On a wing and a prayer: How the Zika virus caught UP unawares

State health minister Jai Pratap Singh admitted that when the first case came to light, only a 400 metre radius of the IAF officer’s house was concentrated upon, and it was increased to 6km only after the number of cases crossed 100.

On October 16, an officer of the Indian Air Force (IAF) walked into the 7 Air Force Hospital in Kanpur’s Cantonment area. The 55-year-old officer, whose identity was not released by the government, was running a fever for many days. He had rashes on his body, and pain in his muscles and joints. At his residence in Pardevanpurwa close to the IAF base, he took paracetamol tablets, but the relief would be temporary and the fever niggling.

Health officials collect blood samples from residents in Kanpur to test for Zika virus.(HT Photo)

On October 16, an officer of the Indian Air Force (IAF) walked into the 7 Air Force Hospital in Kanpur’s Cantonment area. The 55-year-old officer, whose identity was not released by the government, was running a fever for many days. He had rashes on his body, and pain in his muscles and joints. At his residence in Pardevanpurwa close to the IAF base, he took paracetamol tablets, but the relief would be temporary and the fever niggling.

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At first glance, doctors believed he was down with seasonal viral fever, and admitted him. For a week, they treated him with anti-biotics and anti-allergics but the fever refused to subside, and the patient grew weaker. Unsure of their treatment regimen, the doctors sent his blood samples to the Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow – the closest institution where virology testing could be done.

When the results came back on October 23, the doctors were alarmed.

Blood samples showed that the IAF officer had contracted the Zika virus, primarily transmitted by the bite of an infected Aedes aegypti mosquito. These mosquitoes usually bite during the day, peaking during early morning and late afternoon, and also transmit dengue, chikungunya, and yellow fever.

This was the first case of the Zika virus in Uttar Pradesh, said Kanpur’s chief medical officer, Nepal Singh. In the next two weeks,106 people were found infected with the virus in different parts of the city’s Chakeri area, where the IAF base is located. Smaller outbreaks were reported earlier this year in Kerala and Maharashtra.

On November 7, an infection was detected in a village in Kannauj, roughly 80km from Kanpur, taking the tally to 107. Among them are 18 children between 4 and 12, and 11 IAF personnel. Doctors are the most concerned about a pregnant woman who is admitted at Dufferin hospital and monitored round the clock.

“The monsoon spell extended through October and that made it conducive for mosquitoes to breed for a longer period. It was like fuel to the fire,” said additional director, health, Dr GK Mishra .

Tracing a deadly pathogen

First discovered in 1947 from an eponymous forest in Uganda, the mosquito-borne virus reached epidemic proportions in Brazil in 2015, when thousands of babies were born with microcephaly, a disorder that causes abnormally small heads and underdeveloped brains at birth.

A 2019 paper by researchers from the All India Institute of Medical Sciences, New Delhi, and the National Vector Borne Disease Control Programme noted that the serological prevalence of the virus had been documented as early as 1950s. A survey by the National Institute of Virology (NIV), Pune in 1954, showed that Zika antibody was present in 16.8% samples tested from Bharuch district.

The first cases were detected in 2016 and 2017 from Gujarat and Tamil Nadu. The next year, around 150 cases were found in Rajasthan, and another 130 from neighbouring Madhya Pradesh. The 2019 paper said Zika quickly became a “cause of great public health concern because of its two dreaded complications - Guillain-Barre syndrome (where the immune system mistakenly attacks a part of the nervous system), and congenital defects, but added that no neurological disorders were found in any case in India till date.

In Uttar Pradesh, too, the authorities were initially caught unawares. State health minister Jai Pratap Singh admitted that when the first case came to light, only a 400 metre radius of the IAF officer’s house was concentrated upon, and it was increased to 6km only after the number of cases crossed 100.

None of his family members have tested positive for the infection, the chief minister’s office said.

“We are identifying the localities through the satellite mapping with complete focus on trace, test and treatment like the way we did in Covid,” he said. Besides, testing has been ramped up in adjoining districts such as Fatehpur, Hamirpur, Unnao, Kanpur Dehat, Lucknow and Mathura.

“Fortunately, we have not found any case but one in Kannauj, where no further case is reported of the 85 samples tested,” he said.

The health minister said the virus reached Kanpur either through IAF planes, cargo, or men at the base. The health department has marked the storage facility between hangar seven and hangar eight where the mosquito bred and went into circulation, said a health official.

Crippled by fear

Pardevanpurwa is a locality of 50,000 people in panic. Located in Chakeri, the neighbourhood is congested with cramped housing, open drains and overflowing garbage vats. “In 30 years of living in this place, I never saw the roads being broomed twice a day, fogging taking place two times,” said Naushad Ali, a local resident.

