Priyanka Pulla Tracks a Zoonotic Disease Outbreak in India

Courtesy of Priyanka Pulla

Priyanka Pulla

In May 2018, a deadly infection stole into the town of Perambra in India’s southern state of Kerala and struck down four members of the same family. Within weeks, two labs in India had independently confirmed that the country was staring down a Nipah outbreak. The disease would eventually claim 17 lives. But on July 1, about two months after the outbreak began, the Kerala government declared the state Nipah-free.

The disease outbreak’s quick resolution surprised Priyanka Pulla, a science journalist who has reported on a number of mystery disease outbreaks in India. Many of these diseases start with the same deceptively common symptoms: fever, body aches, respiratory issues. Often, diagnoses are a long time coming, if they ever arrive, and official responses to contain outbreaks are slow. But in Kerala, Nipah’s detection and eradication was unexpectedly rapid.

A relatively recent zoonotic disease, Nipah was first documented in Malaysian pig farms in 1998, where it is believed to have jumped from fruit bats to domestic pigs, and then to farmers, killing 105 people. Bangladesh saw multiple outbreaks in the 2000s, and nearly 200 deaths linked to the virus. Nipah hit the Indian state of West Bengal twice—once in 2001 and again in 2007. In the subcontinent, viral transmission was linked to people drinking the fermented sap of date palm trees, a popular sweet drink that’s often contaminated with bat excretions and urine. Once it infected humans, the virus spread from one person to another. In both Bangladesh and West Bengal, it took investigators several months after outbreaks began to find the cause and stop the disease’s spread.

Pulla, who at the time of the Kerala outbreak was a senior assistant editor at the national daily The Hindu, has always been drawn to convoluted disease investigations. So, when her editor asked her to report on the Nipah outbreak for the newspaper, she quickly dove into the scientific literature and followed it up with a short reporting trip. She discovered that Kerala’s story was unique: The pace of the investigation, zeroing in on the causal pathogen in just the second patient, as well as the state’s swift response to contain the spread, were unusual for India. (This year, three students who returned to Kerala after travel to Wuhan, China tested positive for coronavirus disease 2019, caused by a novel coronavirus. All three patients were observed at a hospital and recovered, according to reports.)

Pulla went to Kozhikode and Perambra, the city and nearby town at the heart of Kerala’s Nipah outbreak, and traced how the investigation had unfolded. She published “Nipah virus: Anatomy of an Outbreak” just weeks later, in June 2018. Pulla, a former freelancer, was used to spending weeks on a feature, and found the three-day reporting trip uncomfortably short. But she realized that timely, short trips can yield rich narratives. The story went on to win an honorable mention in the 2018 American Society of Tropical Medicine and Hygiene Awards.

Pulla, who left The Hindu in 2019 to freelance once again, talks to Shreya Dasgupta about how she covered the outbreak for one of India’s leading newspapers, and why this feature was easier than some of her past disease stories. (This interview has been edited for length and clarity.)

 

I was constantly surprised while reporting.”

 

Your story includes interviews with patients’ families, but the focus is on the re-telling of the outbreak investigation. Was that always the plan?

I did want to speak about the patients, but what struck me the most about the story was how well the Kerala government handled it. The very first day when I went to Kozhikode, I attended a meeting where the health minister was there with gram panchayat heads [village council leaders], and they had maybe a two-hour conversation on the Nipah virus, how to control it, and how to reach everybody. They did contact tracing—that is, they got in touch with the hundreds of people who came in contact with the patients. That seemed like a huge logistical exercise. They also identified the virus so quickly. This was mind-blowing because I’ve heard so many stories of illnesses in India not being diagnosed for years. I was constantly surprised while reporting. So the process of how they investigated the outbreak was the key story for me.

How was the situation in Kerala different from other diseases you’ve reported on in India?

