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.
https://www.sciencedirect.com/science/article/pii/S016635421...
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.
https://www.cambridge.org/core/journals/canadian-journal-of-...
So where does 13 come from?
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.
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
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...
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-...
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.
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.
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!
So to summarize, the protocol is to vaccinate even if late.
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.