Rabies is a terrifying disease with an almost zero percent survival rate. If bitten by an animal carrying the virus, a person has just 24 hours (or 48 hours if they are vaccinated) to reach a hospital to stop it from infecting the nervous system, where the infection takes hold and begins causing symptoms. If this is not prevented, from this point on, the person is waiting for death.
Incubation can take weeks or even months, beginning as a flu-like disease with headaches, weakness, and fever, which often last days. Before long, the symptoms progress into neurological problems, culminating in agitation, anxiety, and cerebral dysfunction. Patients may go on to develop a complete fear of water, as the virus prevents the host from drinking, and may experience hallucinations and delirium. This can last for 2-10 days and is almost always fatal – fewer than 20 recorded cases of human survival from clinical symptoms have been recorded, and details are scant on most.
How did those people survive? For some, it required the controversial Milwaukee protocol, a last-resort procedure involving almost complete brain death – its effectiveness is hotly debated and it has been abandoned by most doctors, but it has helped some defeat this formidable disease.
Developed by Dr Rodney Willoughby Jr, the Milwaukee protocol is an emergency effort in fighting off rabies in human patients. Named after the city of Milwaukee, where it was first successfully used in 2004, the protocol relies on the body's own ability to fight off the rabies virus – but only when given enough time.
Rabies moves through nerves in the central nervous system and into the brain, where it replicates and causes neurological symptoms, relying on neurotransmitter dysfunction to continue the life cycle. Willoughby Jr and colleagues postulated that if brain activity can be reduced to the bare minimum, the virus could be slowed enough to keep the body alive and allow the immune system precious time to fight it off.
The protocol was first attempted on a 15-year-old girl, with doctors using drugs to induce a coma, inhibiting nerve activity, while dosing her with a cocktail of antiviral drugs. It was an arduous procedure – but after 76 days, she was released from hospital. Subsequent follow-ups showed she had a speech impediment and difficulty walking. She went on to graduate college and gave birth to twins in 2016.
Since then, the makers of the Milwaukee protocol claim to have saved 18 people as of 2018 (2 in the US and the rest in Peru), though the statistics have since become blurred and experts question these numbers due to their poor documentation.
The procedure has an extremely high failure rate, with a recent preprint showing that just one patient out of 12 treated with an induced coma survived, and that person presented abnormally to begin with. A long induced coma for rabies is expensive, treatment-intensive, and ethically questionable, but with such low survival rates without treatment, it may present the only option for some people. But does it actually work? The jury really is still out.