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EXPEDITIOUS RESPONSE TO EPIDEMICS: THE CHRONICLE OF NIPAH IN KERALA
Ashique Vadakkuveettil1, Aakriti Grover2 and Rohini Menon3
1

Research Scholar, 2Assistant Professor
Department of Geography, Central University of Tamil Nadu, Thiruvarur, Tamil Nadu, India.
3
Research & Documentation Officer, Environment, Technology and Community and Health(ETCH), Kalyan, Mumbai, India
Email: ashique.vv@outlook.com

How to cite this paper:
Vadakkuveettil,Ashique;Grover, Aakriti and Menon,
Rohini (2022) Expeditious
response to epidemics: The
Chronicle of Nipah in Kerala,
Journal of Global Resources,
Vol. 08 (01)DOI:
10.46587/JGR.2022.v08i01.015

Received: 12 Sep. 2021
Reviewed: 03 Nov. 2021
Revised: 16 Nov. 2021
Final Accepted: 02 Dec. 2021

Abstract: Kerala witnessed a catastrophic outbreak of theNipah virus (NiV) in May 2018, with a fatality rate of 40-75 percent. The Nipah virus is recognised by the World HealthOrganization (WHO) as a significant public health concern,and it's one among the priority diseases for accelerated R&D
due to the severe lack of available countermeasures against
it. There is no vaccine or cure for the infection. The state ofKerala showed an exemplary response to the outbreak. This
involved rapid and effective dissemination of necessary
precautions to the broader public. Internet social media playeda crucial role in spreading these messages. Although thedisease claimed 21 lives, it could have been a lot worse if thestate had not taken the measures for proper mitigation. This
work gives a brief overview of the Nipah virus, followed by acomprehensive outline of the Kerala outbreak. Community andindividual responses to the Nipah outbreak have been
analysed to illustrate how various groups and individuals, fromhealth care and tourism departments to religious leaders,played a role in successfully eradicating the virus. Kerala's
experience in containing epidemics is expected to become areference point for other states and regions that may findsimilar situations.
Keywords: Community Response, Epidemic, Nipah Virus
Infection (NiV).

Journal of Global Resources, January 2022, Volume 08 (01) A. Vadakkuveettil, A. Grover and R. Menon Page | 127

Introduction
According to the World Health Organization (WHO), Nipah Virus Infection (NiV) is a zoonotic virus(it is transmitted from animals to humans) and can also be transmitted through contaminated foodor directly between people. Currently, there are no vaccines to prevent NiV (World HealthOrganization, 2018). The virus is a part of the genus Henipavirus and subfamily Paramyxoviridae.
It is a highly pathogenic zoonotic disease that evolves, with outbreaks recorded from countries inSouth East Asia (Thomas et al., 2019). The first known outbreak of the Nipah virus was in
Malaysia in 1998, the second outbreak was in Bangladesh in 2001. In the same year, the firstoutbreak in India was reported in Siliguri, West Bengal, later on in 2007 in Nadia, West Bengal(Lam and Chua, 2002; Chadha et al., 2006; Looi and Chua, 2007; Rahman and Chakraborty,2012). Again, in India, Kerala witnessed the deadly Nipah outbreak in May 2018, claiming 21 lives
out of 23 infected patients with a case fatality rate (CFR) of 88.9 per cent (deaths/laboratoryconfirmed cases, 16/18). From the second case itself, a doctor from Baby Memorial Hospital
noticed some similarities with the death of case 1 & case 2. As a result, on May 18, they sent
samples to the Manipal Centre for Virus Research (MCVR) in Manipal, Karnataka. Following
confirmation of Nipah, the Department of Health and Family Welfare (Government of Kerala)
adopted quick public health response measures, including patient isolation, infection prevention
and control (IPC) and the use of personal protective equipment (PPE) (Sadanadan et al., 2018).
Along with the government, the expeditious response of the people in Kerala was also a key insuccessfully containing the Nipah virus. This paper analyses the community response of people
in the Kozhikode district who were severely affected during the outbreak. The main aim of thisstudy is to understand the evolution and changes in attitudes, knowledge, and behaviours ofpeople in response to the Nipah outbreak.
Study Area and Methodology
This study has been carried out in the Kozhikode district as the first case of Nipah was reported
here (Fig. 1). Kozhikode is one of the coastal districts of Kerala where Vasco Da Gama, the leaderof a trade mission from Portugal, first landed in May 1498 (Ministry of Water Resources, 2013).
The district covers an area of 2344 km2 and is well-connected by road, rail, and air. The Kannur
district borders it to the north, the Wayanad district to the east, the Malappuram district to thesouth, and the Lakshadweep Sea to the west. It lies between the longitudes of 11°08 ' and 11°50'
in the north and 75°30' and 76°8' in the east (Department of Mining and Geology, 2016). The
participants of this research hail from various regions throughout the Kozhikode district, aged
between 18-58. Online surveys have been done with the help of google forms to monitor thecommunity response of people. All the information in this paper is based on the data collectedfrom 100 respondents who took part in the online survey. Selected respondents were interviewed
again personally or on call to share their experience of Nipah. Questions were asked tounderstand people’s perceptions about Nipah and to analyse their behavioural change during andafter one month of the Nipah outbreak. Finally, percentages were calculated, and graphs wereconstructed from the data using OriginPro 2021.
Findings and Discussion
Out of 100 respondents, 76 per cent were males, and 24 per cent were females. Around 63 percent of the respondents were between the age of 18-28, and the remaining 37 per cent werebetween 29-58. Maximum number of people have a graduate degree (51.1%) and a postgraduate
degree (36%). Respondents were the inhabitants of Mukkam, Nadapuram, Vanimal, Thuneri,Changaroth, Koduvally, etc. Case 1 was reported from a place named Sooppikkada inChangaroth village. Most of the patients were the inhabitants of infected areas or had close
contact with the infected persons. In the initial stage, Nipah was not confirmed; hence, the patients
Journal of Global Resources, January 2022, Volume 08 (01) A. Vadakkuveettil, A. Grover and R. Menon Page | 128

