Utah man dies from rabies, the first in the state since 1944
deseretnews.com
deseretnews.com
Not that it would have helped here, when the diagnosis came at such a late stage.
The case report for the patient treatment that pioneered the Milwaukee Protocol—the first-ever successful treatment of a rabies patient—is worth a skim, if you're into this sort of thing.
There is a radio lab episode on how this protocol was established.
https://pandorareport.org/2014/05/01/no-rabies-treatment-aft...
11% RVNA positive, evidence of abortive rabies infection.
EDIT: Seems I'm misinformed. Thanks for clarifying, commenters below.
Well I guess in desperate times all treatments started somewhere, a quick goog is probably as good as any.
I was bit in my finger by a puppy that I was trying to feed when I was up in the desert doing mountain biking. A few days later, I had to get vaccinated because we could not bring the dog for observation. The vaccination itself can be risky. But it is preferable than risking rabies. I was told it is a horrible way of dying.
Lesson learned.
That seems to be a matter of debate.
The other reported Milwaukee protocol survivors apparently include:
(1) people who died of the rabies infection, but were characterized as “survivors” in some reports because they survived past the initial acute phase,
(2) People who received both post-exposure vaccination and the Milwaukee protocol,
(3) One survivor who, based on antibody tests, probably was never infected with rabies in the first place.
https://www.cambridge.org/core/journals/canadian-journal-of-...
AFAICT, the use of the plural is unwarranted; there seems to be one uncontroversial case of someone infected with rabies treated with the Milwaukee protocol and not podt-infection vaccination, who survived the rabies infection.
A large number of stories I've heard involving people playing with small wild mammals end with rabies. When it comes to bats, raccoons, and possums, I was always taught to treat them as rabid because healthy ones won't ever get close to random humans if they can help it. That this guy was letting them lick his fingers is unimaginable to me.
I also live in Utah and it's strange to think that this man was likely already infected, but didn't know it, at the time I dealt with my bat.
It's related to the assertion that fewer than 1 in 100 programmers is unable to write "FizzBuz" in the programming language of their choice.
The rate may be statistically insignificant amongst all programmers, but what is the rate amongst programmers looking for a job?
Different question :-)
The scary thing is that's pretty much how you know that an animal is rabid: animals that would avoid people completely will now bite them.
The exception to this in my case was a little pup that was scared and confused due to a forest fire outside. The smoke drove it into the house and it only screeched a little bit when I picked it up. It's doing fine now.
I guess as I understand it, it doesn’t matter if animals are normally friendly because rabies causes them to act aggressively.
Radiolab did an episode on rabies that is absolutely fascinating. They talk about the “Milwaukee Protocol” for treating it, which I’d never heard of before that. It’s no longer a recommended treatment, if it ever was, but the story really stuck with me.
https://www.wnycstudios.org/story/312245-rodney-versus-death
I wrote a whole comment about bats being asymptomatic carriers, but Googling around the information is not clear. According to [1], bats have been shown to be symptomatic (and they die from rabies), but other bats of the same species remained asymptomatic (but still spread the disease).
At least it seems it's possible there were asymptomatic bats in their house.
No-one know why Ms Giese survived, but the Milwaukee protocol does not seem to have been the reason. Or if it was, it is not repeatable on other patients.
[1] https://www.cambridge.org/core/journals/canadian-journal-of-...
An NCBI article claims 13: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4947331/
It also notes the deaths of at least two of the "known survivors", that others received the PEP vaccine either completely or partially, and that one survivor likely didn't have rabies at all due to no anti-bodies being found.
That leaves just the original case in 2004 where someone survived without vaccine and received the MP.
It's a difficult trade-off for a lot of high risk medical interventions to judge the relative worth of the potential chance of survival vs. that last remaining time, and it's certainly not a choice we can objectively make on behalf of other people.
In this case it's not certain the protocol have helped any patients. If it did help, then the success rate is so low that there are ethical issues with overselling the potential vs. giving people that extra time together.
If a patient wants to try, I'd be all for giving them that choice. But there's a big gap from letting a patient ask for something and promoting it as the recommended course of action without evidence of any efficacy.
https://www.sciencedirect.com/science/article/pii/S016635421...
https://www.cambridge.org/core/journals/canadian-journal-of-...
So where does 13 come from?
Notably:
> Prior to 2004, there were only five documented human survivors, all of whom had received the PEP, albeit incomplete or late [5] > In 2004, the first survivor without PEP was reported after this individual had undergone the MP. However, the use of the MP did not increase survival in subsequent cases [6]. Our patient was managed with aggressive supportive care without the MP or steroids. Our patient survived the acute phase of rabies encephalitis and was discharged after five months of intensive nursing care in the hospital.
