The Bihar government has ordered a socio-economic survey of more than 450 people whose children have either been affected by Acute Encephalitis Syndrome or died of the disease, The Indian Express reported on Thursday. At least 128 people have died of the disease across the state, according to ANI.

State Chief Secretary Deepak Kumar has ordered the survey to be conducted by workers of Jeevika, the Bihar government’s rural livelihood programme. The direction came days after Chief Minister Nitish Kumar had said that a socio-economic survey of the families affected by the disease along with the sanitation status of the areas where Acute Encephalitis Syndrome is prevalent will help find a long-term solution to the deadly disease. Saraiya, Minapur, Mushahari and Kanti blocks of Muzaffarpur district have been affected the worst.

Meanwhile, encephalitis also spread to other districts of Bihar with children being admitted to hospitals in like Samastipur, Banka and Vaishali, The Times of India reported.

Sri Krishna Medical College and Hospital in Muzaffarpur is reportedly struggling to handle the newly-admitted patients. The high profile-visits by Union Minister of Health and Family Welfare Harsh Vardhan and Nitish Kumar have added to the chaos, according to The Times of India.

Hospital superintendent Sunil Kumar Shahi said: “All 637 beds, including 30 in the paediatric ICUs, are occupied. We have had to put two kids on one bed to accommodate more children.” Shahi also said there was a shortage of senior resident doctors in every department. “Around 40-50 new cases of AES have been coming every day, but our resources are very limited.”

A makeshift paediatric Intensive Care Unit with 20 beds and four air-conditioners was set up on Wednesday. However, frequent power cuts hampered efforts to ease the crisis.

According to a research paper titled “Determinants of Acute Encephalitis Syndrome (AES) in Muzaffarpur District of Bihar, India: A Case-Control Study”, the affected children in 123 cases belonged to Scheduled Castes, Scheduled Tribes or Other Backward Classes. The families of children in 100 cases were found to be illiterate and farming was found to be the source of income for the families of 114 children. Other surveys have also drawn some conclusions on the basis of eating habits, lifestyle, economic status and caste background but the cause remains clinically unidentified in several cases.

The symptoms of Acute Encephalitis Syndrome, which causes fatal inflammation of the brain, include fever, mental confusion, disorientation, delirium, or coma, and 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.