Nowadays, the crowded streets are empty as authorities ward people off open areas. Fear of the virus has also emptied roads, pushing people indoors, where health teams visit to collect blood samples. As it was during the second Covid wave, the different agencies have been integrated — each doing a specific job in close coordination with each other, said district magistrate Vishakh G Iyer.

“I am telling them this can be caused by a mosquito bite, all they need to be vigilant, use mosquito nets, do not allow the clean water to accumulate and they must inform the teams if they see mosquitoes in any part of the house,” he said.

Some 100 teams are engaged in sampling and screening. Ram Prasad, a businessman from Pokharpur, whose sample was taken on Tuesday morning, said health teams visited him after learning that he was running a mild fever. “I was bit afraid initially but the team members told me It was for my own good,” he said.

The neighbourhood was battered by Covid during April, May and June as infections soared and bodies piled up at local crematoriums and graveyards. At least 1,200 people died during that time. Some residents say Zika has stifled any hope of a recovery. “Everyone is scared; this Zika has come on the back of this Covid. The situation is the same as it was during the second wave,” said Prasad.

Nearby, Mohammad Zubair, who used to run a tea stall, said his daily income had dried up when the locality was converted into a containment zone two weeks ago. “I suffered during Covid; now when sales were improving, this Zika has arrived and killed my earnings. I am struggling to feed my family,” he added.

Containment strategy

The Zika containment strategy is focused on people down with fever, children, pregnant women, and source reduction (eliminating mosquito breeding points).

A six-member team from the National Communicable Diseases Control (NCDC) in New Delhi has been camping in Kanpur for two weeks now. A state health department official, Raj Kumar, said the teams were told about the importance of killing breeding points. “We have been asked to tell the people also so that they can inform us,” he said. The teams have collected 3499 samples and sent them to the National Institute of Virology in Pune.

While there has been no official demarcation of containment zones, people with symptoms have been advised to remain indoors.

Other teams have put 36,000 homes under surveillance and conducted anti-viral and anti-larva spraying at these spots. A separate study to assess the density of mosquito per 100 houses found that mosquitoes spreading Zika dengue had a density of two to three per 100 houses. This is far higher than last year, when it was one in 200 houses, said additional director, health, Dr GK Mishra.

Another problem faced by authorities is that 70% of the patients are asymptomatic. The symptomatic patients have mild fever, rashes on the body and muscular and joint pain. The health department report, which HT has seen, says 400 pregnant women in a population of 52,000 were under high risk. CMO Nepal Singh said every expecting woman was being screened throughout the city.

Dr Mishra said the destruction of mosquitoes and their breeding spots was the only way to check the virus spread. “It is heartening that the temperature has dropped considerably with the start of November. The wintry condition will end the breeding and hopefully the infection spread will be fully contained by November 20,” he said.

Unprepared and overwhelmed

Despite the scale of the virus control now, some officials admit that the detection of the first case was a stroke of luck. Two senior health officials said on condition of anonymity that if the air force hospital hadn’t opted for virology tests, everyone would have assumed it to be seasonal viral fever and forgotten it.

“It looks like it was passing off like a viral fever, when I tested positive, I could not believe that I had Zika virus infection. There were no symptoms at all. I told CMO sahab that there may have been a mistake in my case,” said a health department employee living in Shyam Nagar.

Nepal Singh said 170 beds have been reserved in four hospitals and testing of samples will begin in the city in a day or two. With local primary health centres and rural institutions ill-equipped to deal with virus control protocols, patients have been streaming into city hospitals.

At the Kanshi Ram Memorial Hospital, where 100 beds have been reserved, a 12 year-old girl lay down under a mosquito net. Her mother sat on the bed adjacent to her, both confused after they were quickly shifted to the hospital on Monday evening .

Her mother said health teams visited three days ago and collected their blood samples. Then a team came down to the house again on Monday and told them that they had to go to the hospital. “No one is answering our questions but keeping us here,” she said.

Chief minister Yogi Adityanath has regularly monitored the outbreak and instructed officials to deal with the outbreak on a war footing. He is scheduled to visit family members of Zika patients in Shyam Nagar and Pokharpur after reviewing the situation in Kanpur on Wednesday.

In preparation for his visit, local authorities have given the two localities a facelift, repaired cratered roads, picked up overflowing trash cans, and cleaned gutters. Local residents said the neighbourhood looks changed overnight. “Had they done it earlier, Zika wouldn’t have taken such a toll,” said an IAF officer living in the area, requesting anonymity.