And:
> Out of the seven reported rabies survivors until 2008, only the index case that used the MP did not receive PEP. Rabies virus was detected in only one case in all of the others that were diagnosed using only the rabies antibody [9]. Our case was diagnosed using both the rabies antibody and highly specific rabies antigen detection tests.
The article points out a number of confounding factors that makes it hard to determine what saved the patient, including potential effects of use of PEP even if unsuccessful in stopping the disease completely (e.g. note that the virus itself was only found in one of the cases of survivors discussed by this article), the high level of other interventions to manage the disease, as well as the potential for genetic variations and the possibility that some of them didn't have Rabies in the first case
Several others had completed most or all of the PEP treatments, and it's not clear if the MP had anything to do with their survival, given other patients have survived without MP in similar circumstances.
If I were there patient and my options were medicated coma that possibly has an 8% chance of healing me and possibly has no benefit, I'd prefer that to the excruciating death by rabies I'd be facing otherwise.
Treatment success rates: Vaccination: ~100% PEP: ~100% MP: ~8%
So MP provides a slightly less than 1/10 chance for life when the patient would face otherwise certain death.
You might find this interesting: http://www.mjdrdypu.org/article.asp?issn=0975-2870;year=2017...
So yeah I really don't understand why any doctor wouldn't want to try the Milwaukee protocol. Even if it had 99% fatality rate it would still be a huge improvement and afaik it's more like 80-90% i.e. from 10 tries it worked twice or so. Also there are plenty of small changes to it that might make a difference. We just don't know, we do know however that untreated rabies is fatal in the closest to 100% fatality of any disease ever known.
Hell, rabies (post the 24h post exposure vaccination period) has a higher fatality rate than lethal injection and the electric chair!
A further problem is that many of the patients have had the PEP treatment partially or wholly first. In those cases we don't know if the outcome was due to MP or PEP. Several other (single digit numbers) patients have survived without MP. It is not clear why. It's not clear that their treatments had any effect. Or it might have saved them. It may be genetics. It may be difference in virulence. It may be specific aspect of the treatments. It may be aspects of how the patients are treated that are not part of the protocol itself. It may be dumb luck.
The problem is that this is not a matter of MP or nothing. It's a matter of MP or trying to find other alternatives. If MP serves no purpose in saving these patients - and it may very well not - then focusing on MP may hinder exploration of other options.
So to summarize, the protocol is to vaccinate even if late.
https://www.reddit.com/r/news/comments/9vdumn/utah_man_dies_...
Of course I "get" your joke - and sympathize with the sentiment. I am on your team wrt vaccination policies.
However, I also cringe at the notion that critical thought about vaccinations has been completely reduced to extreme, fundamental positions.
I consider a specific, personal experience of this debate: I am a typical, unremarkable advocate of and participant in vaccination protocols in the United States. And yet, I think there should be critical thought and robust debate about the influenza vaccine(s)[1] and the emerging consensus that we should all consume this product, annually, forever.
In my experience it is impossible to have this discussion because it immediately (and incorrectly) becomes a "vaxxer" debate. This should not be the case. Our critical thought about these increasingly complex medical, scientific, social and economic[2] issues should be encouraged - not swept up in a proxy fight between two "tribes".
[1] A vaccine that I consume annually as part of local protocols for first responders / EMRs / Paramedics.
[2] https://www.cnbc.com/2015/10/19/the-16-billion-business-of-f...
I am uneasy about the very rapid (<10 year) shift from the influenza vaccine as a tool for immune-compromised individuals or emergency/health workers to a universal good that everyone consumes.
I think there's a qualitative difference between a standard vaccine for a deadly or crippling disease like Rubella and a non-standard, reformulated every season, coin-flip efficacy vaccine for an illness that healthy adults and children in first world settings can withstand just fine.
This is an application of a conservative heuristic: "if it isn't broken, don't fix it".
One can at least raise an eyebrow though in noting how major pharmacy chains have taken to so promoting vaccinations. It started with flu. The latest is shingles. Again, I have no opinion on whether these are good ideas in general or not. But there are certainly commercial interests aligned with giving them to people.
A key point is I don't get the vibe that the vaccine push is a money grab, but is a sincere effort to manage communicable disease in a modern society.
The reason the opposition to vaccines is not a reasonable view is because these are correlations and correlation is not the same as causation. At the same time consider the innumerable number of social views that people hold, and that continue to be published about, that are based absolutely and completely on correlations relying on the absence of evidence against causality, as evidence of causality. But of course proving a negative is impossible -- the burden of proving causality is on the one suggesting such exists. Failing to recognize this is the exact logical fallacy that drives the opposition to vaccines.
If all correlations were held to the same standard as those that reflect negatively of vaccines, the world (and science itself) would be in much better shape.
And they are wildly misinformed about the risks.
