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LETTERS TO EDITOR
Year : 2018  |  Volume : 40  |  Issue : 4  |  Page : 387-389  

Psychological interventions during nipah viral outbreak in Kozhikode District, 2018


1 Govt. Medical College, Calicut, Kerala, India
2 Government Mental Health Centre, Calicut, Kerala, India
3 IMHANS, Calicut, Kerala, India

Date of Web Publication16-Jul-2018

Correspondence Address:
Dr. Midhun Sidharthan
Nodal Officer, DMHP, Government Mental Health Centre, Kozhikode, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJPSYM.IJPSYM_249_18

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How to cite this article:
Swathy S S, Sidharthan M, Issudeen M, Shibukumar T M, Kumar A, Tharayil HM. Psychological interventions during nipah viral outbreak in Kozhikode District, 2018. Indian J Psychol Med 2018;40:387-9

How to cite this URL:
Swathy S S, Sidharthan M, Issudeen M, Shibukumar T M, Kumar A, Tharayil HM. Psychological interventions during nipah viral outbreak in Kozhikode District, 2018. Indian J Psychol Med [serial online] 2018 [cited 2019 Aug 18];40:387-9. Available from: http://www.ijpm.info/text.asp?2018/40/4/387/236650



Sir,

Nipah viral infection is a zoonotic disease caused by Nipah virus (an RNA virus belonging to the Henipavirus genus of the paramyxoviridae family). The virus first came into medical attention in 1998 in Malaysia during a disease outbreak. There are two strains of the virus: The Malaysian strain and the Bangladesh strain. These two strains differ in their infectivity, clinical profile, and genetic makeup.[1]

Fruit bats of Pteropus genus are the reservoirs of this virus. Humans get the infection either directly from bats (as in Bangladesh) or through other infected animals like pigs (as in Malaysia). Human-to-human spread of the infection, through contact with an infected person's body fluid, was noted in the disease outbreaks in Bangladesh and Siliguri, West Bengal. There has been two outbreaks in India: A major one occurred in 2001 in Siliguri (case fatality rate; CFR 68%) and an isolated incident happened in Nadia, also in West Bengal, in 2007 (CFR 100%).[2] The average CFR was around 40% in the Malaysian outbreaks and nearly 75% in Bangladesh and India. The incubation period of the illness varies from 4 to 18 days. The clinical picture may range from asymptomatic infection to serious encephalitis or severe respiratory distress.[1]

Some of the health workers who had attended to these patients had contracted the illness during the outbreak in Bengal. The high fatality rate of the illness had caused considerable panic and fear among the people and health workers during these various outbreaks.


   Outbreak in Kerala Top


There was an outbreak of Nipah virus disease in Kozhikode and Malappuram districts of Kerala state, India,[3] during May–June 2018. The person who is considered as the index case had died on May 5, 2018, but this was not confirmed virologically. Altogether, there are 18 confirmed cases of Nipah as on June 08, 2018. Sixteen of them died.[4] The CFR of the illness in Kerala has come to be 89.5%. One of the persons who had contracted the illness from the index case was a staff nurse in Taluk Head Quarters Hospital, Perambra, Kozhikode who later succumbed to death.[5]

This situation created panic and confusion among the health workers and the general public. The doctors, nurses, and staff in the hospitals where these patients had been treated before diagnostic confirmation were apprehensive over their chances of contracting the illness.

The government machinery mounted a rapid, consistent response with an unusual speed. Top officials, including the Health Minister, other ministers from the district, Director of Health Services, and Principals and Superintendents of major hospitals in the district, were all part of the team, with the District Collector as the coordinator. Daily meetings of experts were conducted at Medical College Hospital and with the district administration.

Faculty from the departments of Medicine, Emergency Medicine, Infectious Diseases, Pulmonology, otorhinolaryngology (ENT), Microbiology, Pathology and Community Medicine worked with good coordination, with support from all categories of staff from nurses to paramedics. Central agencies, such as Indian Council of Medical Research, National Centre for Disease Control, offered onsite support, guidance and monitoring of activities done by their local teams. All the health professionals stood hand-in-hand to contain the deadly virus, but to deal with panic and anxiety was a formidable task.


   Intervention Top


The District Medical Officer, Kozhikode entrusted the team of District Mental Health Programme (DMHP), Kozhikode to address the panic and fear among the hospital staff who had initially treated these patients without taking sufficient precautions as they were unaware of Nipah infection during that period. The DMHP team visited these hospitals to assess the situation and to plan an appropriate intervention. There were widespread confusion and misconceptions among the staff regarding the Nipah virus disease and its transmission and infectivity. And there was genuine concern among the staff members who had close contact with these patients.

The intervention strategy included a general plan for health education regarding the illness and the nature of disease transmission and infectivity, along with specific interventions to deal with associated anxiety and psychological stress. A general health education class was provided to the staff as a group. Individual problems were assessed. Most of them had anxiety symptoms. A fraction of them had insomnia. Benzodiazepines were prescribed for a few of them. Relaxation techniques were taught. Follow-up psychological support was offered and provided through the phone.

