The death of a nurse due to Nipah encephalitis and the detection of the virus in the blood sample of a nursing student in Kerala’s Kozhikode district have exposed the vulnerability of health workers attending to patients infected with the highly contagious virus.

Lini Puthussery, who worked as a nurse at the Government Taluk Hospital in Perambra, died on May 21. She was part of the team of health workers who attended to Mohammed Sabith – the first suspected Nipah victim in the state –who died on May 5. Puthussery and the team reportedly attended to him without using protective equipment. “The presence of Nipah virus was not confirmed at that time,” said Saseendran, the health inspector at the hospital.

The presence of the Nipah virus was confirmed after tests conducted on Sabith’s brother Muhammed Salih, who died on May 18. Their paternal aunt Mariyam died on May 19 and father Valachuketti Veettil Moosa died on May 24. They were all from Soopikkada village in Kozhikode.

The blood sample of the nursing student tested positive for the Nipah virus on May 24. could not verify reports that the student did not use protective gear while attending to patients. A health department official said the distribution of protective gear in hospitals began on May 19.

Nipah encephalitis is a rare disease. Fruit bats are considered to be the reservoirs of the virus. The virus is usually transmitted through contact with saliva or excreta of infected bats – by eating contaminated fruit, for one – and can spread from one person to another through contact and exchange of body fluids. Infected patients show symptoms of fever and cold in the early stages. This quickly advances to encephalitis, or inflammation of the brain, which can turn fatal. It has claimed 12 lives in Kerala so far. Nine of the victims were from Kozhikode and three from neighbouring Malappuram district.

Studies into a Nipah outbreak in Siliguri, West Bengal, in 2001 have clearly illustrated the virus’ capacity to spread in hospital settings, both to healthcare staff and to other patients. In the Siliguri outbreak, the virus apparently spread from one unidentified patient at the Siliguri District Hospital to 11 other patients. These patients were then transferred to other health facilities. In two of these facilities, 25 staff members and eight visitors got infected.

Protecting health workers

Kerala Health Minister KK Shylaja said the government is committed to ensuring the safety of health workers who attend to patients diagnosed with Nipah encephalitis as well as those suspected of having contracted the virus.

“The virus spreads through infected patients,” she said. “So doctors and nurses have to take extra caution while attending to them. We have bought enough masks and protective kits for them. We sourced them from different places on an emergency basis.”

She said that the Kerala Medical Services Corporation Limited, a government institution that procures essential drugs and equipment for all public healthcare institutions, has bought 10,000 masks so far. The minister said protective gear is mandatory for only those who make close contact with the patients.

Dr Fabith Moideen, president of the Society for Emergency Medicine in Kerala, said those who attend to Nipah-infected patients should wear goggles, a cap, a head-to-toe gown, a mask, gloves, and covers on their footwear. “General public should take standard precautions like washing hands with soap and water, keeping a distance of one metre from an infected person, not sleeping in the same bed as a person who is infected or suspected to have the infection,” he said.

But on Wednesday, this correspondent met a group of Accredited Social Health Activists or ASHA workers as they conducted a door-to-door awareness campaign in Soopikkada village – the ground zero of the Nipah outbreak – where four persons have succumbed to the virus so far.

None of them used hand sanitisers or were particular about washing their hands after visiting the houses in the village. “We have not got hand sanitisers or handwash liquid from the health department,” said one ASHA worker.

The minister, however, said there is no scarcity of personal protection equipment.

Moideen had the same thing to say. He said all health workers had started using safety gear while treating Nipah patients or those suspected of having contracted the infection. “All the doctors and nurses who treat suspected patients are using it,” he said. “There is no scarcity of safety gear.”

‘We’ll know our fate on June 5’

As Kerala takes steps to contain the spread of the virus, there is panic at the Government Taluk Hospital in Perambra in Kozhikode district. Health workers at the hospital said that they are worried after nurse Puthussery’s death. All of them had visited her while she was being treated at the hospital prior to being shifted to the Government Medical College Hospital in Kozhikode.

“Lini died on May 20 and the virus has an incubation period of 15 days,” said health inspector Saseendran. “So we will know our fate only on June 5. None of us used personal protection equipment while treating Sabith or Lini.”

But he said fear did not prevent them from doing their job. “We are health workers,” he said. “We are fighting a disease that is threatening society. Panic will not prevent us from discharging our duties.”