And they neglect to consider that the reward of them vaccinating their kid is that MY KID is less likely to get those diseases. That's how herd immunity works.
If they were only risking their own kid's life, then it'd be a very different conversation.
> largely supplemented by a large number of correlations to all sorts of nasty things with vaccines.
Except those are almost all exaggerated or outright lies.
To be clear: if I were a selfish individual, I might not get vaccinated. Vaccines have actual risks. But the actual risks are minimal and rare.
But I recognize that herd immunity works, and that the risks are minimal and rare.
Correlation does not equal causation.
There's an extremely strong correlation between US spending on science, space, and technology and suicides by hanging, strangulation, and suffocation. The correlation is a 99.8% fit. But this means absolutely nothing whatsoever. There are some 30,000 various correlations available here [2]. You'll find many, such as the one I mentioned, are incredibly strong fits. But that's really the danger of data. Just because something fits, doesn't mean anything. The entire process of science is about discovering causation. Correlations mean nothing without clear causation. Even correlations that make sense mean nothing without causation. For instance, I'm sure you'd agree that US spending on science has pretty much nothing to do with suicides by hanging. So it's easy to see it's spurious. What if instead that correlation was e.g. an increase in enrollment in STEM degrees being pursued? Again, you should assume this correlation is spurious until you have a very compelling reason, certainly beyond bias confirmation, to do otherwise.
[1] - http://www.nationalacademies.org/hmd/Reports/2011/Adverse-Ef...
As soon as people realize they can blackmail me for my daughter's health, what wouldn't I pay?
I propose we as a society set a fair price, instead:
I vaccinate myself and my kids, and you vaccinate yourself and your kids.
If you want a vaccine with lower risk and inconvenience, you are entitled to ask the government to spend more on research, or you can donate your time and money to that research.
Because you don't need everyone vaccinated, you need most. Most already do it for their own interest. Bear in mind that this is what the state usually does by giving out free vaccines: they are effectively paying people that wouldnt pay for them. But some feel strongly against it.
> I propose we as a society set a fair price, instead.
There is no fair, certainly not in economics. There is only consented prices. You can propose whatever you want, but in the end you need to persuade those that have different ideas than you, or force them to do it. Forcefully vaccinating people is against the practice and principles of medicine, and against common decency, if not morality.
Have you researched different vaccines to find out how their effectiveness falls with the percent of the population that is not vaccinated?
Genuinely curious if you have.
I suspect you have not.
> Forcefully vaccinating people is against the practice and principles of medicine, and against common decency, if not morality.
You're right. People who refuse to get vaccinated should have to get insurance to pay for the damages of the illness and death they cause, right? Or place the money in escrow?
And if that insurance is prohibitively expensive, and someone won't pay it, then we can just send them to prison, right?
If you cause me harm through your behavior, that's against common decency, too, right? If not morality?
And if it's hard to determine who caused me harm directly, then the "pollution" is an externality, right? Tragedy of the commons?
You're literally polluting the environment with a virus.
Of all of the topics Libertarians have an interesting position on, I am by far least impressed with their efforts to describe how they think we should protect the environment. Shedding viruses everywhere you go falls pretty well into that discussion, don't you think?
Also I'm quite sure that medicine allows for quarantine, against your will.
I am very well aware of the basic concepts of epidemiology, why launch this gratuitous disqualification attack?
> You're right. People who refuse to get vaccinated should have to get insurance to pay for the damages of the illness and death they cause, right? > And if that insurance is prohibitively expensive, and someone won't pay it, then we can just send them to prison, right?
You make the ultimate escrow with your own body, since you risk infection as well. But now you mention again the application of force. I ask you, are you willing to go into peoples homes and forcefully inject them with vaccines? Because then I can use your same argument to you: you propose using force but you are demanding others to apply it. How about each time you propose to impose your view on other people you are also responsible to physically do it. You know, put your skin in the game.
Regarding your environment argument, I reiterate that herd immunity is a benefit, not having it is not a cost. Its too onerous a requirement to demand of people to do things to help someone else at their own expense. There would be no limit. You could ask for anything and always find a way to justify taking it.
That says you know what percentage of the people I am in contact with need to be vaccinated for some level of what you think I would consider to be "acceptable risk."
So, do you know what that percentage would be, for various vaccines?
And how did you define what my acceptable risk would be?
Because I think you must have an opinion on both of those things, if you're willing to advise me that "I need most."
Since you're favoring an economic slant to this discussion, how, exactly, did you decide what I need?
> You make the ultimate escrow with your own body, since you risk infection as well.
People can be carriers of diseases, and not become ill from them. This nullifies your argument.
Also, that line of argument can be used as a defense of drunk driving.
Drunk driving is not victim-less, even if your own body is risked, as well.
