Kannur: In the recent Nipah virus outbreak in Kerala, Dr. Anoop Kumar AS, a critical care specialist in Kozhikode, emerged as a pivotal figure in the battle against this deadly disease. Drawing from his experience in the 2018 Nipah outbreak, where he played a crucial role in identifying the first cases of the virus in Kerala, Dr. Kumar brought valuable knowledge and expertise to the forefront in responding to the current crisis.

In a candid conversation with Health on Air, Dr. Kumar commended the prompt measures taken by the Kerala government to contain the disease. The state’s effective response once again brought the spotlight on the widely discussed Kerala health model. However, he also added a cautionary note, urging states with less robust healthcare systems to remain vigilant and prioritize testing.

In this in-depth interview, Dr. Anoop Kumar AS, sheds light on whether concerns about Nipah persist and why this virus continues to resurface in Kerala.

Q: What is the current status of Nipah in Kerala?

A: Currently, there have been a total of six Nipah cases in Kerala- two fatalities and four other cases, including the primary case. Fortunately, all four of the surviving cases are on the road to recovery, and we anticipate their discharge within a week. There have been no recent reports of new cases, with the last case reported around 12th or 13th September. Thus, it is highly unlikely that we will see new cases. The outbreak appears to be well-contained at this point.

Q: How did the Kerala government and the medical community respond to this outbreak?

A: Addressing this outbreak involved two primary steps. First and foremost, it was crucial to make a swift diagnosis. Once the diagnosis was confirmed, the government and health department quickly implemented a comprehensive response. This response included quarantine measures, isolation protocols, contact tracing, and continuous screening for individuals displaying similar symptoms. Through these efforts, we were able to identify two additional cases. Following that, no new cases emerged. Thus, active containment and prevention measures were instrumental in our response.

Q: Can you explain the difference between Nipah and COVID for our audience?

A: Certainly, there are significant differences between Nipah and COVID. The most notable distinction is in their mortality rates. COVID has a relatively low mortality rate of about 1.5%, whereas Nipah has an exceptionally high mortality rate of approximately 60% to 70%. This means that the chances of survival for Nipah patients are much lower compared to those with COVID.

Another key difference is in how easily the disease spreads. COVID is highly infectious and can rapidly pass from person to person, leading to widespread transmission. This is reflected in its R0 value, which is estimated to be around 1.5. In contrast, Nipah has a much lower R0 value of around 0.2. This means that as Nipah progresses from one person to another, the chances of transmission decrease, ultimately leading to containment. COVID, on the other hand, continues to spread, which is why it has caused a global pandemic with a large number of infections worldwide. Nipah has remained relatively rare, with only about 655 cases reported worldwide.

(R0 often pronounced as “R naught,” serves as a mathematical indicator of the contagiousness of an infectious disease, commonly referred to as the reproduction number. Essentially, it quantifies how an infection multiplies when transmitted to new individuals.)

Q: Do you believe that with the ongoing outbreaks, there is a continuous need for vigilance and pandemic preparedness?

A : Absolutely, there is an ongoing need for vigilance and preparedness within the health system. We must remain vigilant because outbreaks like Nipah, COVID, and other similar illnesses are still possible. In India and around the world, we must be prepared for these scenarios. To achieve this, we categorize viruses into high-priority diseases, which helps us focus our surveillance efforts. In the case of Nipah, surveillance for encephalitis cases, especially when accompanied by respiratory symptoms, is essential. The state government is actively planning and implementing such surveillance to detect cases early and initiate containment efforts.

Q: In the last five years, Kerala has seen four Nipah outbreaks. In 2018, it claimed as many as 17 lives. Why does the Nipah virus keep resurfacing in Kerala?

A:  Nipah is not unique to Kerala; it is not limited to this state alone. However, Kerala has been more successful in identifying cases due to the awareness and vigilance of clinicians. We actively screen for Nipah whenever we encounter clusters of encephalitis cases. Similar screening efforts should be implemented in all states across India, which could potentially lead to the identification of cases in other regions as well. Therefore, Nipah is a concern not only in Kerala but in all parts of India.

Q: Do we still need to be concerned about Nipah now?

A: Yes, we must continue to be concerned about Nipah, not only in Kerala but in all regions of India.