While the pandemic Covid-19 has completely taken over the health infrastructure in the country and all eyes were on it, the annual havoc created by Acute Encephalitis Syndrome (AES), popularly known as Chamki Bukhar is already making news in districts of Bihar. There is a real fear that other infectious diseases such as Japanese Encephalitis (JE) and AES may come roaring back in Uttar Pradesh and Bihar as the healthcare systems scramble to support outbreak response. The onset of the monsoons in eastern Uttar Pradesh and Bihar rings the alarm bells for outbreak of JE/ AES in the region as it is endemic to these areas.
The diseases have been plaguing the two states over many years. Is the health system prepared to respond to this unprecedented challenge amid the humanitarian crisis created by Covid-19?
Encephalitis is an acute inflammation or swelling of the brain caused mostly due to viral infection. Infants and the elderly are particularly at risk of getting infected. With high temperature, headache, nausea, vomiting, and joint pain as early symptoms, encephalitis, if not diagnosed in time, could lead to varying degrees of brain damage, which may require long-term supportive care and therapy.
The disease outbreak is usually reported during monsoons (June-October). It can be caused by virus, bacteria, fungi, and a range of agents.
In Uttar Pradesh, seasonal outbreaks of AES with high fatality have been reported from Gorakhpur division since 1978.
According to the National Vector Borne Diseases Control Programme (NVBDCP), 22,949 AES cases were diagnosed from 2013 to 2019 with 3,298 deaths in UP.
In Bihar, more than 500 children have died in the last decade due to AES, mainly in Muzaffarpur and its neighboring districts of Vaishali, Sitamarhi, Samastipur, Sheohar, East and West Champaran.
Last year, in June, the AES outbreak in the five North Bihar districts had resulted in the death of over 150 children and more than 600 children suffering from AES were admitted to hospitals.
By the first week of April, Bihar had reported 6 cases of AES ahead of the summers and a palpable sense of panic gripped many.
The intersecting crisis of Covid-19 and JE/AES could limit the health systems ability to respond to the pre-existing problems. The social stigma around the pandemic in particular makes the already inaccessible health services unreachable. According to the World Health Organisation (WHO), prevention and treatment services for non-communicable diseases have been severely disrupted since the onset of Covid-19 pandemic.
In case of JE/AES, the high number of cases as well as the number of deaths has always been attributed to the poor health infrastructure in these states. Will the knock-on effects of Covid-19 worsen the existing health crises and create new ones altogether? Will our fragile health care systems and infrastructure be able to deal with the burden of existing diseases?
The states governments do claim that they have completed the immunization and awareness programmes. According to newspaper reports, over 11.36 lakh persons in 38 affected districts of Uttar Pradesh have been immunized against JE and AES in a special campaign between March 1 and 15, 2020. In Bihar, immunisation for JE was carried out in 26 districts ahead of the lockdown, but could not be completed in the remaining 12 districts. Officials said that the JE vaccines were administered to 7.89 lakh children in three districts including AES-affected Muzaffarpur ahead of lockdown.
Other than prevention and preparation, the challenge is to make the treatment available and accessible to people, else the disease could come surging back in places. News reports abound on how basic health services are being denied by healthcare professionals due to fear of Covid-19. The fear is so strong that people with other illnesses are missing routine care due to the coronavirus pandemic or are struggling to find treatment.
A recent news item pointed to how someone lost their life after being denied treatment by multiple doctors and hospitals over doubt of Covid-19 due to similar symptoms. Hospitals in the country are struggling to cope with the number of patients they’re getting and are demanding a clearance from the family that the patient is not suffering from Covid-19.
The panic over the spread of Covid-19 and lack of reliable information has increased the fear among doctors, who are denying treatment to patients with symptoms akin to coronavirus.
Situations like this can make life miserable for families having a JE/AES patient as they already belong to the marginalised, vulnerable section of society. One needs to acknowledge that AES affects the poor overwhelmingly and it has numerous linkages with socio-economic condition, access to food and nutrition, climatic condition and overall poverty and marginality.
Several socio-economic survey reports of the victims of AES revealed that AES cases are mostly coming from the underprivileged and marginalised communities due to their poor living conditions.
As estimated more than 75 percent of the victims belong to socially marginalised section – comprising mostly Dalits along with Extremely Backward Classes (EBC) and Muslims. There is hardly any case in which the AES-affected child belongs to a rich and well-off family.
So, the communities already marginalised would not be able to bear the pain of discrimination and stigma any further. And this is what makes them extremely vulnerable.
We are told by almost all the health experts that Covid-19 is not going to vanish any time soon and we need to learn to live with it. It is imperative that our health system also learns to live with it and doesn’t forgo the health issues especially routine medical care and burden of disease at hand.
Pratima Kishore is pursuing her M.A. Social Work in Public Health from the Tata Institute of Social Sciences, Mumbai and has been associated with the Gorakhpur Environmental Action Group, Gorakhpur.