That's insufficient escrow even for automobile insurance.
> But now you mention again the application of force.
Yes, I think people can enact a government. A government has an enforced monopoly on force, and hopefully has established a system of laws that give the people the opportunity to change those laws over time.
And frankly, we voted. We use force against ourselves. We're okay with that.
Feel free to vote that we shouldn't be okay with that. Also, feel free to move and renounce your citizenship.
Those legal options are available to you.
You can also attempt to resist the laws of your country, peacefully or otherwise. I wouldn't recommend it.
> I ask you, are you willing to go into peoples homes and forcefully inject them with vaccines?
If you want to discuss actual policy, I agree it's complicated.
1) Medical wavers. Some people cannot get vaccinated, for many different reasons.
2) If you want to live in a bubble with no human contact, and you can demonstrate that, then maybe that's fine.
3) If you want to form a colony of leapers, who have no contact with the rest of us, then maybe that's fine, too.
> How about each time you propose to impose your view on other people you are also responsible to physically do it. You know, put your skin in the game.
Fine by me.
Counter-proposal, each time you increase the statistical chances of someone else suffering through an externality such as a pollutant, or increasing the risk of disease, how about you put your skin in the game:
Watch them die.
Here, this child recovered. It shouldn't be too emotionally difficult for you to imagine my daughter dying like this.
https://www.youtube.com/watch?v=S3oZrMGDMMw
(The beeping sound is her oxygen level falling to dangerous levels, on the verge of causing brain damage.)
Watch her mother sit there, completely helpless. Imagine that's me and my wife, watching our daughter die.
> Regarding your environment argument, I reiterate that herd immunity is a benefit, not having it is not a cost.
Oxygen is a benefit. Not having it is not a cost.
Have I somehow used a slippery slope argument? Or is your line of argument fundamentally flawed? Genuinely curious what you think.
> Its too onerous a requirement to demand of people to do things to help someone else at their own expense. There is no limit.
Ah, there, you ARE engaging in a slippery slope argument!
It's NOT too onerous, actually. We have government to debate issues exactly like this. We compromise. There are limits, they're enforced by making changes to the law slowly, and by people voting.
> You can ask for anything and always find a way to justify it.
You can deny anything, and always find a way to justify it.
Together we vote. Hopefully we find a compromise.
In this case, our current compromise is that you're not forced to vaccinate yourself or your children. But your children may lose access to public schools. And you may be forced to continue paying taxes in to public schools. And there may be jobs you are disqualified from holding.
Feel free to advocate for changes to that.
Personally, I'm realizing I should be trying to get my employer to demand all of the employees be reasonably vaccinated, via their employment contracts. Flu, MMR, etc.
You need most to get herd immunity. It varies on the disease, but you dont need unanimity to get it. Herd immunity was the prize you mentioned that justified using forceful mechanisms, where I answered you dont need it. What you individually want most is your judgement, I'm just telling you that you dont need everyone to agree with you to get herd immunity effects.
> People can be carriers of diseases, and not become ill from them. This nullifies your argument. Also, that line of argument can be used as a defense of drunk driving. Drunk driving is not victim-less, even if your own body is risked, as well. That's insufficient escrow even for automobile insurance.
In drunk driving, you are harming someone. In not vaccinating, you are not protecting someone. The comparable analogy would be that as long as you have space in your house, you should be forced to home the homeless. Since you, by taking space, are directly harming them with your negligence and self-interest, which then also have cumulative effects on society.
> Yes, I think people can enact a government. A government has an enforced monopoly on force, and hopefully has established a system of laws that give the people the opportunity to change those laws over time. And frankly, we voted. We use force against ourselves. We're okay with that. Feel free to vote that we shouldn't be okay with that. Also, feel free to move and renounce your citizenship. Those legal options are available to you. You can also attempt to resist the laws of your country, peacefully or otherwise. I wouldn't recommend it.
It is illegal to force vaccinations in the U.S. If you live in the use, you should move to a country that enforces your vaccination ideals.
> (of physically forcing people) Fine by me.
When you do it successfully, please send me proof and Ill gladly share your story with the world. I'd like to see you try doing this. Until then, talk is talk.
> Oxygen is a benefit. Not having it is not a cost.
Oxygen is nature, herd immunity is a societal benefit. Humans dont own oxygen, but they do, in a way, own the capacity to build herd immunity. This kind of logic is trying to reverse the burden of proof: that whatever you dont have is yours because it could be. Herd immunity is not a right, its not a natural right, not a legal right, etc. It's merely an effect of vaccines.
> We have government to debate issues exactly like this.
Governments have decided against forceful vaccination. Albeit some arguments about kids, babies and dogs, but to adults its generally in most cases, illegal to force it.
