping when the first casualty occurred on 5th May this year, followed by another in two weeks. 
Back in 2001, when the ‘mysterious fever’ had claimed 45 lives in a month in Siliguri, West Bengal, the Indian healthcare system was again caught off-guard. The story wasn’t too different in 2007, when Nipah struck another West Bengal district, Nadia.
Given that there are no known drugs or vaccines to fight the deadly virus, transferred to humans from fruit bats, better public health awareness, surveillance and preparedness is the only way to curb the menace, concur experts. 
Myriad challenges 
However, Nipah is not the only threat. There’s Kyasanur forest disease (monkey fever), Crimean-Congo haemorrhagic fever, Zika virus, Ebola (though not yet present in India). Further, global warming is contributing to the increased populations of vectors, such as mosquitoes that carry diseases like dengue, chikungunya, malaria and Japanese encephalitis (Gorakhpur in UP is considered the epicentre of encephalitis-induced deaths). Others, like the Influenza viruses, are constantly evolving, making annual vaccinations inevitable.
According to the Integrated Disease Surveillance Programme (IDPS), 1.14 lakh Indians were infected – and 8,543 killed - by H1N1 between January 2010 and October 2017. Maharashtra (23,812 cases & 716 deaths), Gujarat (18,206 cases & 431 deaths) and Rajasthan (13, 158 cases & 235 deaths) were the worst hit. 
Maharashtra also tops the list of maximum number of new HIV cases. Although the number of people living with HIV in India has reduced, Maharashtra, Andhra Pradesh and Karnataka reported 20,000-plus new infections in 2016-17. From April 2017 to March 2018, 1,327 lives were lost in Maharashtra alone.
Each week the IDSP, on an average, reports about 30 outbreaks, says the National Centre for Disease Control. Even a state like Kerala, that ranks high on the health index, reported an estimated 3.5 million fever cases, including dengue, chikungunya and leptospirosis, last year. 
Belling the cat
The Indian government has, supposedly, decided to form a national task force, including medical, veterinary and environmental experts, to fight the growing threat posed by lethal viruses. There are also talks of making veterinary public health a part of the national health mission. 
Experts underscore the importance of training in personal protective equipment (PPE), infection prevention and control, diagnostic testing, and clinical management protocols. National disease surveillance systems also need to be strengthened and modernised to help early detection of outbreaks. But, most importantly, the government needs to get private healthcare providers – who cater to 70 per cent of the country’s population – into its disease surveillance network. 
Only then, can we hope to prevent another Gorakhpur tragedy. Or, be ready to face the return of Nipah.