Dr Anup Warrier.
Dr Anup Warrier.

People can survive Nipah, says doctor treating Kerala patient

A big panic has not set in. There was a level of preparation since we already faced this once last year. The state government has also been very pro-active and supportive, says Anup R. Warrier, consultant for infectious diseases, Aster Medcity Hospital, Kochi

BENGALURU : Anup R. Warrier is one of the doctors treating the Nipah-hit patient in Kerala’s Kochi. Nipah has no vaccine and has a mortality rate of 70%, and killed 17 people in Kerala last year, setting off panic in the state. A consultant for infectious diseases and infection control at the Kochi-based Aster Medcity hospital, Warrier gives an inside account of the ground situation in Kerala and what to expect.

Edited excerpts from an interview over the phone:

How is the patient?

First, this is a relatively new thing for all of us, including public health workers, officers and medical staff. It is a new thing for possibly India also because we have not had this kind of illness in this part of the world, not for a very long time. So it is very difficult to predict how this will go. Last year in Kerala’s Calicut, if I remember correctly, 88% of people died. So within a couple of days, the cases had progressed to a very serious system. In this case, this boy is into his 15th day of illness. In spite of that, he is quite stable. He has a fever, but it has reduced. His brain involvement is affecting balance and memories, but has not turned into a fix or unconsciousness. So his brain involvement has not deteriorated. This is what we mean by saying the patient is stable. These are positive signs.

What was his condition when he first came to the hospital?

He came on 30 May. His parents brought him. He had about 10 days of fever already by then, with imbalance while walking, slurring of speech, no responses and so on. What we usually do in such cases is a syndromic evaluation, that means we will en-bloc test the kind of virus that affects the brain. There are about 10 to 15 viruses and bacteria tests together which can cause brain involvement. It was during that we had a suspicion of Nipah. The evaluations were done in Bengaluru and by 1 June, we had the results.

Can someone survive Nipah?

Let’s take a look across the world. There have been a couple of outbreaks—Singapore, Malaysia, Bangladesh, West Bengal and Kerala. So, we have about four outbreaks in our history to study. In all these four outbreaks, between 40 to 80% was the death rate. In Malaysia and Singapore, four out of 10 people died, while Bangladesh and Calicut eight out of 10 died. Still, in the first, six people survived and in the second, two to three survived. So definitely, people can survive Nipah. In all these cases, the survival is determined by three things.

One, is there a medicine against the specific pathogen? Second, when there is an organ involvement, how can we medically support that organ function? Suppose lungs deteriorate and need ventilator support. Third, the immune function of the patient is also very important. We are also giving ribavirin, an antiviral has been tried on this.

Some nurses who treated the Nipah patient are down with fever. How are they?

We don’t know whether they are infected. When there is a situation where they have been in contact with an already Nipah-positive patient, anybody and everybody who have been involved in the care are expected to quarantine and isolate and do tests. They developed a fever which may or may not be due to this. It may be a seasonal fever or cold too. But because they had contact with this person, we have to do the tests.

Do you see chances of a larger epidemic outbreak?

We need to wait for the state epidemiology’s investigation to be completed. Right now, they are going to all places where the first patient had been to—the people who stayed with him, had food with him, travelled with him in a bus— and checking if someone is down with fever and so on. They would have to meet some tens of thousands of people. Then if someone is found to have Nipah symptoms, then we will have to trace people who have been with that person. So day by day, the list can multiply and grow. How much has Nipah affected us will only be clear after we finish this investigation.

How long will it take?

Usually, we have to observe twice the incubation period. So, that means it will take about three weeks to get a full picture. So, the next three weeks will be crucial.

Do we have the capacity to observe and, if needed, treat people at this scale?

A big panic has not set in. One, there was a level of preparation since we already faced this once last year. There was also constant interaction, briefing and addressing concerns. Government has been very pro-active and supportive. For example, we received the preliminary report at 9pm and informed the government immediately. And by next day 12pm, we had received the ribavirin vaccine from the government, sourced from Kottayam Medical College. All district medical colleges have been adequately amped up to provide necessary facilities to accommodate people in large numbers, if needed, from what I know. And then, we only need to observe thousands of people, not everyone will be having a fever or other symptoms— only those people need to be taken to hospital isolation wards, the rest are observed at their homes. Right now, out of 311 people we checked, only five have a fever.

How are things back at the hospital? How is the work environment?

It is too early to say anything now because the public announcement happened on Tuesday. In the coming two to three days, we will know how hard it will hit us. Staff is definitely anxious. What we have done is, from day one, after receiving those preliminary test results of the patient, we are interacting with the staff every day. We explain the things to them and answer if they have any concerns.

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