Also, I find the line of argumentation about government kind of off-the-mark. Government is not supposed to be the way you force other people to do your will. That is a tyranny. If 51% vote to enslave the other 49%, a disservice to mankind was made. Thats why the modern governments are democracies with severe limitations on individual rights.
> Personally, I'm realizing I should be trying to get my employer to demand all of the employees be reasonably vaccinated, via their employment contracts
I hope your employer has the right to do that. He might not have it, due to some other person believing the opposite to your point, and willing to break into the employers home and physicially forcing them to do it.
Agreed.
And you've suggested I track down and pay some of the people I come in contact with, who have not vaccinated, to convince them to vaccinate, if I think the percentage of them is too high?
> In drunk driving, you are harming someone. In not vaccinating, you are not protecting someone.
Walking around, spreading a disease, is analogous to getting in a car's driver seat when you're drunk. If you want to avoid driving drunk, don't get drunk, or don't drive.
If you want to avoid spreading a disease, get a vaccine.
Also, drunk driving is NOT harming someone. It has increased the risk you will harm someone, to a level our government has deemed unacceptable.
The analogy seems very appropriate.
Do you want me to go around finding people with a certain blood alcohol level, and pay them to not drive?
Our laws bar drunks from driving. That can actually be a life-or-death situation for them, or cause severe financial harm. "I need to get where I'm going for my job, and I don't have any money, but I'm inebriated."
We use force against people who are drunk, because they increase the risk of harm. We detain them in jails, we put them in prisons, we rescind their privilege to drive.
That's a lot of force being used against someone who didn't even cause any harm!
> When you do it successfully, please send me proof and Ill gladly share your story with the world. I'd like to see you try doing this. Until then, talk is talk.
If it's the law, and they need people to help enforce it, I may do my service. As my father was a veteran, my uncle is a veteran, my grandfather was a veteran, etc, serving your country and doing things that are not universally beloved is something my family has done.
> It's merely an effect of vaccines.
...and arguably the most important thing humanity has done. It's a shame to watch people abandon it pointlessly, endangering those around them.
> Albeit some arguments about kids, babies and dogs, but to adults its generally in most cases, illegal to force it.
We're not debating whether is IS legal, we're discussing whether it should be. It's not like I'm unaware of the law.
You seem to question the basis of a government using force. Governments do use force, that's all I'm saying.
> Government is not supposed to be the way you force other people to do your will.
It's how we compromise to live together. Intelligent creatures change their environment to suit them. We will all attempt to force other people to do our will.
I think governments should enforce Intellectual Property rights. That means the government will use force to take property away from you, if it is found to be infringing someone else's government-granted monopoly.
That is me using the government to force other people to do my will.
> That is a tyranny.
Tyranny is when you don't have a vote, don't have representation, can't speak your view, and can't move.
It's entirely possible for you to lose faith in the government. Any government. And then you could reasonably see the laws of that government as tyranny. There's nothing illogical about that. But literally anyone can declare that at any time.
> If 51% vote to enslave the other 49%, a disservice to mankind was made.
Which is why it's great that our government protects us from exactly that kind of vote. We can debate whether it protects us well enough.
NB: Our Constitution permitted slavery. It took a bloody Civil War to change that. People fought the righteous fight to end slavery. To a degree, we have to count on our government and our fellow man to protect us from being enslaved.
> Thats why the modern governments are democracies with severe limitations on individual rights.
I'm not sure where you're going with this. I presume you think that's a bad thing.
> willing to break into the employers home
Why would you go there?
Don't you believe in Free Association?
If my employer wants to limit employment only to people who have been vaccinated, are you going to argue they don't have that freedom?
Regardless, I'm betting you use vaccines, and you just enjoy moral / legal debates. That's fine.
Or are you really personally against using vaccines?
Im questioning the value of a solution with the application of force. A dangerous tool, that requires all sorts of limitations to make sure it is not used abusively. And injecting things into people against their will is pretty high up there.
It is not the intention of the act alone that decides if its moral or not: the act itself is. I think we have had enough experiences to know that if the government decided what to do with your own body, great tragedies follow. If you can force people onto their bodies, can you forbid them to each unhealthy foods? can you ban drugs and alcohol? Can you decide on forcefully aborting, or forbidding abortion? How people are dressed? Its not the act of using a hammer on a nail that is in question: its the hammer itself, and the act of nails voting who gets hit next.
Why would government enacted violence be any more dignified than individual violence? What change does it make to the morality of a violent act if it was voted on?
Governments use force. By definition. That means you question the value of governments.
I don't. The alternative is warlords, who also use force.
The benefit of a Government, specifically of a mostly democratic one, is I have some say in when and how that force gets used, without myself having to be a warlord.
> A dangerous tool, that requires all sorts of limitations to make sure it is not used abusively.
