Did your character get bitten by a rabid dog? Do they know the signs of rabies? Are they living in an era with rabies treatment? How long is the incubation period? Do they know what to do if an animal dies of rabies?
Rabies is one of the most feared diseases on earth, with almost a 100% death rate. It not only has no cure, but after a bite, the person has to wait to see if they show signs of the disease. The time it takes from the moment of infection to the first signs is called the incubation period. It typically lasts two to three months but can be as early as one week to as long as one year. The location of the bite in proximity to the brain, the type of rabies virus, and any immunity, such as previous rabies shots, make a difference in how long the incubation period could potentially be. This brings a terrifying uncertainty to every bite.
According to the World Health Organization (WHO), approximately 59,000 people die worldwide every year from rabies. That is roughly 161 people per day. Domesticated dog bites cause 99% of the transmissions. Human-to-human transmission is very rare, but it could potentially happen through kissing, sex, or potentially breastfeeding. However, I can find no research about breastfeeding and rabis other than it is a risk that should be avoided.
Rabies exists on all continents except Antarctica. However, Asia and Africa make up 95% of the human deaths. Children under 15 years of age make up 40% of those cases.
There is a post-exposure treatment that, according to the World Health Institute, is almost 100% effective in treating rabies after a person is bitten. The first dose needs to be given within the first 24 hours. However, it is still recommended for up to two weeks, but the longer the character waits, the less the chance of survival. If a person starts to show signs, it is too late for treatment, and only comfort measures can be taken at that point.
This early lifesaving treatment can cost an estimated $108 US dollars, while people in the most rabies-stricken countries only make 1-2 US dollars per day. The treatment, travel, and time out of work can leave them financially crippled.
Something I recently learned is that there are two types of rabies. The one we all think about with the foaming at the mouth is called furious rabies, and the second is called paralytic rabies, sometimes referred to as dumb rabies. Roughly 80% of rabies cases are furious rabies, and only 20% are paralytic rabies. Paralytic rabies typically takes longer to show symptoms and the patient will take longer to succumb to the virus.
Both types attack the nervous system but start off with the same symptoms. These include:
burning, tingling, itching, pain, or numbness at the site of the bite wound.
fever
fatigue
cough
sore throat
muscle pain
nausea and vomiting
headaches
The next signs depend on what type of virus the person has. Symptoms of paralytic rabies are
stiff neck
weakness starting at the wound site and moving out to the rest of the body
tingling, pins and needles, and other strange sensations
paralysis starting at the wound site and slowly working its way through the rest of the body
coma
Sometimes this form of rabies can be misdiagnosed as Guillain-Barré Syndrome (GBS), a rare disorder in which your body’s immune system attacks your nerves.
The symptoms of furious rabies are:
hyperactivity
insomnia
agitation
aggression
seizures
hallucinations
muscle twitching
racing heartbeat
fast breathing
excessive salivation
two different-sized pupils
facial paralysis
fear of water, known as hydrophobia
fear of air being blown in their face
delirium
Remember, furious rabies can come with periods of calm between episodes.
Both types will eventually lead to death.
Rabies is formally diagnosed through a blood test, saliva test, skip biopsy, cerebrospinal fluid test, or MRI, although it cannot always be picked up on an MRI.
There is, however, one case from Wisconsin in 2004 of a 15-year-old girl who was bitten by a bat that transmitted the rabies virus to her. She received no post-bite treatment, and when she showed signs a few weeks later, the doctors put her in a medically induced coma in an attempt to save her. By the grace of God, it did, and she is still alive at the time I am recording this over 20 years later.
Historically some of the attempted cures were gross, while others sound painful. These include amputation of the bitten limb before it can infect the rest of the body, burning the wound with hot pokers, and eating the hair of the rabid dog that bit them. In contrast, others believed no cure was possible and would take people to the firing squad to spare them the terrifying and prolonged death they would later suffer.
Where I grew up, we were always told that if you saw a nocturnal animal out in the daytime, it was likely rabid and should be immediately shot. Never touch the dead animal. You burn the body where it lay and then bury the ashes. While this might seem extreme, fire is how people have dealt with many diseases, including Ebola and the black plague. If an animal were to eat a carcass that had rabies, it could potentially infect them. The fire will kill the virus, which is actually a way that characters could safely get rid of a rabid animal. This would be true in a historical story and in a post-apocalyptic story.
A quick side note, seeing a nocturnal animal in the daylight does not necessarily mean it has rabies.
Fun fact: The longest recorded rabies incubation period is 8 years, but according to the National Library of Medicine, there is a case of rabies that had a bite from 25 years prior. I’ll leave a link in the show notes.
What could possibly go wrong:
Likely to go wrong: Your character, or even their loved ones, do not believe there is any need to worry about rabies for their bite and do not seek treatment. This will lead to death if the animal that bit them was rabid.
Likely to go wrong: Your character with rabies, or even potential rabies, is shunned by their family and friends for fear that they might contract rabies from them.
Possible to go wrong: If your character is getting rid of a rabies carcass with fire, they could burn it in brush or too close to something flammable and light the forest on fire or even their home if they are too close.
Possible to go wrong: Your character doesn’t realize that the first symptoms of rabies is anything more than an ordinary illness.
Unlikely to go wrong: Your character has rabies, or someone they love has rabies, and there is a discussion about if your character should be killed to put them out of their misery.
Unlikely to go wrong: Your character has paralytic rabies and is misdiagnosed.
Improbable but technically still in the realm of possibilities: In a moment of calm and clarity, your character with rabies asks to be put out of their misery. This would create a moral/ethical dilemma for those nearby.
Helpful links to learn more:
What is rabies?
Global Alliance for rabies control:
https://rabiesalliance.org/about/about-rabies/signs-and-symptoms-rabies
Rabies in children:
https://kidshealth.org/en/parents/rabies.html
The only person to have survived rabeis:
Possible longest incubation period for rabies:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3424805/
Historical treatments:
https://www.notesfromthefrontier.com/post/rabies-on-the-frontier
Videos:
(Warning: this video has cadavers and covers what happens inside the body at an anatomy level.)