Take scrub typhus, which was identified as a possible etiology in [outbreaks of encephalitis in] Gorakhpur [a city in northern India] a long time ago. Nobody did anything about it. It wasn’t just a medical problem in these places, it was a political one. From what I hear about people looking at encephalitis historically, in either Gorakhpur, or in the northeastern state of Assam, it is basically a story of political neglect, and politicians not implementing the recommendations of doctors. In Kerala, I did not see that gap between medical findings and implementation, and the information provided by medical researchers was acted on very quickly.

When did you start following the Nipah outbreak?

The impetus came from my editors. They wanted me to do an Edit [piece] on the Nipah outbreak, which is the newspaper’s official line [editorial] of about 400 words. I was also asked to write about the outbreak for Briefcase, which is The Hindu’s mobile app where they give you very short summaries of recent news items, and one explainer of around 650–700 words. So I started tracking the outbreak and did a lot of background reading on other outbreaks in Malaysia and Bangladesh, which actually got me interested. For example, the virus spread from pigs to humans in the Malaysian outbreak and from person to person in the Bangladeshi one—all those differences were very interesting to me. I wasn’t doing any [primary] reporting myself, but I was following what was being reported by The Hindu journalists who were in Kozhikode.

When did you decide that you would go to Kerala?

Again, it was my editor who asked if I wanted to go to Kerala. I was hesitant at first because my impression was that it’s a very contagious illness, but I was also excited. I knew one of the main investigators of the outbreak, G. Arunkumar, who I’d interviewed for encephalitis stories. I asked him about how contagious the illness was, and by then they had come to the conclusion that transmission was via droplets, and likely not beyond three feet. The answers gave me the confidence to go ahead.

 

“One of the staunch points [reporters I asked for advice] made is that you have to respect patient privacy and never reveal their names unless they want you to.”

 

Did you feel like you needed help for any part of the reporting plan?

Nipah was going to be the most infectious disease I’ve ever covered, and maybe I was a little apprehensive because I was traveling to the epicenter at the height of the outbreak. I posted a question on an online group for science writers and asked them how they cover an outbreak. I knew there had been discussions around covering Ebola in the group. So I wanted advice from people who are covering similar stories.

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The basic advice was to take personal precautions. But one of the staunch points they made is that you have to respect patient privacy and never reveal their names unless they want you to. That really stayed with me, and immediately after that I contacted my editors. I had not been with The Hindu for long, and I asked them what our policy was: How do we cover such stories? Do we reveal patient names? And my editor agreed that this was something we have to be careful about, and that you have to take permission, or you have to say explicitly that we took permission. [Editors’ note: Pulla’s story included a footnote explaining that The Hindu had obtained consent from family members of Mohammed Sabith, who was “patient zero” in the outbreak, to use their names.]

Did you have a team with you in Kozhikode?

I had a photographer with me, and took advice from a reporter based in Kozhikode; both work with The Hindu. The photographer was also my translator because I don’t know Malayalam.

Did you have meetings in place before going to Kerala?

I had already set up a meeting with Arunkumar, who was there in Kozhikode. I’d also contacted some Kerala officials. Since the photographer and the reporter had been following the story, I had some amount of certainty that I would be able to contact the patients when I went there.

How did you contact the families of people who died in the outbreak?

We went up to the house in Perambra where patient zero, Mohammed Sabith, had lived, and we saw his house. There was a cage of rabbits that I mention in the story, but there was nobody living in the house. His brother had passed away; his father had too. Only his mom was alive [but had left the village at the time]. Sabith’s aunt had also passed away. In fact, most of the people had deserted the village. But when we came out of the house, people living across the road saw us and asked us if we were reporters and then called us inside. As we started talking to them, we realized that we were talking to the aunt’s family. We hadn’t planned for this meeting, so it was a coincidence that they happened to be there.

 

“In my experience, many of the patients I meet from socially and economically disadvantaged backgrounds are actually looking at the media as a way to get their story out and to get some help or treatment.”

 

Since it was a chance meeting, how did you decide what you wanted to ask?

