Precaution and not panic is the key in preventing Nipah infection: HCFI

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Monitoring and surveillance are the need of the hour

New Delhi, 6th June 2019: A total of 314 people have been quarantined and placed under observation for having been in immediate contact with the 23-year-old youth diagnosed as having contracted the Nipah virus. The boy, however, is stable and eating well. Two more persons were admitted to the Government Medical College (GMC), Ernakulam, taking the numbers of suspected Nipah infections to seven. The need of the hour is to educate the public on taking precautions and not panic.

Nipah virus infection is a newly emerging zoonosis, which causes severe disease in both humans and animals. The associated mortality is high. The natural hosts for the Nipah virus are the fruit bats of the Pteropus genus, which are symptomless carriers.

Speaking about this, Padma Shri Awardee, Dr K K Aggarwal, President, HCFI, said, “About 60% diseases in humans and 75% of emerging infectious diseases are zoonotic in nature and are spread from animals to humans. Nipah is an emerging disease. Many re-emerging diseases such as avian influenza are also transmitted from animals to humans. Animals are also susceptible to some diseases and environment hazards similar to humans. Hence, they may also be early warning signs of impending human illness. Zoonotic diseases should be identified at their animal source itself and acted upon at that point of time in the cycle. And, instead of considering a human patient as the index case, the infected animal should be the index case.

Adding further, Dr Aggarwal, who is also the Group Editor-in-Chief of IJCP, said, “There are lessons to be learnt from the Nipah outbreak. Monitoring systems should be in place preempt any future outbreaks. Disease surveillance should be continual and not episodic. It is also of utmost importance to increase public awareness about these diseases so that they can take due precautions. Otherwise, a small outbreak such as this may well turn into an epidemic.”

With geographical boundaries fast disappearing today, the pathogens get greater opportunity to rapidly travel around the world to different locations where they were previously unknown. However, there is no need to panic and some precautions must be taken to prevent the infection from spreading.

  • Ensure that the food you eat is not contaminated by bats or their feces. Avoid consuming fruits bitten by bats.
  • Avoid drinking toddy that is brewed in open containers near palm trees.
  • Avoid contact with anyone who has contracted the disease. Sanitize and wash your hands thoroughly if you happen to visit someone with NiV.
  • Clothes, utensils and items typically used in the toilet or bathroom, like buckets and mugs, should be cleaned separately and maintained hygienically.
  • It is important to cover the face while transporting the dead body of anyone who dies after contracting Nipah fever. Refrain from hugging or kissing the dead person and take precautions while bathing the body before cremation or burial.

Autopsies: Respect Cadavers Too

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By Dr KK Aggarwal

The Delhi government has opposed installation of CCTV cameras inside autopsy halls in mortuaries, stating that it amounts to a violation of constitutional rights of the dead. The statement was part of the minutes of a meeting held by the Delhi chief secretary on March 28 to discuss the proposed action on the Delhi High Court’s directions on management of mortuaries.

This stand opposed the amicus curiae’s recommendation of providing a facility to record post-mortem procedures and install CCTV cameras in all mortuaries to check the practices being followed. The minutes were annexed as part of the affidavit filed before a bench of Justices GS Sistani and Jyoti Singh which was hearing a plea to frame guidelines on the disposal of abandoned bodies and to carry out complete videography and photography of the last rites of unattended bodies.

As per the code of ethics for the Medical Council of India, all health care providers are required to respect and honour the dignity of every person. As per the Indian Medical Association, even after death, a person needs to be treated as a living entity until his body mixes with the five basic elements of nature.

The Right to Life is recognised in Article 3 of the 1948 Universal Declaration of Human Rights and Article 6 of the 1966 International Covenant on Civil and Political Rights. The “right to life” is enshrined in our Constitution in Article 21, which says: “No person shall be deprived of his life or personal liberty except according to the procedure established by law.” The scope of Article 21 has been expanded over the years in various judgments of the Supreme Court by adding the dimensions of the right to health.

The right to life also means the right to live with human dignity. In its judgment in Francis Coralie Mullin vs The Administrator, Union Territory of Delhi & Ors dated January 13, 1981, the Supreme Court had held: “The right to life includes the right to live with human dignity.”

It’s not just the living who deserve our respect…the dead too deserve dignity. A dead person has the right to be treated with dignity as exemplified by the right to a decent burial or cremation. A dead person has the right to remain undisturbed and unharmed.

Section 297 of the Indian Penal Code punishes anyone trespassing on a burial place or on places of sepulture. It says: “Whoever, with the intention of wounding the feelings of any person, or of insulting the religion of any person, or with the knowledge that the feelings of any person are likely to be wounded, or that the religion of any person is likely to be insulted thereby, commits any trespass in any place of worship or on any place of sepulchre, or any place set apart from the performance of funeral rites or as a depository for the remains of the dead, or offers any indignity to any human corpse, or causes disturbance to any persons assembled for the performance of funeral ceremonies, shall be punished with imprisonment of either description for a term which may extend to one year, or with fine, or with both.”

In the 2018 case of Common Cause vs Union of India, the apex court held that the right to life and liberty, as envisaged under Article 21 of the Constitution, is meaningless unless it encompasses individual dignity. The right to live with dignity also includes the smoothening of the process of dying in case of a terminally ill patient or a person in a persistent vegetative state with no hope of recovery.

Also, organs or tissues of a dead person can be harvested as defined under the Transplantation of Human Organs and Tissues Rules, 2014. For most organs and tissues, the time between death and donation is 12 to 36 hours. However, tissues can be processed and stored for an extended period of time. The maximum time span between recovering organs/tissues and transplantation is as follows for various parts: Lung (4-6 hours); heart (4-6 hours); liver (24 hours); pancreas (24 hours); kidney (48-72 hours); corneas (7-14 days); bone (5 years); skin (3-5 years) and heart valves (5-10 years). A dead body is living as long as organs can be harvested and it deserves to be treated with respect and dignity. Except for the cornea, many organs can be harvested for donation after a person has been declared brain dead. The vital organs of the body such as the heart, lungs, liver, intestine and kidneys can be kept viable for some time if a brain-dead person is kept on a ventilator to maintain oxygenation of organs so that they remain viable till they are harvested. The patient will maintain blood pressure, gastrointestinal functions, urinary functions and reproductive functions. The life force resides in each one of us.

Thus a living person has a right to live with dignity so does a dead body with retrievable organs and tissues. Even with respect to cadaveric dissections, certain protocols have to be maintained. These include:

Every dead body donated to a medical college needs to be treated with respect.
No dead body can be put on hold on the grounds of non-payment.
Dissection of the human cadaver is a fundamental part of training of doctors. It is important to cultivate in medical students respect for the cadaver. While being taught anatomy, they can also be taught “humane” qualities, which will make a medical student a good doctor later on. These cadavers were once living persons, just like us, and therefore, need to be respected.
Disrespecting the cadaver would also mean disrespecting the family of the dead person.
After they have been studied by medical students, cadavers are usually buried without any rituals. But there should be a funeral service for the used cadavers with all rituals as an act of respect.
All medical students need to follow IMA cadaveric rituals which include the cadaveric oath on the first day he is in the dissection hall.
And the same respect has to be shown while doing medico-legal or pathological autopsies.

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA