Bihar Chief Minister Nitish Kumar faced protests on Tuesday during his visit to the Sri Krishna Medical College and Hospital in Muzaffarpur as the toll from from encephalitis rose to 127, The Hindu reported.

Of the 127 deaths, 108 were reported from Muzaffarpur. Suspected Acute Encephalitis Syndrome has killed 89 people at Sri Krishna Medical College and Hospital and 19 in Kejriwal Hospital so far, ANI reported. As many as 85 of the deaths at Sri Krishna hospital and 18 at Kejriwal hospital till Monday night were of children, NDTV reported.

Relatives and families of those who died of encephalitis gathered outside the Sri Krishna Medical College and raised slogans such as “Nitish Kumar go back” while waving black flags at him.

A protestor, pointing to a water tanker, said it was being spruced up to make a favourable impression on the chief minister, reported PTI. “Had the CM visited earlier, it would have made the concerned people pull up their socks and many lives could have been saved.”

Chief Secretary Deepak Kumar said the chief minister reiterated that patients will not have to bear expenses to come to hospitals, ANI reported. “Their fare will be reimbursed, they’ll be given Rs 400 at flat rate,” he said. “He [chief minister] said main reason of deaths is that patients reach hospitals late.”

Quoting the chief minister, Deepak Kumar said that while there was no dearth of doctors, a few more doctors from the Dayanand Medical College and Hospital and Patna Medical College and Hospital will be brought in.

The chief secretary said the Sri Krishna Medical College, which has 610 beds at present, will be converted into a 2,500-bed hospital, according to ANI. The hospital will be upgraded to 1,500 beds in the next one year and then to 2,500 beds. The Intensive Care Unit will be expanded to accommodate 100 beds, he added.

Medical Superintendent of Sri Krishna Medical College SK Shahi said the chief minister ordered the hospital to release a daily bulletin at 3 pm, reported ANI. Shahi said Nitish Kumar met patients and their relatives and was satisfied by the medical treatment being provided. “He was pained by the fact that adequate facilities for treatment were not available here.”

“To establish the cause of the disease, there is an urgent need for an inter-disciplinary, high-quality research team,” Union Minister of Health and Family Welfare Harsh Vardhan said on Monday following a high-level meeting with officials from the ministry, the All India Institute of Medical Science and the Indian Council of Medical Research. “The research team shall work with the children suffering from AES looking at various aspects including periodicity, the cycle of disease, environmental factors, and metrological data, besides other factors.”

The National Human Rights Commission had on Monday issued notices to the Union Ministry of Health and Family Welfare and the Bihar government led by Nitish Kumar, following the encephalitis outbreak. It said that the ministry and state government should respond within four weeks.

A case had been filed against Vardhan and Bihar Health Minister Mangal Pandey in a Muzaffarpur court on charges of negligence leading to the deaths of the children. Activist Tamanna Hashmi filed the case that will be heard on June 24.

Pandey had courted controversy on Sunday during a press conference with Vardhan and Minister Of State for Health and Family Welfare Ashwini Kumar Choubey. “How many wickets have fallen till now?” he had asked, referring to the India-Pakistan World Cup game. “Four wickets,” he was told.

Vardhan visited Muzaffarpur on Sunday to take stock of the situation. Families of patients, especially at Sri Krishna Medical College and Hospital, protested when Vardhan arrived at the hospital. People demonstrated against the inadequate facilities at the hospital and alleged negligence on the part of hospital staff. They waved black flags at Vardhan’s convoy.

The disease

Acute Encephalitis Syndrome causes fatal inflammation of the brain, along with fever, mental confusion, disorientation, delirium, or coma, and cause onset of seizures.

The Japanese encephalitis virus is the most common cause of Acute Encephalitis Syndrome in the country, causing 5% to 35% of the cases. But the syndrome is also caused by scrub typhus, dengue, mumps, measles, and Nipah and Zika viruses. However, the cause remains clinically unidentified in several cases.