As the news of the infections spread and the Department of Health decided to keep the contacts of the infected patients in isolation for observation, the general public got alarmed and widespread panic set in. In this situation, psychological intervention required a scaling up and reorientation. The Director of Health Services convened a meeting in which representatives from Department of Psychiatry, Government Medical College, Kozhikode; Institute of Mental Health and Neurosciences (IMHANS), Kozhikode; and Government Mental Health Centre, Kozhikode participated. It was decided to launch a telephonic Nipah mental helpline to deal with the new situation. This was considered the best option as people were not confident to come to the hospitals for fear of contracting the disease.

The DMHP Kozhikode coordinated the program. The helpline provided three telephone numbers to the public who could call for psychological help related with Nipah viral disease, between 9 am and 5 pm. The numbers were publicized. Psychiatrists handled the phone calls at these three institutes.

Apart from the telephonic helpline, an outpatient (OP)-based support and counseling clinic was launched in the Department of Psychiatry, Medical College Hospital for catering to the psychological problems among the health care professionals and staff.

Two survivors were also visited at the end of the quarantine period, and necessary psychological support given.


   Results Top


A total of 145 calls (99 from males and 46 from females) were received till June 11, 2018. Three were from doctors, one was from a health care staff, and all other calls were from the public. Twenty-eight people required psychological intervention in the form of brief supportive counseling and relaxation techniques. Most of the queries were regarding transmission and doubts whether their individual symptoms are Nipah or not [Table 1].
Table 1: Types of interventions done via Nipah mental health help line

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   Discussion Top


There is no published data on the psychological interventions done during previous Nipah outbreaks. Even though the need for psychological support during quarantine and isolation has been identified,[6],[7] it is given the least practical importance.

One of the most important steps in dealing with public anxiety during an epidemic is risk communication. In risk communication, all the public concerns are considered legitimate, regardless of how unscientific or unfounded they may be – then only effective messages could be provided. Thus, dealing with anxiety, fear, and sundry other problems was a novel experience.[8]

Inadequate information regarding the illness can be identified as the major reason for the exaggerated risk perception and the associated behavioral responses during this outbreak. The misinformation that spread through social media had made the situation more complex. The fact that the major concern of the people who called Nipah mental helpline was to clarify the factual doubts regarding the illness illustrates this aspect of the problem.

About one-sixth of the callers presented with problems requiring psychological help. We could not get calls from people who are kept in isolation either in the home or the hospital. So, reaching to those people who are more vulnerable for psychological issues may require a specific and targeted approach.

Considering this, plans have been made to conduct focused interventions for health care professionals in the form of debriefing sessions, along with assessment of psychological problems and offering guidance and support for quarantined people. Future plans also include field visits to deal with grief and other trauma-related problems in relatives of the deceased. The most important lesson that we can learn from this is that mental health professionals can best respond to such disasters not by treatment after the event, but by preemptive community education and consultative support.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
The epidemiology of Nipah virus infection. Available from: https://www.cdc.gov/vhf/nipah/index.html. [Last accessed on 2018 Jun 06].  Back to cited text no. 1
    
2.
Kulkarni DD, Tosh C, Venkatesh G, Senthil Kumar D. Nipah virus infection: Current scenario. Indian J Virol 2013;24:398-408.  Back to cited text no. 2
    
3.
Notification for Nipah outbreak in India. Available from: http://www.who.int/csr/don/31-may-2018-nipah-/india/en/. [Last accessed on 2018 Aug 06].  Back to cited text no. 3
    
4.
Nipah virus statistics daily updates. Available from: http://dhs.kerala.gov.in/docs/transfer/addlph/adph_11062018.pdf. [Last accessed on 2018 Jun 10].  Back to cited text no. 4
    
5.
Nipah virus infection in Kozhikode. Available from: http://www.thehindu.com/news/cities/kozhikode/nipah-virus-one-more-dead-in-kozhikode/article23948165.ece. [Last accessed on 2018 Jun 08].  Back to cited text no. 5
    
6.
Hawryluck L, Gold WL, Robinson S, Pogorski S, Galea S, Styra R. SARS control and psychological effects of quarantine, Toronto, Canada. Emerg Infect Dis. 2004;10:1206-12.  Back to cited text no. 6
    
7.
Smith MW, Smith PW, Kratochvil CJ, Schwedhelm S. The Psychosocial Challenges of Caring for Patients with Ebola Virus Disease. Health Secur 2017;15:104-9.  Back to cited text no. 7
    
8.
Communication during outbreaks. Available from: www.who.int/csr/resources/publications/WHO_CDS_2005_32web.pd. [Last accessed on 2018 Jun 08].  Back to cited text no. 8
    



 
 
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