Given that Sabith’s family had gone through such an incredible tragedy and lost four people, I was fully expecting that they wouldn’t want to talk. If so, I was going to be okay with it. Patient experiences are extremely important, but if they are reluctant to talk, you can’t push your way through.

However, Sabith’s aunt’s family was very eager to share their experience. I guess part of it was because they were angry—and I wrote about that in the story—because there was this tendency to link Muslim communities to the outbreak, without evidence. There were rumors that Muslim migrants from Bangladesh, where previous Nipah outbreaks had occurred, had brought the illness to Kerala. In the case of Sabith’s family, a newspaper published that Sabith traveled to Malaysia and had gotten the virus from there. The family felt isolated and they really wanted to talk. So, they actually invited us into the house.

Initially, I was being very careful about what questions I asked. I would say, “Are you willing to talk about this?” But I very quickly realized that they really wanted to speak about their experience. So I just asked them to describe what they went through and it didn’t really require so much prodding.

In my experience, many of the patients I meet from socially and economically disadvantaged backgrounds are actually looking at the media as a way to get their story out and to get some help or treatment. They are eager to talk and even be photographed. That actually makes me wonder if they think about privacy the way I do, whether they even know that they have a right to refuse to talk and whether they’re even considering that. So, one of the things I have been trying to do is to ask them if they are comfortable with their names being mentioned. This way, they know that they have the option of refusing, and they have a moment to think about it.

How did you go about contacting government sources? And how did you know what questions were important to ask?

I was trying to reach out to people at almost every level, and I think I actually managed to, because I went at the right time.

Since I was going at the height of the outbreak, I knew that a lot of press-conferences would be happening and that once I got there, access to government officials would be fairly easy. That particular meeting with the health minister and the gram panchayat heads wasn’t planned, but I happened to be at the place. Also, I ran into a lot of sources when I visited the animal husbandry officials at the public health department. So I was able to meet several other health officials, who had their headquarters there.

I knew that the health minister was very deeply involved in coordinating the response to the outbreak. Within a couple of days of the first case, she had come to Kozhikode and had been staying there ever since. Typically, speaking to state health ministers is very tough. But it was easy for me to get through to her. I did not meet her during my trip, but I got her cell number and I was able to call her later.

 

“If more government officials are willing to talk about the challenges they face in things like data collection, journalists would give them a longer rope than they do now, because we’d understand that their job is not easy.”

 

Was anything easier about this story, compared to your other outbreak reports?

People communicated the challenges in their investigations very clearly. The state government was also putting out press releases every single day on Nipah, such as the number of people who are under observation, and the number of people who have passed away. In other outbreak investigations that I have covered, it’s been harder for me to develop a perspective.

Is it because researchers, doctors, and officials were more open to talking to journalists during the Nipah outbreak?

Yes, all of them were very willing to talk. In fact, I asked an official from the district animal husbandry department if we could accompany his team for their bat blood and urine sampling exercise. Very few government officials anywhere would entertain such a request. He did not give us permission, but he refused very nicely. He said that if we allow journalists to come, there’ll be more journalists there than bats. But then he spoke to me about the difficulties in things like collecting bat urine, and that made me realize that if more government officials are willing to talk about the challenges they face in things like data collection, journalists would give them a longer rope than they do now, because we’d understand that their job is not easy.

Did this story change your approach to field reporting in any way?

I felt like this was a really short reporting trip, only three days, during the outbreak, and the time for me to publish it was maybe a week and a half or two. But my editors insisted that we do it this way. But because the story was so well received, I feel like maybe this was a good way to do it after all. And I feel like it’s possible to get a lot of information within three to four days. Until then, I thought that you have to spend months to write a story that really uncovers something worth reading.

 

Abhishek Madan

Shreya Dasgupta

Shreya Dasgupta is an independent science writer based in Bangalore, India. Her work has appeared in Mongabay, Nature, BBC Earth, Smithsonian.com, New Scientist, Ensia, and other publications. Follow her on Twitter @ShreyaDasgupta.

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