On the morning of September 11, critical care specialist Anoop Kumar was presented with an unusual situation. Four members of the identical family had been admitted to his hospital—Aster MIMS in Kozhikode, Kerala—the day past, all similarly sick. Would he have a look?
He gathered his team of doctors to analyze. Soon they were on the bedsides of a 9-year-old boy, his 4-year-old sister, their 24-year-old uncle, and a 10-month-old cousin. All had arrived on the hospital with fever, cough, and flulike symptoms. The 9-year-old was in respiratory distress, struggling to breathe properly, and had needed to be placed on a noninvasive ventilator, with air pumped through a mask to maintain his lungs expanded.
Their symptoms were concerning and mysterious—not one of the team could pinpoint what was incorrect. But delving into their family history, Anoop and his colleagues soon uncovered a clue. The father of the 2 young siblings, 49-year-old Mohammed Ali, an agriculturalist, had died lower than two weeks previously. And when the team at Aster MIMS got in contact with the hospital that had treated Ali, they found that he had been admitted with similar symptoms, pneumonia and fever.
Digging deeper, they learned from the opposite hospital that Ali had also had some neurological symptoms, which had seemingly been missed by his doctors—he’d had double vision, suffered seizures, and spoken with slurred speech. Despite this, Ali’s death had been attributed to “multi-organ failure,” a vague diagnosis with no indication of the cause. Alarm bells began ringing in Anoop’s head.
Ali’s case reminded Anoop of May 2018, when he’d diagnosed five patients with a mixture of flulike symptoms, respiratory distress, and neurological problems. Those patients had been suffering with a rare but deadly zoonotic virus called Nipah.
Believed to be spread to people from bats, Nipah has a fatality rate in humans of somewhere between 40 and 75 percent. In the 2018 outbreak in Kerala, India’s first ever, 18 people caught the virus. Seventeen died.
“You can contract it with direct contact with infected animals, comparable to bats or pigs, or from food or water contaminated with their body fluids,” says Thekkumkara Surendran Anish, associate professor for community medicine on the Government Medical College in Manjeri, Kerala, who leads the state’s Nipah surveillance team. “Close contact with an infected person and their bodily fluids can expose you to Nipah as well.” The virus has since emerged multiple times in Kerala.
Anoop and his team knew that they had to act swiftly—there are not any authorized treatments for Nipah, nor are there vaccines for defense. If the virus were to take hold or spread outside of the local area, the results might be catastrophic. But first they needed confirmation.
The cluster of mysterious cases in these patients, their connection to Ali, his concerning neurological symptoms, his lack of a correct diagnosis—“We had strong reason to suspect Nipah again,” Anoop says. “Another red flag was the rapid decline of the patient,” Anoop says of Ali. Within a matter of days, he had fallen sick and died. And then there was one final alarm: “Ali lived near the epicenter of Kerala’s 2018 Nipah outbreak.”
