Fear stalks Soopikkada, a sleepy village in Changaroth gram panchayat of Kerala’s Kozhikode district. The streets are eerily empty as the residents barely venture out of their homes. When they do, they wear face masks and avoid public transport. Soopikkada is the ground zero of the Nipah outbreak. The virus has killed three of a family in the village and is suspected to have caused the death of a fourth member as well.

“We are passing through a difficult phase,” said KK Ayisha, president of Changaroth gram panchayat who lives in Soopikkada. “Everybody is worried about their health. We pray the virus will not create any more havoc.”

Such is the fear that many villagers have left to stay with their relatives outside Soopikkada. According to state health officials, 77 people from 17 families have moved out in the last five days. “It seems they have gone to their relatives’ homes,” said health inspector KM Rajan. “They might come back after things settle down.”

A villager who goes by Ajmal confirmed that many people had left but disputed the number mentioned by the health officials. “Some of the houses in their list have been closed for many months,” he said. “The health department should have sought help from local people while surveying the area.”

Nipah encephalitis, as the infection caused by the virus is known, is a rare disease. Until this week, there had been one known outbreak of the infection in Malaysia in 1998, two in West Bengal – Siliguri in 2001 and Nadia in 2007 – and several in Bangladesh since 2001. Infected patients show symptoms of fever and cold in the early stages that quickly advance to encephalitis, or inflammation of the brain, which can turn fatal.

The virus is usually transmitted through contact with saliva or excreta of infected bats – by eating contaminated fruit, for one – and can spread from person to another through contact and exchange of body fluids.

In Kerala, the first suspected casualty of Nipah was from Soopikkada. Muhammed Sabith, 26, died on May 5. He had been undergoing treatment for stomach ulcers and was diagnosed with fever on May 3. Initially, the villagers just thought the fever had complicated his stomach ulcers, causing his death. But when three members of his family died in a span of just 20 days, fear gripped the village. Sabith’s brother Muhammed Salih, 23, died on May 18. Their paternal aunt, Mariyam, 55, died a day later and their father62-year-old Valachuketil Moosa on May 24. They all showed symptoms of fever and cold, encephalitis and myocarditis, which is inflammation of the heart.

On May 20, the health department confirmed that Salih and Mariyam had died from the Nipah infection but did not say if it had been the cause of Sabith’s death as well, though that is widely suspected to be the case. As the health officials began to track down other patients who might be infected and tested them for the virus, the death toll started to rise. By Thursday evening, it was 12. Nine of the victims were from Kozhikode and three from neighbouring Malappuram district.

Raveendran in his fish shop in Changaroth. Photo credit: TA Ameerudheen
Raveendran in his fish shop in Changaroth. Photo credit: TA Ameerudheen

Uncertain times

Not surprisingly, daily life has become uncertain in Soopikkada. Raveendran, a fish vendor, has been struggling to find customers. “Very few people venture out of their homes these days,” he said. “It has affected fish sales.”

Raveendran gets fish from Kozhikode to supply in Changaroth town. “I used to sell 100 kg of fish a day,” he said. “People from neighbouring villages come to the town to purchase fish and other provisions. That has almost stopped now.”

Bus owner Riyas said people are avoiding public transport for fear of contracting the infection. “I will stop the service if I do not get enough passengers in the next few days,” he said.

Abdul Rasheed, a schoolteacher in Soopikkada, said he was getting calls from parents asking if the government would postpone the reopening of schools. Kerala’s schools are scheduled to reopen next week after the two-month summer break. “Some of them are thinking of taking their children to schools in neighbouring villages,” Rasheed said.

The villagers claim the pervasive fear has even affected health professionals. “I took a relative to the taluk hospital the other day and when the doctor realised we were from Changaroth he refused to treat her,” alleged Mujeeb, a Soopikkada resident. “Why are they discriminating against us? Have we done anything wrong?”

Ajmal claimed the taluk hospital was short of staff. “The government has to urgently solve the issue,” he added.