Absolutely. A Constitution enacting checks and balances, and guaranteeing free speech and a free press, are the best ways I know to limit that power.
> And injecting things into people against their will is pretty high up there.
Sure?
Allowing nuclear testing where it can impact people is also bad. (We did that.)
Allowing the for-profit sale of known carcinogens is also bad. (We do that. See: asbestos, tobacco.)
We've also committed absolute atrocities. [1]
Clearly we need more checks and balances, and a more powerful press.
> It is not the intention of the act alone that decides if its moral or not: the act itself is.
Is the act of murder moral?
I'm pretty sure you would say, "no."
What about when the US sees Germany invading neighboring countries, and killing Jews and gypsies? Is it moral for the US to start murdering German soldiers, in open war?
I'm pretty sure you have to concede, "yes."
Therefore, it is not the act alone. The intention also plays a part.
> I think we have had enough experiences to know that if the government decided what to do with your own body, great tragedies follow.
I'm pretty sure great tragedies will happen regardless, and unfortunately, governments have to make decisions. King Solomon's wisdom over deciding to cut a baby in half comes to mind.
> can you ban drugs and alcohol
I think a far better parallel track of conversation is antibiotics.
If you don't follow the prescribed course of antibiotics, you can breed drug-resistant bacteria. That's a very good argument in favor of limiting access to antibiotics, to people who have consulted with a doctor.
There are countries (India) where antibiotics are much more freely available, and people don't use them properly. They take them for a few days, until they feel better. Breeding dangerous strains.
The argument can be made that governments should stop you from improperly using antibiotics, because it increases the risk to all of us.
> Can you decide on forcefully aborting, or forbidding abortion?
We do decide that. We have to make decisions about how our laws work.
> How people are dressed?
We decide that, too, yes.
> Its not the act of using a hammer on a nail that is in question: its the hammer itself, and the act of nails voting who gets hit next.
Hitler 2.0 comes up. Should we murder his soldiers?
I vote yes. How vote you?
> Why would government enacted violence be any more dignified than individual violence?
"Dignified" is an interesting word choice.
"having or showing a composed or serious manner that is worthy of respect."
The simple answer is that the government composed a law in a respectful manner, and hopefully the officers of the government carried out the law in a respectful manner.
When they don't, we're supposed to hold them to account.
> What change does it make to the morality of a violent act if it was voted on?
Catholics say a phrase, "in what I have done, and in what I have failed to do."
It can be immoral to NOT act.
It would be immoral to not intervene in WW3 with Hitler 2.0.
The way we decide if it's time to intervene is that we vote on how our representative government is run.
[1] : http://www.slate.com/articles/health_and_science/cover_story...
What you'd really like to do is ask an anti-vaxxer woman who is pregnant or trying to conceive what she thinks about measles, mumps and rubella vaccine, especially rubella.
PEP works by massively boosting the patient's immune system (via immunoglobulin) and sensitizing it to the rabies virus (via the vaccine) before the virus can get to the points (the brain) that it's impossible to remove it from. Think of an army retreating in wartime: if you know that the enemy has successfully established a beachhead within your country, the logical next step is to start fortifying cities & chokepoints so that as the enemy advances, they meet unbeatable resistance. That's also why it's critical to get treated ASAP after being bitten: once you show symptoms, it's too late.
Probably even before symptoms show up, right?
I'm sorry for the family but I can't exactly say I'm not surprised. Generally having any wild mammal hanging out where you sleep is a very bad idea.
Edit: Reworded to be less arse
Not to judge, but isn't this getting a little too close with nature?
The odds of surviving rabies once it becomes symptomatic are negligible. They can throw the hail Mary from the 5 yard line in a snowstorm but the chances of winning the game with it are slim.
If you can, bring in the animal that bit you; you don't want to go through the shots unless they are necessary, but you also don't want to die.
Looking down the rabbit hole on the internet was absolutely terrifying. I talked to my doctor and our daughters pediatrician but there is really no standard on what you should do because it varies so much by location. We went to the ER and chose not to get the PEP since we were about 99% certain I caught it right after it entered our house and my wife and daughter were in other rooms with doors closed.
It still makes me feel uneasy when thinking about it or reading stories like this.
Don’t they still need to kill the animal and send it’s head to the lab? At least when I was a kid you still needed the shots because it took a week to get the animal’s results back.
There is a lot of difference between risk depending on the bat species, so it helps a lot if can be classified by a specialist.
As I understand it, removing and examining the brain can yield a definitive diagnosis in cases where time is of the essence. In cases where it's not immediately obvious that the animal is rabid, it can take a week or two of observation to look for more overt symptoms.
