Bihar is staring at another health crisis as encephalitis cases begin amid Covid outbreak

Acute Encephalitis Syndrome or ‘chamki bukhar’, which primarily affects children, had caused 176 deaths in Bihar last year. Govt says it’s better prepared this time.

Sukhlal Sahni and his wife, who had four children, lost their twin daughters to the disease at the end of April, in Roshanpur, Muzaffarpur district, UP | Suraj Singh Bisht | ThePrint

Muzaffarpur: In the midst of the fight against Covid-19, Bihar has been hit by another health crisis — Acute Encephalitis Syndrome (AES), locally known as ‘chamki bukhar’ — which inflames the brain cells and targets children in particular.

Five children have so far died of the disease this year, while the number of cases reported until 13 May is 49, which is worrying, because the AES is believed to peak in June and July. Muzaffarpur, the epicentre of last year’s outbreak, has already reported 20 cases this year, while East Champaran district has reported 13.

Union Minister of State for Health and Family Welfare Ashwini Choubey had told the Lok Sabha last year that the AES outbreak in Bihar had led to 176 deaths, and this time, the opposition has begun questioning the preparations made by the Nitish Kumar-led JD(U)-BJP government.

Earlier in May, Bihar Health Minister Mangal Pandey had detailed the state’s preparations for AES this year. “After Union Health Minister Harsh Vardhan’s announcement last year, and eight months of labour, a new hospital has been constructed in Muzaffarpur,” the minister had told ThePrint.

What is AES and how does it happen?

Some of the early symptoms of AES include high temperatures, headache, vomiting, with hypoglycaemia — a drop in the body’s sugar levels — also being observed in a lot of cases.

“The disease most commonly affects children and young adults and can lead to considerable morbidity and mortality,” says the National Health Portal of India.

Officials at Bihar’s health department say there are a number of theories behind the occurrence of AES, including the consumption of the litchi fruit, but there is no conclusive evidence yet.

This has prompted the state to involve other organisations to carry out research and find the reasons behind the disease. Some of the contributing factors behind AES are said to be malnutrition, hygiene, heat and dehydration.

Sanjay Kumar, Bihar’s principal secretary (health) told ThePrint: “We are better prepared this year for sure. This year, there are agencies whom we have also requested to come and do research. We have signed an MoU with NIMHANS (National Institute of Mental Health and Neuro Sciences), and we are getting support from the Bill and Melinda Gates Foundation.

“The Union Ministry of Health has also put all the laboratories of the Indian Council of Medical Research on the job, because we need to get clarity on this.”

A father’s pain

The people know so little about the AES that Sukhlal Sahni, whose twin daughters died of the disease at the end of April, still doesn’t understand very well what happened to them.

Sahni, a resident of Roshanpur in Muzaffarpur district, rushed his four-year-old daughters Mausam and Sukhi to the Sri Krishna Medical College Hospital on 24 April, with no idea what had happened to them. They died on 27-28 April.

“At around 1 am, they got mild fever so we monitored them, and early in the morning, we took them to the hospital. There is no pucca road in the village, so it is difficult for an ambulance to come. I took one on my cycle and someone else took the other on a motorbike. They were admitted there for a few days and then died,” Sahni said when ThePrint visited his village.

However, Dr Sunil Kumar Shahi, superintendent of the SKMCH, said people had been asked to seek immediate help if any of the symptoms appeared.

“We are more confident this year as there is greater awareness this time. Everyone has been told that if any symptoms are visible they should seek immediate help. The next two months are very crucial,” he said.

Covid has affected preparations

State government officials say this is the time of the year when most of the preparations for AES are done, but Covid-19 has displaced everything this year.

“The state has seen three AES peaks in the last 10 years — 2012, 2014 and 2019, with the highest peak being in 2014. Coronavirus has come and displaced everything, but we are trying our best,” said a senior Bihar health department official.

The official added that a study of the cases reported last year has revealed that 80 per cent of them come from four districts — Muzaffarpur, Vaishali, Sitamarhi and East Champaran. Of these, 60 per cent of cases are from Muzaffarpur alone, specifically from five blocks, including Mushahari block where Sahni’s village Roshanpur lies.

A second official concurred: “Most of the cases that are reported in Muzaffarpur are from blocks either side of the river. We don’t know what the link is.”

The construction of a 100-bedded paediatrics intensive care unit (PICU) at Muzaffarpur’s SKMCH was affected due to the lockdown, as labourers were not available.

“Forty beds became operational on 12 May, 70 will become operational by 15 May, and by the end of the month, we will complete 100 beds. It is going to be the largest PICU in the country,” said Kumar, the principal secretary (health).

Kumar further said that as AES onset begins early in the morning and children are brought to health facilities between 4 am and 8 am, medical officers in-charge, along with their teams, have been directed to be present in the morning. “Their attendance is being monitored to ensure there are no lapses,” Kumar said.

 

Politics over AES

Bihar is scheduled for assembly polls later this year, and opposition parties have already been targeting the government for its handling of Covid-19.

“The chief minister should focus on this (AES) immediately. This is not to be taken lightly as five deaths have already been reported. I had also written a letter to the CM, but so far, not much has been done,” said Madan Mohan Jha, Bihar Congress president.

Manoj Jha, Rajya Sabha MP and spokesperson for the Rashtriya Janata Dal, added: “The Bihar government has not understood the magnitude of the problem and a major indicator is that no capacity building of health infrastructure has been done. There is conspicuous silence from the Bihar government.”

RJD leader Tejashwi Yadav said the Bihar government responded to the situation late.

“Thousands of children have lost their lives to AES in the last 10 years. This government has blood of poor children on its hands. The Bihar government is found wanting even in reactive response to the annual occurrence of the epidemic, expecting a proactive response is a too far fetched dream,” he said.

Yadav added, “We have been alerting the Bihar government for a long time about the impending threat of AES, but the government is more worried about managing perception rather than the disease and its spread.”

Taking a dig at CM Nitish Kumar’s ‘Sushasan Babu (good-governance man)’ image, Yadav said last-minute spending “opens up a lot of avenues for unchecked corruption by blue-eyed ‘babus’ (officials) of ‘Sushasan'”.

However, officials say the government is concerned and is taking all possible measures.

“The chief minister is really concerned about the deaths that have taken place and asked us to carry out a survey to assess the socio-economic status of Muzaffarpur. Following this, rations cards were issued and children were enrolled in ICDS too,” said a government official.