'Not Fear, but Caution': How Kozhikode Villages Are Battling the Nipah Outbreak

Seven villages in Kozhikode have been turned into containment zones; 700 contacts have been identified.

Patients wear safety masks as a precautionary measure after the Nipah virus outbreak, outside the Kozhikode Medical College. Image used for representational purposes.

(Photo: PTI)

When K Sajith, the president of Maruthonkara panchayat in Kerala's Kozhikode district, heard that his 44-year-old neighbour, Mohammed Ali, died of pneumonia on 30 August, he – like others in the nondescript North Malabar village – was shocked. 

"He was young and wasn't sick for long, but he suddenly died. We suspected that something was wrong," 47-year-old Sajith told The Quint.

But it wasn't until Ali's nine-year-old son, four-year-old daughter, 25-year-old brother-in-law, and a 10-month-old child related to the family were admitted to a private hospital in Kozhikode on Sunday, 10 September, that Sajith knew that something was really wrong.

On the night of Tuesday, 12 September, Kerala Health Minister Veena George confirmed that Ali, his son, and his brother-in-law were positive for Nipah – a zoonotic virus that spreads through animals (like infected pigs or fruit bats), contaminated fruits, or human-to-human contact.

This is the third time the virus has surfaced in Kozhikode and the fourth time in Kerala.

Another 40-year-old man from Kozhikode's Ayancheri, who died on Monday, 11 September, also tested positive for the infection. It is suspected that he came in contact with Ali – who has been identified as the index patient – at the hospital where he was being treated.

The harsh memories of the 2018 Nipah outbreak – which claimed 17 lives in Kozhikode – fresh in their minds, Sajith, other panchayat officials, and local healthcare workers swung to action even before the Nipah cases were officially confirmed this time.

After all, five years ago, the infection's epicentre was Perambra town, less than 20 kilometres from Maruthonkara. Moreover, the panchayat is located close to the Janaki Forest, which is known to be home to carriers of the virus – fruit bats.

"So naturally, we are better prepared this time," he told The Quint.

A health worker visiting undertaking a wellness survey in Maruthonkara village.

(Photo: Accessed by The Quint)

Contact Lists to Containment Zones

"On Sunday (10 September) itself – when Ali's family was taken to the hospital – we started taking some precautionary measures from our end," Sajith said. Ali's son, who is in critical care, had trouble breathing and had epileptic seizures at the hospital.

"We made a list of 90 people who were in contact with Ali and his family – the people who washed his body at the funeral, his relatives, the students at the school where his kids studied, etc. We made a rough route map, too, though hoping we wouldn't have to use it."

Panchayat workers and health workers also went the homes of those people who were in the initial 90-member contact list, he added.

"They are in isolation and we have been in touch with them. If they display any symptoms, we have started a help desk for them. They can call us. We have also made arrangements for them to not go out for emergencies like food, medicines, etc.," explained Sajith.

The Kerala government on Wednesday, 13 September, declared seven villages in Kozhikode – including Maruthonkara – as containment zones. The other villages are Ayanchery, Tiruvallur, Kuttiyadi, Kayakkodi, Villyapalli, and Kavilumpara.

Currently, as many as eight wards in Maruthonkara – wards 1-5 and 12-14 – have been declared as containment zones, Sajith told The Quint.

Here are some of the measures that are in place in these areas:

• Masking has been made compulsory

• Schools in the region have been shut down, switching to online classes

• Travel from and to the containment zones are prohibited until further orders

• Buses or vehicles plying on national highways will not be allowed to stop in the affected areas

• Shops selling essential items will be permitted to run

• Hotels and other business establishments are shut down

At present, the government has identified over 700 people as the contacts of the positive patients, including the latest patient, a 24-year-old health worker. Out of these, 77 are in the high-risk category, the health minister said on Wednesday.

Sajith told The Quint that the public has generally been very cooperative because they have battled an outbreak before. "People know it is more dangerous than COVID, so they have been very cooperative. What prevails now is not fear, but caution," he added.

A team of health workers and panchayat workers in Maruthonkara.

(Photo: Accessed by The Quint)

Awareness in Migrant Camps

Kuttiyadi village is about 1.5 km from the site where the infection cluster has been reported.

Speaking to The Quint, OT Nafeesa, the president of the panchayat, said that as soon as they were alerted about the Nipah suspicion on Monday, "we were ready with our mics."

Once Nipah was officially confirmed, a team of workers went around all the 14 wards in the village in a jeep, announcing the protocol and requesting residents to be on high alert.

"Eight wards in the village (3-10) have been declared as containment zones. We have identified only four people as the primary contacts here and they are all under isolation. A team of officials had visited them yesterday (Wednesday), asking about their well-being. They don't have any symptoms yet."

Kuttiyadi panchayat also made sure not to leave anyone out in their efforts to mitigate the crisis. "Kuttiyadi has at least 10 areas where guest workers (migrant workers) live. A team, including me, went to these areas and took a Hindi teacher along with us. We explained what is going on to the workers in a language they can understand," Nafeesa said.

"We have also requested the building owners of these guest workers to make arrangements for food for them and other emergencies as well," she explained.

'In 2018, We Had No Idea...'

Kozhikode battled Nipah in 2018 and 2021. In 2021, one person died of the infection, but the spread was quickly arrested. In 2019, one case was reported in the Ernakulam district as well. There were no casualties.

"Back then (in 2018), we had no idea what this virus was. We had no idea how infective it is, how to manage it, and how it spreads," Rajeev Sadanandan, the former additional secretary (health) of Kerala, told The Quint. 

"But today, on paper at least, the state is very well prepared," Sadanandan, who was the state's Nipah outbreak mitigator, said.

"Our ability to handle health emergencies has gone up considerably and we are much better prepared now than we were in the past. And this is a familiar virus," he added.

In 2018, the mortality rate in Kozhikode was 70 percent, and 17 of the 18 people infected had died.

But the damage then was not limited to just loss of life. There was a brief ban on fruits and vegetable exports from the region, which affected several businesses.

When the manager at a popular fruit shop in Kozhikode's Malaparamba – over 50 km from Maruthonkara – learnt on Monday that another Nipah outbreak was imminent in the district, he knew that his business would be hit for the next couple of weeks. 

"Over the last couple of days, our business has come down by 40 percent. People are avoiding fruits – especially guava and rambutan – fearing that it may be infected. They are not even stepping out, so generally the market is down," he told The Quint.

He, however, added: "I understand their fear but I also know that the outbreak will be arrested soon. Because we know about Nipah, because we have experienced it in the past, this outbreak should end soon."

This begs the question: Why does Nipah keep returning to Kozhikode?

Sadanandan explained to The Quint:

"The Nipah virus would have come to Kerala from Bangladesh through bats. Bats fly for over 50 km. What happens with bats is that if they are infected, their body fluids can be transmitted to the next bat."

"And the problem is that not all bats die of infection, and the virus will keep replicating itself in their bodies, especially during the reproductive period, which is Decemeber to June. During this period, they become highly infectious and the viral load will be high. If they eat fruit, the viral load will remain in the fruit – and anybody who eats that fruit will be infected. You can also get it if you're handling a bat – any kind of exposure will lead to this," he further said.

Sadanandan added that when the National Institute of Virology (NIV), Pune, performed a survey five years ago, "it was found that 22 percent bats in Kozhikode were infected with Nipah. We knew then that this number would only grow. This means that the infection may keep coming back – and that means Kozhikode will always have the probability of a Nipah outbreak."