Researched by: Sara Varghese and Surabhi Shukla

What’s happening here?

In one neighborhood in Firozabad—Sudama Nagar—six-year old Vir died within hours of contracting a fever. The report on his death noted “severe respiratory distress”, “gasping condition”, “high grade fever” and an oxygen saturation level of 40%. In nearby houses, other children died in similar circumstances: six years old Krishna and Lucky—also Tanu (4), Hema (12), Rakhi (7), and Nikhil (8). They all had similar symptoms of a high fever, joint pain, headaches, dehydration, nausea and low platelet count. In some cases they reported rashes on their arms and legs.

The Firozabad administration has recorded 40 such deaths—including at least 34 children. And 230 children are currently undergoing treatment in the pediatrics section of the local hospitals. A senior health official admits: “The patients, especially children, in hospitals are dying very quickly.” According to BBC News, the affected districts now include Agra, Mathura, Mainpuri, Etah, Kasganj and Firozabad.

Point to note: As always with such stories in India, the numbers vary from one news report to another. According to NDTV, 45 children and 8 adults have died of this mystery illness in Firozabad.

The fallout: Classes have been halted for children in grades 1-8 until September 6. CM Yogi Adityanath has ordered an investigation—and personally visited Firozabad. Krishna’s father recalls:

“'He spoke to me for two minutes about what happened to Krishna. Then he went away, without any assurance or help.' But his neighbourhood in Firozabad—drowning in filth and uncollected waste—finally received a once-in-a-generation clean up. One local resident said: 'I’ve lived here for 20 years. And I’ve never seen a clean up drive like that. They properly cleaned the drains and even took away the garbage.'”

Point to note: Despite conspiracy theories being touted by a former MLA, there is no evidence that these are hushed-up Covid deaths. None of the dead tested positive, and a 11-member Indian Council of Medical Research investigation also ruled out any link. 

Ugh, why are these children dying?

Not a mystery: Let’s first establish the fact that—despite all the headlines to the contrary—this is not a ‘mystery illness’, but a poorly monitored and diagnosed cause of death. The now-famous paediatrician Kafeel Khan says: 

“There is no such thing as a mysterious fever. There has to be a provisional diagnosis, which then upon further examination and tests turns into a differential diagnosis.”

And as BBC News notes, Uttar Pradesh routinely reports such “mystery fever” cases after monsoon rains every other year. Much of the mystery is due to a total absence of key information:

“[T]here is no clear record of how these fevers began and progressed; and whether the severity of the condition was determined by the long, arduous journeys that people have to make to government hospitals for treatment. Or whether the afflicted children were suffering from other conditions such as tuberculosis… ‘If we don't investigate properly and regularly, a lot of things will continue to remain a mystery,’ says an Indian virologist, preferring to remain unnamed.”

Example to note: The cause listed on a death certificate often offers very little clue about the underlying disease. In one case, it cited ‘massive splenomegaly’ as the disease—which essentially is an enlarged spleen. But that can be caused by a variety of infections from mononucleosis, cystic fibrosis, malaria and even juvenile rheumatoid arthritis.

Leading candidate, dengue: The Firozabad administration noted that 225 people in the district have tested positive for “suspected dengue”—of which 75 are children. And the death certificates in the district noted ‘dengue/viral’ as the cause of death.  Many of the patients were taken to the hospital with a declining platelet count—which is usually a symptom of severe dengue. And one of the victims suffered from bleeding gums—which is a sign of hemorrhagic dengue. FYI: 

“Transmitted by female mosquitoes, dengue is mainly a tropical disease and has been circulating in India for hundreds of years. It is endemic in more than 100 countries, but some 70% of the cases are reported from Asia. There are four dengue viruses, and children are up to five times more likely to die during a second dengue infection than adults.”

Next up, scrub typhus: In Mathura, the cause of the ‘mystery fever’ was identified as scrub typhus—a disease caused by a bacteria called Orientia tsutsugamushi. It spreads through bites of larval mites. The symptoms include fever and chills, headache, body aches, rashes and muscle pain. And it can result in respiratory distress, brain and lung inflammation, kidney failure, multiple organ failure and death. These mites thrive during the post-monsoon period:

“The mites settle on the thriving vegetation in the villages after monsoon rains. Scientists found the mites on firewood which villagers store inside their homes. A lot of the time, scrub typhus spreads when children handle firewood at home or defecate in the open in the bushes infested with the mites.”

Point to note: We don’t know if the cases in Mathura are related to those in Firozabad.

The real culprit: A near-lethal lack of basic sanitation measures. Every year, the monsoon season brings a new spate of outbreaks—and this year, it has been exacerbated by the pandemic. It has put children at even higher risk of disease due to lowered immunity. And the government takes few or no preventive measures. For example, in Sudama Nagar, there have been no mosquito fogging drives… ever! 

A damning NewsLaundry ground report shows that the neighbourhood is inundated in filth. As one public health expert notes:

“The drains are wide, dirty and uncovered. It has rained heavily this year and most of them are clogged with garbage. I’ve seen children play beside these and that’s how the fever is spreading.”

Here’s what weekly cleaning looks like in Sudama Nagar:

“They sweep the streets, but no work happens on the drains. They take out the garbage from it and keep it on the road. It rots for a day or two and, if we’re lucky, they then take it away. Else it’s washed into the drains again.”

A monsoon special: So it isn’t surprising that Indians die of a cocktail of diseases in the wake of each monsoon. 

• The mosquito-borne Japanese encephalitis has claimed more than 6,500 lives since first identified in 1978. Seventeen children died of the disease in Gorakhpur so far this year, and 428 cases were recorded. 
• Also in Gorakhpur: reacting to a similar spate of deaths among children, scientists in 2014 found that 160 out 250 kids had antibodies to scrub typhus. 
• A separate study found that scrub typhus and dengue were mainly responsible for post-monsoon fever cases in six UP districts between 2015 and 2019—and it identified a potentially fatal bacterial infection called leptospirosis plus the mosquito-borne chikungunya.

The bottomline: The root of all Indian misery is always the same: a total absence of governance. And it’s killing children every year.

Reading list

There isn’t a lot of reporting around this. BBC News has the most comprehensive take, while NewsLaundry has a must-read ground report from Firozabad. The Week debunks the idea of a mystery illness. News18 has everything you need to know about scrub typhus.