Rabid (25 page)

Egypt, in fact, was the site of the most dramatic reaction to the pandemic: the wholesale slaughter of the country’s 300,000 pigs,
despite the lack (at the time of the edict) of a single documented case in either pigs or humans. These pigs were the treasured property of Egypt’s Coptic Christian minority; in Cairo, a devoted population of Coptic trash collectors, called the
zabaleen,
had for decades employed thousands of scavenging pigs in disposing of the city’s waste. But relations between Muslims and Christians have for decades been tense, sometimes erupting into outright violence, and it was hard not to see this preemptive move by the government as an act of prejudice carried out via the law.

A cynical view of the government’s motives seemed especially justified once the methods of the massive pig cull became known. Officials had promised that the animals would be humanely slaughtered, with throats cut, and the meat preserved; but an Egyptian newspaper, after following a truck of seized pigs, found that their treatment was nothing short of barbaric. Video footage shows workers using a front-end loader to fill an enormous dump truck with screaming, squirming pigs, piled atop one another. Then the truck deposits the pigs at a vast burial ground, where they are killed slowly—“covered with chemical products and left for thirty or forty minutes until they are dead,” one worker tells the camera—and then unceremoniously covered with quicklime. Other amateur footage showed pigs brained in the streets with metal poles, piglets stabbed to death.

It was a scene that could have played out in the nineteenth-century streets of London or Paris, except with a different animal as victim. For all the ways that scientific advancement during the past century or so has served to beat back superstition, it’s worth reflecting that our zoonotic sleuthing in particular—our establishment, beginning with
Y. pestis
in 1894, that most of our myriad afflictions have an origin in animals—has been something of a Pandora’s box. For centuries, after all, we suffered through waves of flu without having to blame some different creature for each set of shivers. Today, though, every new strain will expose some species to the sort of TV coverage normally reserved
(at least where animals are concerned) for shark attacks alone. Four thousand years after the Laws of Eshnunna, and more than a century after Pasteur slew rabies, acquiring a disease from animals still shocks us, and, as the pigs of Cairo discovered, it can still drive humans to hysterical violence.

*
It’s this variety that best fits Chuck Klosterman’s puckish notion of zombies as a metaphor for our high-tech modern life: “Continue the termination. Don’t stop believing. Don’t stop deleting. Return your voice mails and nod your agreements. This is the zombies’ world, and we just live in it.”

*
Today’s scientists believe that AIDS most likely arose through the hunting of monkeys and apes for bush meat.

*
There is a curious American footnote to this peculiarly British outbreak of hysteria. For a few months in the fall of 1977, the horror writer Stephen King lived in England, during which time he penned the first draft of
Cujo,
America’s most famous rabies-horror yarn. King has always maintained that the inspiration for the novel came from “reading a story in the paper in Portland, Maine, where this little kid was savaged by a Saint Bernard and killed.” But it’s hard to believe that he wasn’t at least subconsciously influenced by the rabies-horror boom in Britain. He could hardly have been unaware of either book while in England, particularly because the latter book,
The Rage,
has an almost identical title to a novel of his own—
Rage
—that he had just published under his pen name, Richard Bachman.

Photograph of Matthew Winkler, a six-year-old boy who survived rabies in 1970. Dr. Rodney Willoughby taped this photo to the wall of Jeanna Giese’s hospital room in 2004.

D
r. Rodney Willoughby, a specialist in pediatric infectious disease at the Children’s Hospital of Wisconsin, in Milwaukee, was dubious when he heard that a possible case of rabies was being transferred to his care. “I was skeptical she had rabies,” he recalls. “Because that never happens.”

It was October 2004. The patient was a high-school athlete, a fifteen-year-old girl who was suffering from fatigue, vomiting, vision disturbances, confusion, and loss of coordination. Willoughby considered some other brain infection or various autoimmune diseases as more likely causes for her condition. But he made sure that the samples necessary to rule out rabies were collected and sent to the Centers for Disease Control and Prevention (CDC) in Atlanta within hours of the girl’s arrival. In the meantime, she was put in strict isolation to protect hospital personnel from possible exposure. Her condition quickly deteriorated; she began to salivate excessively and developed an involuntary jerking in her left arm. Soon, Willoughby had to sedate her and insert a breathing tube. As hours ticked by, he began to prepare for the possibility of a positive test result.

The girl’s name was Jeanna Giese, and her troubles had begun a
month beforehand, during a Sunday Mass at St. Patrick’s Church in her hometown of Fond du Lac, Wisconsin. As she sat beside her mother, Giese observed the small silhouette of a silver-haired bat flitting against the sanctuary’s tall stained-glass windows. When the bat fluttered down toward the back of the room, barely above the heads of the worshipping congregation, an attending usher batted the creature to the ground. Giese decided she would take it outside. With her mother’s permission, she slipped quietly from her seat and walked back to where the bat lay prone. As she picked the bat up by the tips of its wings, it shrieked, but still she continued with it toward the door. Just as she nudged her way out into the open air, the bat reared its head around and bit its Good Samaritan on her left index finger.