That's how my parents ended up adopting a stray dog, who later became just about their favorite pet ever. By the time they'd watched him for a couple weeks, he wasn't going anywhere. :)
Even with advances it is a bit of a longshot but it is still better than the alternatives. There is an irony in medicine that it becomes ethical to be more reckless when odds are longer. It makes sense of course but there is some dark comedy that trying something drastic and seeing if it sticks being the moral thing.
The expansion of the golden jackal as new centroeuropean animal promoted for the deliberate extinction of the gray wolf by man, could also increase this probability. Jackals are much more prone to bite and interact with dogs and cats without killing it.
Can you be more specific? Are you talking about the early 2010s?
The areas of Spain in the European continent are declared free from the presence of rabies virus, but rare cases can occur. We had a case in 2013 from a female dog that got the virus after a travel to Morocco.
Also AFAIK Germany isn't free of rabies, either.
http://www.faz.net/aktuell/wissen/medizin-ernaehrung/tollwut...
The shots aren't that bad these days. It's just a series of relatively large intramuscular injections.
I may still choose to go through with it, but I am not entirely sure.
Yes, the odds of you getting it are small, but the downside is that if you do get it you’re almost guaranteed to die.
Though the other nasty thing is that getting rabies shots cost thousands or in some cases tens of thousands of dollars in the US, which leaves a lot of people with the choice between bankruptcy or some unknown probability of getting rabies and the subsequent guaranteed death.
[0]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5525325/ [1]: https://academic.oup.com/cid/article/48/11/1493/347031
It sounds like a horrible way to die. She gave me shit for going to work with bats...even after getting the shots...
Rabies is pretty intense. Even after being vaccinated you still need to get a titer shot every few years to keep your level of antibodies high enough to fight off the virus if you're exposed to it.
The real cost came with the Human Rabies Immune Globulin shots I had to get after being potentially exposed to the virus. These are shots of the rabies antibody that they administered in the area where the dog bit me. Kaiser charged $15,000 for this stuff (insurance brought it down to $1,250 to me). It is costly because they make it by vaccinating humans and then collecting antibodies from their blood/plasma.
I would add that the rabies vaccine shots themselves were not painful and are like flu shots. However, I ended up being allergic to the shots and would break out in hives and get flu-like symptoms for days after each one. I actually stopped the vaccine series early because the symptoms kept getting worse after each shot and by the time the last shot was due animal control told me the dog that bit me made it out of quarantine without showing rabies symptoms.
The Immune Globulin shots were the most painful because it was a thick gauge needle and a super viscous material. I could see a big, swollen lump under my skin after getting the series of Immune Globulin shots. There was pain and bruising for a few days, but it eventually went away.
If you vaccinated everyone for rabies, the cost per vaccine would come down but you would likely do more harm than good. Vaccines (like all medicines) come with risks. I've printed the specific risks for the Rabies vaccine taken from the CDC so you can get an example.
Mild problems • soreness, redness, swelling, or itching where the shot was given (30%–74%) • headache, nausea, abdominal pain, muscle aches, dizziness (5%– 40%) Moderate problems • hives, pain in the joints, fever (about 6% of booster doses)
My friend's dog nibbled my ankle in Vietnam and I picked up a few precautionary shots. Perhaps 3 of them and it wasn't a financial crisis. I thought about it just as much as I think about buying lunch.
I don't even recall the number. Probably like $20-40 out the door after all 3, with walk-in service. Being able to monitor the animal to see that it is fine saved me a few bucks. You have to get more if the animal dies or is in the wild.
I had no idea this was something you would want to insure against in the US. Totally absurd.
- 1 USD in Nepal
- 5 USD in India
- free in UAE
- ~350 USD in Texas
It's not a common vaccine, typically it is only given to vets and vet techs. I think that is a public health decision - rabies exposure is very rare in the United States.
I was getting it because I was going to Peru for a caving expedition. It probably wasn't necessary for me, but the travel pharmacist said it could get it due to possible stray dog exposure in remote Peru and possible bat exposure in caves. I never saw a single bat in the caves there. But since the travel pharmacist recommended it, my insurance paid, which was nice.
I received Imovax. It was a brilliant purple color - it was the prettiest vaccine I have ever seen. Shot #2 is 1 week after the first, shot #3 is 3-4 weeks after the first.
https://www.vaccineshoppe.com/image.cfm?doc_id=5983&image_ty...
Rabies vaccine and BCG are two of my rebuttals when I hear the allegation public health doesn't consider risks and benefits when selecting vaccines. You can add OPV to that list, too.
They give you a schedule for up to 5 shots. If you decide to skip one, they send police to your house, who will take you to ER.
It's pretty well known that you can user veterinary antibiotics to treat humans for a fraction of the price, I wonder if rabies vaccine doesn't make the cut too...