had close contact with people in and around hospitals (Fig. 1). Most cases are transmitted either
from the hospital or from the patient's home. Once it was confirmed as Nipah, the government
took immediate actions like asking schools and other educational institutions to remain closed,
implementing travel bans, distributing awareness notices to all government and private
institutions, pasting posters in public places and other public gathering places like hospitals,mosques, etc. Awareness was given to people from mosques regarding the safety measures asthese areas were Muslim majority regions, and most of them gathered in the mosques on Friday.
Figure 01: Study area

Initially, most of the people received information about Nipah through social media (43%),
newspapers (25%) and T.V/Radio (18%). At the same time, some of them (14%) get to know
about it from their friends or relatives (Fig. 2). This shows the role of social media in the presentera for disaster mitigation. It is to consider that Kerala's high literacy rate helped people be moreaware of the outbreak. The lifestyle of people had a very noticeable change at this time. Many ofthe people (43%) rarely went outside during the outbreak time while not many of them (6%) neverwent outside. Majority of people (47%) went outside to an average extent, and very few people(4%) went outside frequently. Some of them even continued to remain cautious even after being
free from the disease (Fig. 3). As the fruit-eating bats caused Nipah, most people avoided buying
fruits during that time, but later, when the state was free from Nipah, people started buying it again(Fig. 4a). However, most of them avoided eating bird or animal bitten fruits during and after Nipah(Fig. 4b). Needless to mention, it affected the daily life of the people. Shops, restaurants, buses,public places, hospitals etc., remained empty during those days as people were being very alertand cautious to avoid visiting infected areas particularly, and crowded places in general (Fig. 5).
Many people preferred to cancel their travel plans and other public events out of the fear of getting
infected (Fig. 6).
Journal of Global Resources, January 2022, Volume 08 (01) A. Vadakkuveettil, A. Grover and R. Menon Page | 129

Figure 02: Initial sources of Nipah updatePeople preferred travelling in private vehicles rather than public transport. A complete
transition has been taking place in people’s lifestyles, illustrating how terrified people were in
those days. Most of them (93%) kept checking Nipah updates regularly because of its severity(Fig. 7). When the virus got cured, and patients became free from it entirely, the majority of people
believed that this disease was curable (64%). However, most individuals were aware of how
deadly this virus was (71%) (Fig. 7). It took plenty of time for the people of Kerala to restart theirlives normally, even after Nipah was cured. Many of them remained fearful of the next outbreak.
Figure 03: Public Response

Journal of Global Resources, January 2022, Volume 08 (01) A. Vadakkuveettil, A. Grover and R. Menon Page | 130

Figure 04: Frequency of people went out during and after Nipah

Figure 05: Alertness towards visiting places (in %)Figure 06: Response to travel plan andpublic gathering (in %)Figure 07: People’s perception onawareness and severity of Nipah (in %)Journal of Global Resources, January 2022, Volume 08 (01) A. Vadakkuveettil, A. Grover and R. Menon Page | 131

Conclusion
The deadly zoonotic Nipah Virus, which put the state of Kerala to a standstill, has shown theimmense sensible precautions taken by the people. The outbreak of the virus made people awareof their surroundings and cognizant of how to handle such situations with a comparatively low
death toll due to the highly positive response to the disease. Social media played a vital role inspreading awareness about the virus, which indeed had a significant role in response andprecautions taken by them, which helped to cease the spread of the virus to the massive groupof people. The government also immediately shut down the institutions, distributed Nipah virus
awareness notices, advised less human contact with the infected and requested to avoid crowded
places, etc. Concerning all this, the people's lives were adversely affected, but after the statecame out clean, everyone continued with their daily life. Nevertheless, this disease left a negative
impact as well. The fear of getting infected made people a little less of a human in treating thepeople who had the virus or the people belonging to the infected area. The fear made them treat
these people indifferently even after the cure. The previous carrier of the virus and their families
faced isolation and an undeclared social boycott. To resolve this maltreatment towards suchvictims and their families, a few doctors themselves came in direct physical contact with them.
They talked about how unacceptable and unnecessary it is to give such treatment to them. By
taking care of the infected patients by this deadly virus, the government and health officials
showed great bravery. Not to mention the sacrifice of the nurse named Lini Puthussery, who got
infected and lost her life during the service. She set an example of humanity, empathy andcompassion in the society. The immediate efforts taken by the government and health officials
during the Nipah virus outbreak in Kerala were acknowledged and appreciated in different partsof the world.
Acknowledgements: We would like to thank all of our respondents for their time in helping uscomplete our survey. We are also thankful to Monib Ahmad, Salih Madathil and Aisha Wani for
their kind support and assistance.
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Journal of Global Resources, January 2022, Volume 08 (01) A. Vadakkuveettil, A. Grover and R. Menon Page | 132