The Hindu : Lessons from Andhra Pradesh

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Saturday, Jul 19, 2003

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Lessons from Andhra Pradesh

FOR ABOUT A month now, a virulent viral fever suspected to be encephalitis has afflicted Andhra Pradesh and claimed at least 120 lives. Central teams of paediatricians and virologists are studying the epidemic, but the unfortunate truth is that the disease has not been established at the laboratory level, even if the symptoms and a few cases suggest Japanese encephalitis or brain fever. Although this has been a recurring phenomenon in Andhra Pradesh and some other States, the authorities have responded in a way that suggests they were completely unprepared. Normally, the disease is observed during the monsoon season and also in the post-monsoon phase; the problem usually peaks in September. This year, it has broken out in June and has claimed over 120 lives in a month's time. The health authorities are now reporting a decline in the number of cases turning up at the hospitals. Almost all of them are children in the two to nine age group. The Telangana region is said to be the worst affected. Karimnagar and Warangal districts have each reported more than 40 deaths. The Telugu Desam Party Government has launched a public health campaign, asked the Director of Health Services to go on leave, and suspended some of the public health staff. But serious damage has been done.

In the initial phase, when the virus spread and deaths were reported in more than half-a-dozen districts, all that the health authorities could say was that an "unidentified virus" had claimed so many lives. The past experience with encephalitis, suspicious symptoms pointing to the same virus, and the fact that children were the bulk of the victims might have jolted the administration into a realisation that matters were going out of control. The presence of a fairly large population of pigs, unhygienic conditions and the breeding of mosquitoes during the pre-monsoon showers must have also raised the level of concern. That the public health authorities failed to read the signals and act swiftly to contain the virus shows an abdication of responsibility. At least now, before the monsoon picks up and the northeast monsoon begins later this year, the Government will have to get its act together and prevent the recurrence of such an outbreak of the deadly virus, which kills within 24 hours or less. The district administration in the affected areas must rise to the challenge.

A matter of great concern arising out of this crisis is the lack of high quality, specialised testing facilities in the State to enable the Government to diagnose the disease in time and take swift, preventive action. That a large State like Andhra Pradesh should depend on just the National Institute of Virology or the Institute of Communicable Diseases for a diagnosis is a sorry state of affairs. Given his clout with the Centre, the Chief Minister, N. Chandrababu Naidu, must get this public health problem sorted out at once. The Union Health Ministry must also set up regional testing centres that can provide a clear picture on the ground within a short time frame. If this is going to be the official response to a known virus like encephalitis, what would have happened had SARS struck in India can be left to the imagination. The Centre and the State Governments will have to give priority attention to preventive medicine, hygiene and sanitation and get the civic authorities to clean up their cities and towns, which may be vulnerable to several diseases and viral infections.

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