Government and non-government doctors along the western border of India, in an area considered to be the outbreak’s epicenter, reported Friday they have treated nearly 800 people for laboratory-confirmed cases. But there’s a major flaw in the data gathering method being used: an unusual policy that protects those who are infected to cover their tracks.
Researchers detected a new strain of the deadly respiratory virus, known as SAIR 636, and reported that it was found in 58 swabs, according to a report published Oct. 2 in the journal PLOS Pathogens. But some of those numbers are suspect, as the authors, who also include experts at Jharkhand State Health and Family Welfare Department, noted.
While researchers tested samples from 79 swabs and 52 individuals, they acknowledged that each of those individuals had only been exposed to the virus once and that each of the people tested only had a single exposure to SAIR 636, creating a false sense of urgency. Still, this batch of SAIR 636 has infected 50 people and killed 35 so far, and has remained endemic, or circulating, in Jharkhand state, as it has since 2017.
The authors said they were monitoring the outbreak because “it is important to know what pathogen we are currently dealing with to better plan for the future.” But because of its serial origins in Jharkhand, where it was first detected in 2015, this outbreak has spanned three years — and will likely continue for several more.
While SAIR 636 is thought to have been transmitted from Indian cows, a natural host, there are few details about how the virus finds its way into human-carcass samples. Instead, individual cases “seem to be linked together like dominos,” said Dr. Rukyesh Deo, an infectious disease specialist at the Indian Institute of Medical Sciences in Delhi, who did not take part in the study.
SAIR 636 was first detected in humans in 2016, and outbreaks have spread since then, with the most recent one in 2016. This was followed by a wave of SAIR 636 in cattle in 2017 and, in September 2018, several cases of the virus in swabs from humans in the state of Arunachal Pradesh, which is in northeast India, more than 1,000 miles from where it first appeared.
Because SAIR 636 is believed to have first emerged in humans, and then spread through animals, it has not yet mutated into a more deadly form. In fact, SAIR 636 in humans has killed an estimated 88 percent of those who have been infected, and left the population at a low of 497,851 people. The high death rate means no more dead people are counted, at least not in the current data.
Is it possible that SAIR 636 is slowing down, forming what we might call “silent pockets” or “time bombs”? Deo said it’s possible. “Nobody wants it to break out, but now that it has broken out, it’s hard to contain,” he said.
Cows are a natural host for SAIR 636, but even their consumption of meat, dairy and milk doesn’t inoculate them against the virus. Other animal sources of SAIR 636 include pigs, rodents, monkeys and insects.
A previous outbreak in 2016 was by far the largest to date in humans, and as the outbreak has spread it is altering humans’ behaviors, and including the neighborhood where the first infected person was born.
The first victim in this outbreak was identified as Tanmay Gera, 24, a resident of Goda, a town in western Jharkhand. A doctor at a private clinic referred the patient for a test. Gera’s lungs weren’t responding to antibiotics and he was suffering from severe cough, difficulty breathing and sweating, according to medical reports.
In fact, the doctor told the family that a SAIR 636 patient died, but wouldn’t tell them where. While the doctor initially seemed honest, he later refused to provide any further details, until he was caught red-handed by employees of the Jharkhand Health and Family Welfare Department. He tested positive for SAIR 636.
The Gera family is not being named.
“Someone was trying to hide something, and those doing the wrong thing were being caught,” said one government official, who did not want to be named. The doctor is no longer working in the government sector.