Later, Giese showed the tiny wound to her mother, who ensured that it was thoroughly cleaned. No one in the family thought to seek postexposure treatment for rabies. But after symptoms set in four weeks later and Giese was admitted to a local hospital, her mother mentioned the bat bite to the pediatrician. Arrangements were immediately made for Giese’s transfer to the Children’s Hospital and into Dr. Willoughby’s care.

Like the vast majority of American physicians, Willoughby had never seen a case of clinical rabies before. He telephoned the CDC to ask if there was any treatment for rabies somewhere in the research pipeline—some promising new therapy, perhaps, that had been attempted in a case or two but not yet published in any medical journal. The CDC could offer no such hope. Not one person had ever been shown to survive rabies without receiving at least partial vaccination against it prior to the onset of symptoms. All the treatments tried to date had failed. No consensus existed for what therapy should be attempted next. Aside from palliative care, standard practice was to use intensive therapy but in a purely reactive way, trying to control the dangerous complications of rabies as they arose. But this had never saved a single patient in Giese’s predicament.

Willoughby attacked the problem with quick but deliberate reading.
With less than a day to formulate a plan, he started out by searching for any recent papers that hinted at a possible treatment. None turned up. “I did a couple hours of diligence and figured out that nothing was new,” he recalls.

So he decided he would use his limited time to review the basic neuroscience of rabies. His understanding—though the science is still far from settled on this subject—was that rabies did not cause inflammation in the brain, nor did it destroy the brain’s slow-growing, densely networked cells. Instead, it seemed to interfere with how they communicated with one another, ultimately disabling the brain from performing crucial functions such as controlling cardiovascular activities and breathing.

Willoughby was struck with a novel idea for how to assist a patient through a rabies infection. The solution, he says, looking back, “was hiding in plain sight.” He sat down at his computer and searched the scientific literature for the terms “rabies neurotransmitters” and “rabies neuroprotection” and then quickly tried to absorb the fifty or so papers his query returned. As he read on, he began to permit himself to hope that even if Giese was confirmed to have rabies, there might be a way to help her survive. “With a little more reading,” he says, “it seemed to me like there was a real opportunity.”

Willoughby had started thinking about becoming a physician when he was still in high school. His mother’s father was a doctor, and Willoughby liked science, so it seemed a natural fit. He picked up the prerequisite courses as a Princeton undergraduate while still considering other possibilities; when none proved compelling, he enrolled in medical school at Johns Hopkins.

He most certainly did not become a doctor because of any burning desire to solve the human rabies problem. Not that he was unaware of the dreadful nature of the disease. During much of his childhood, Willoughby’s large Catholic family lived in Peru, where his father worked for an American oil company. There, his younger sister was bitten by a
guard dog that was defending the home of a family friend. The bite itself was not terribly serious, and if the dog had been observed to remain in good health over the next week or two, no further action might have been necessary. However, just after this incident, in the course of a burglary, someone threw poisoned meat over the broken-glass-topped concrete wall that surrounded the friend’s property, killing the dog. Given the prevalence of canine rabies in Peru at the time, the Willoughby family did the prudent thing and started the girl on Pasteur’s vaccine.

Willoughby himself would often accompany his sister to the clinic for her inoculations. It was clear that those fourteen shots, delivered into the sensitive muscles of her abdominal wall, were tremendously painful. But the injections were made much more frightening by the brutal manner of the German nurse who dispensed them. “Frau Nurse would tell her to toughen up, and then would slam the shot into her belly,” he says. “The nurse was scarier than the shots were.”

By the time Willoughby graduated from Johns Hopkins in 1977, human rabies had become vanishingly rare in the United States. “For the boards,” he recalls, “you only needed to know one thing about rabies: it was 100 percent fatal.” Willoughby committed this fact to memory, passed his boards, and didn’t think much about the disease again for many years—even as he continued his training, first at the University of California at San Diego and then back at Johns Hopkins. “It’s so rare in this country, only a few cases per year. So I figured I’d go pretty much forever without seeing one.”

Willoughby would become a specialist in pediatric infectious disease, with a strong emphasis on clinical research. His work would center on diseases with importance in the developing world, such as rotavirus (a common and often fatal diarrheal infection in children) and cerebral palsy (which sometimes can be triggered by brain infection in young children). Along the way, his training exposed him to many talented clinicians and researchers. He was particularly impressed by Richard Moxon, now chair of pediatrics at Oxford, for the way he engaged in collaborative, open scientific discourse—to the
point of being willing to share laboriously obtained DNA extracts from his laboratory with rival researchers. “That kind of openness to move the field forward, even if it doesn’t benefit you personally, has always been inspirational,” Willoughby says.

He had been practicing at the Children’s Hospital of Wisconsin for only five months when Jeanna Giese came under his care. The night she arrived was just his second night on call. Treatment of Wisconsin’s first human rabies patient in several years would turn out to be a great way to get to know his new colleagues and to reach out across the pediatric disciplines. With the help of his new boss, Michael “Joe” Chusid, Willoughby assembled a diverse team of talented clinicians. There were two neurologists, two criticalists, another infectious disease person, and an anesthesiologist—“a bunch of smart people,” says Willoughby, each bringing a different but relevant area of expertise to his fast-moving conundrum.