The government wants to take this figure further up to an ambitious – though not impossible – 80 per cent in 2018, said Dr Srivastava.

Four years ago, the state government had acted on expert advice and set up 104 encephalitis treatment centres (ETCs) in seven districts of eastern UP. But the facilities are marred by neglect and corruption. Pharmacists double up as doctors, while doctors are nowhere to be seen.

“We strengthened these 104 centres to improve facilities. The AES death rate here has been just 3 per cent,” said Dr Srivastava. To improve things in district hospitals, a paediatrician from each district was sent to BRD for a week-long training in AES before monsoon, he added.

Data compiled for Gorakhpur division shows that patients seeking treatment at primary centres doubled in 2017 from the year before.

“The better these primary facilities get, the more lives are saved. It also takes a lot of pressure off us,” said Dr Pushkar Anand, additional director at BRD.

“The transportation system was strengthened and more ambulances made available this time,” he added. The state government says that 238 ambulances of the 108 and 102 services were attached to ETCs for seven districts of Gorakhpur and Basti divisions.

Dr Anand said they are facing a greater challenge in 2018. “We have seen some improvement but it would mean nothing if we can’t maintain it,” he said.

The state government has already brought out a definitive action plan for 2018 to fight encephalitis. It’s a first-of-its-kind initiative with monthly goals and tasks clearly allotted. The thrust is on prevention and prompt treatment.

Continuing the focus on primary centres, paediatric intensive care units in smaller hospitals in nine worst-affected districts in Gorakhpur and Basti divisions will get five more beds each. A three-bed mini paediatric intensive care unit will be set up in 15 ETCs.

There is emphasis on simple measures like telling parents to stop making their children sleep on mud floor and avoid taking kids to paddy fields. To crack the AES mystery, detailed death audits will be carried out to know the symptoms before people succumbed to AES.

There is also a great deal of focus on cleanliness. A major chunk of the plan deals with ways to curb the dirt and smut that abounds in the poverty-stricken region.

The 2018 plan has marked 617 particularly filthy villages as highly sensitive and efforts are on to make them open defecation-free on priority. Residents are being encouraged to install and consume water only from an 'India Mark-2' tap. They are also being told to bathe more often, at least once in a week.

This is because after the JE virus, the biggest trigger for encephalitis is believed to be a polio-like virus called Enterovirus, which spreads through faecal-contaminated water. Open defecation is rampant here, and human and animal excreta often mixes with drinking water. This means that those who escape the menace of mosquitoes, fall prey to the disease thanks to bad quality water.

A number of studies in the past decade have found evidence of Enterovirus infections in AES patients, even though this finding remains debatable. After a 2012 study by the National Institute of Virology found 10 per cent positivity in 1,000 samples, this theory has gained credence and has been considered by the government for various programmes in the past.

Cornered for multiple deaths, Chief Minister Adityanath also blamed poor sanitation for bringing children in droves to the hospital in the first place.

But will this make a dent in queues outside BRD’s encephalitis wards? Some experts say no, arguing that Enterovirus contributes a tiny fraction of cases, and accuse the government of ignoring science and repeating discredited arguments.

The reason is this: Latest studies have discovered a bug that seems to be triggering more encephalitis cases than others. Researchers found the presence of a disease called Scrub Typhus, caused by the bite of mite larvae, in as high as 65 per cent of AES cases. The microscopic larvae bite ill-covered kids roaming barefoot in soil. If the patient gets antibiotics in the early days, it is easily curable. If not, it advances to encephalitis triggering brain inflammation.

At the beginning of 2017 itself, the Indian Council of Medical Research advised the Uttar Pradesh government to give Doxycycline antibiotic to all children with fever for five days. But it looks like the advice fell on deaf years, until the BRD controversy shook the government into acting on it. Dr Ravindra Kumar Srivastava, chief medical officer of Gorakhpur, said Doxycycline and Azithromycin antibiotics were duly given to all such patients from September onwards. In 2018, however, the government plans to use this treatment at the onset of the outbreak itself.

Even though the government seems to be accommodating all theories and taking no chances, experts feel that it should focus on prevention through cleanliness and that it is indeed the best it can do. Dr R N Singh, a long-time campaigner for the eradication of the disease, even rubbished the Scrub Typhus-is-the-mystery-cause theory. “Why did deaths not come down drastically after antibiotics were given?” he asks.

Going by years of experience, Dr Singh suspects Enterovirus to be the cause in 75 per cent of cases. A neurosurgeon at BRD, who did not wish to be named, agreed with Singh. “Why doesn’t this epidemic hit people like you and me? Why are only the poor who live in deplorable conditions, its main victims?"

Indeed, 62 per cent of the victim families are below poverty line, according to the Health Ministry.

Singh’s belief in rooted in a sanitation campaign he ran in a village called Holiya, 23 kilometres from BRD hospital, that he adopted in 2010. Toilets were built, anti-open defecation drives were undertaken, and people were asked to disinfect drinking water such as by keeping it in sun for six-eight hours. According to reports, not a single child fell prey to encephalitis in 2011, 2012 and 2013.

“Yogi has promised every house in UP area will have a toilet by 2018. The Centre too is pushing to stop open-defecation under Swachh Bharat Abhiyan. If substantial part of this promise is fulfilled, it can be a game-changer,” said Singh.