There should not be any difference in suitability between the vaccines, but you might want to check if the same style of vaccination (i.e., kind of disease and procedure of deriving the vaccine) is used for both humans and some animal the vet would use the vaccine for if you hadn't come. You might do that with a different vaccine, but there isn't much difference between mammalian vaccinations.
"... the bats .... were carriers of a rabid and highly contagious virus."
Yes, it is a rabid virus...
"A person usually has some time before it is necessary to get the post-exposure prophylaxis vaccination."
A friend had to handle a bat in her cabin, and she was not told she had "some time" before the shots. If you've been exposed get your butt to the ER.
"An estimated 40,000
people in the US who might not be up-to-date on vaccinations
get preventive treatment for rabies after a bite or scratch from a dog or cat."
Statistically 100% of peeps aren't up to date on rabies vaccines. Vets, bat researchers, and bat house zookeepers may be up-to-date, but no one else is.
Rabies shots costs thousands of dollars, btw. Tricare, for military dependents, doesn't charge a copay for rabies post-exposure injections. My friend's insurance had something like $4000 copayment.
I assume you mean in the US. Really? I had no clue. They are like $5 in Eastern Europe.
Edit: I am referring to the post-exposure shots.
Edit 2: All of this reads like a bad joke - if our numbers are representative, rabies treatment is 20-2000x the cost of other countries in the US. Would be interesting to see someone play devil's advocate on this.
The course of treatment is injections 0day, 3day, 7day, and 14day. I went to the emergency room to get these injections, at the recommendation of my primary doctor.
Unfortunately I don't have the bills anymore, but the total cost was a bit over $20,000, which insurance adjusted down to about $500/visit.
Basically, it would have bankrupted me if I didn't have insurance. Yes, the US healthcare system is really this broken.
On the somewhat funny side, it's weird walking into an ER and being greeted by first name and a wave . . .
I also was told that the immune globulin is a bit complicated because it needs to be prepared specifically for the person's weight. So unlike off the shelf vaccines, it requires an on duty pharmacist to actually do something before they can give it to you, which I'm sure adds to the cost.
I know these costs from direct experience. I also know that insurance coverage for this cost varies widely as well.
My entire family had a nighttime (meaning the family members were in bed asleep) exposure to an untested bat. Following the U.S. Center for Disease Control and local health department guidelines, plus the advice of infectious disease MD specialists, we had to receive both the immune globulin and rabies vaccine. These costs were not covered expenses under my (otherwise pretty solid) medical insurance plan - we wound up having to pay approximately 30% of the total cost.
In the end, I felt fortunate that at least our insurance kicked in to cover 70% of the costs and that we were in a financial position that allowed us to pay the low five-figure out-of-pocket expense for our treatment without undue hardship.
I'm actually debating keeping our vaccinations up-to-date going forward - I think the booster vaccine, while still uncovered by my medical insurance plan, is relatively low cost and incidences of rabid animal encounters seems to be steadily rising in my home state.
You can get a rabies titer to see if you need the vaccine booster.
https://www.cdc.gov/rabies/specific_groups/doctors/serology....
Rabies is endemic in Ceuta and Melilla in any case. I don't know if people in those places are systematically vaccinated but would be a surprise to me.
About Ceuta and Melilla, there have been efforts to have pets vaccinated for free: https://elfarodeceuta.es/sanidad-vacunacion-gratuita-rabia/
The article doesn't claim otherwise. Rabies can usually be treated successfully days or weeks after the initial bite. Obviously you should get the shots ASAP regardless; it's more likely to take hold with every day that passes.
> Statistically 100% of peeps aren't up to date on rabies vaccines. Vets, bat researchers, and bat house zookeepers may be up-to-date, but no one else is.
Again, the article doesn't say otherwise. It doesn't say "40,000 people aren't vaccinated," it says "40,000 people (who aren't vaccinated) get rabies shots after a dog/cat bite."
"An estimated 40,000 people in the United States who might not be up-to-date on vaccinations," again, I used quotes specifically because that is how it is worded, "people who might not be up-to-date on vaccinations," as it is less usual for someone to be up to date on rabies vaccinations.
The science was badly worded, as if it was copied without understanding the context, and this is a legitimate concern when the press misstates medical advice. The number is probably from the CDC information page,
"Every year, about 40,000 people receive a rabies prevention treatment called post-exposure prophylaxis (PEP) because they had contact with potentially rabid animal."
CDC also doesn't say dog/cat bite or scratch, just potentially rabid animal, mostly dogs or cats.
I read the article, notices her carelessness, checked sources. There are more errors. It's badly done.
Microbats shouldn't be, never, ever, manipulated with bare hands. Specially if they seem to be sluggist or ill. Full stop. You need strong gloves, or much better, let it to a trained zoologist or veterinary.