Home of bats

Furit bats are natural hosts of the Nipah virus and the forested terrain around Soopikkada, which lies about 50 km north of Kozhikode city, is home to a large population of them. The village is in the middle of the 131-hectare Janaki forest, named after the statesman VK Krishna Menon’s daughter VK Janaki Amma, who owned the land before the Kerala government took it over. The forest is home to many bat species. It is easy to spot bats hanging from trees on either side of the road the leads from Soopikkada to the picturesque Peruvannamuzhi dam.

A team from the National Institute of High Security Animal Diseases in Bhopal has been catching and testing fruit bats in the village since Wednesday, but it is yet to ascertain their role in the outbreak. Many villagers, however, believe the bats are not the villains. Ajmal contended that the infection would have reached Soopikkada much sooner if it was indeed spread by the fruit bats. “This village is a bat hub,” he said. “Thousands of bats can be spotted on every tree top.”

But Ayisha cautioned against making such assumptions. “People believe the bats are not the culprits,” she said. “Let’s wait for a couple of days. The health department will confirm soon.”

Youth Congress workers distribute masks in Changaroth gram panchayat on Wednesday. Photo credit: TA Ameerudheen
Youth Congress workers distribute masks in Changaroth gram panchayat on Wednesday. Photo credit: TA Ameerudheen

Clearing the air

On Wednesday, Dr Lailabi, an associate professor of community medicine at the Kozhikode Medical College, and her team met the villagers at Soopikkada’s mosque. The meeting was part of the health department’s awareness campaign to dispel misinformation about the infection and help people protect themselves against it. The campaign has assumed significance given that social media, particularly WhatsApp, is awash with unverified claims about the Nipah, even conspiracy theories.

One message is based on the outlandish claim made by a naturopathy practitioner, Mohanan Vaidyar, that the Nipah virus is a creation of the Kerala health department. Vaidyar has posted a video on Facebook in which he claims to have eaten fruits bitten by bats in Changaroth. “If this is virus, I will die tomorrow,” he is heard saying in the video, which has been viewed and shared by thousands of people on social media. The police have registered a case against him for spreading fake news.

Shalini Prakash, an Accredited Social Health Activist, said people were eager to know about the veracity of Vaidyar’s claims. “We told them the health department will issue advisories based on thorough research,” she said. “We requested them not to go after controversies and secure their health.”

The health department has deployed the health activists to conduct a door-to-door campaign in all 19 wards of Changaroth gram panchayat. CK Pushpa, one of the activists, said she visited 25 houses in Soopikkada on Wednesday. “I told them about the precautionary measures against Nipah,” she added. “People are worried. They have many doubts about the virus.”

The awareness camps focus on educating the people about precautionary measures. “We ask people to maintain safe distance from people who might have contacted Nipah virus infected persons,” said Rajan. “We also ask them avoid fruits contaminated by bats and sanitise hands quite often.”

Ayisha believes the awareness campaign is helping restore some calm in the community. KP Yusuf, who owns a shop in Soopikkada, agrees. “The cloud of suspicion is slowly moving out of the minds of Soopikkada residents thanks to the awareness classes,” he said.

The health department is also taking measures to stop the infection from spreading. At least 15 field workers are monitoring Soopikkada for fresh fever cases. “We took blood samples from 16 people who were in close contact with the dead,” said Dr Bijesh Bhaskaran, medical officer at the primary health Centre in Changaroth. “We are also closely monitoring 107 people in Soopikkada. If we notice fever or related cases we will rush them to the Medical College Hospital.”

OT Mohammedali helped bury the four villagers who died from the Nipah infection in Soopikkada. Photo credit: TA Ameerudheen
OT Mohammedali helped bury the four villagers who died from the Nipah infection in Soopikkada. Photo credit: TA Ameerudheen

‘Allah will protect me’

There are a few people in Soopikkada, though, who do not seem to be worried. This is troubling as they may not be taking adequate measures to protect themselves. OT Mohammed Ali, 35, a daily wage labourer, helped bury all the Nipah victims in the village. “It is our duty to tend to the dead body and give a respected burial,” he said.

Ali said he did not use any protective gear such as gloves while handling Sabith’s body. Ali had also accompanied Moosa, who died on Wednesday, to the hospital in Kozhikode. “But I am not worried,” he said. “This is the holy month of Ramzan and Allah will protect me from Nipah.”