A Cure or a Miracle?
Two years ago, 15 year old Jeanna Giese became the first person, without the aid of a vaccination, to survive Rabies. Rabies is a killer, one of our most ancient and deadly enemies. When doctors see the symptoms, there is nothing they can do. Rabies is 100% fatal.
In the history of humanity, no-one has survived rabies. Once the virus gets into the host body, it moves swiftly through the nervous system, hijacks the brain and always kills the host. As many as 100,000 people die from rabies every year, most of them in the developing world. The smallest bite, a single drop of saliva, will kill. Children are very often the victims.
Dr. Stephen Scholand works in South East Asia battling this curse: “When you see what rabies can do to someone, it’s absolutely devastating. The deaths that they have are probably the worst deaths you can imagine. If you have clinical rabies, it’s a death sentence, you’re going to die”.
Modern medicine can save us from killers like Smallpox, Cholera and Typhoid, but despite centuries of searching, there is still no cure for rabies. The age-old treatment remains unchanged; Isolate the victim, tie them down and wait until the virus destroys them.
Rabies is largely forgotten in The First World, but is making a dramatic comeback. Scientists are studying a new super-strain of the virus in the bat population of America. Rabies has reached epidemic levels amongst wild animals, and every two minutes someone in the US has a close encounter with a rabid bat, skunk, or racoon. In Europe only Sweden and Norway are rabies free. In 2002 a man was killed by a rabid bat in Scotland.
It was in the late summer of 2004, in Fond-Du-Lac, Wisconsin, in America’s mid-west, that the remarkable story of Jeanna Giese began. The fifteen year old was a typical girl-next-door, an A-Grade student and a star of the high school volleyball team. September 12th was just another Sunday. It started, as usual, with mass at St. Patrick’s Church. A little black bat was flying around the church, swooping over the heads of the congregation, who swiped at it with their hats. Someone made contact, and the bat fell to the floor. Jeanna, an animal lover, picked the bat up to take it outside and received a bite on the finger for her trouble.
The end of the football season is the time for parties and dancing, so Jeanna didn’t see a doctor and the bat bite was soon forgotten. There is a vaccine for rabies, but if there is a delay of more than 24 hours in receiving an inoculation after being bitten, if the first symptoms appear, then it’s already too late. It was nearly Halloween when Jeanna began to notice the first symptoms of what would become her own horror story.
She started with a weird tingling in her arm. This meant the virus was on the move, travelling inside her nerves, heading for her spinal cord and brain. Next she felt very tired, had flu-like symptoms, her hand started to jerk and her speech became a little slurred.
Nearly a month after the bite, Jeanna began to get double-vision. Her doctors started to test for every disease they thought likely, but not rabies. It was only after all other possibilities had been exhausted, that Jeanna’s mother, Ann, remembered the bat bite. The doctor was horrified. If it was rabies, Jeanna would progress to the final and terminal stages in a matter of days. The local doctor realised that he needed help.
Now, when the textbooks said it was already too late, Jeanna was referred to the Children’s Hospital in Milwaukee. The doctor on call, Dr Rodney Willoughby, faced the deadliest virus known to man. Just the suspicion that he had a rabies case sent Dr Willoughby on a frantic, although he knew a hopeless, search for a cure. He immediately sent samples of her spinal fluid to the CDC for confirmation. He tells us: “I think we consider rabies to be The Mount Everest. It’s uniformly fatal, it’s quickly fatal, people have tried forever to treat it and it’s never worked”.
But, if it was rabies, Willoughby knew he was out of his depth. He’d never even seen a case before, but he knew enough to be afraid. He needed to know if there was anything out there, in the medical papers, that might lead him to a possible treatment. Everything he read said there was no cure, nothing had ever worked. Jeanna was going to die.
Once rabies takes hold, the virus invades the victim’s mind. They froth at the mouth and lurch from horrified awareness of what is happening to them, to insanity and back again. They develop an irrational fear of water, known as hydrophobia which for many years was an alternative name for rabies. Without a miracle, Willoughby knew this would be Jeanna’s fate.
But then, working against the clock, Willoughby found an obscure paper on the Internet which suggested the first glimmer of an idea. The author had discovered that while rabies patients die having violent fits and convulsions, their brain’s appear to be physically undamaged. This turned our understanding of the way rabies killed on it’s head. From what Willoughby was reading, the virus seemed to hijack the brain, scrambling it’s messages, causing havoc in the host body that led to the failure of all vital organs. It was the rabid brain that killed the patient.
He began devising a radical treatment that might save a patient from their own brain. What was at stake was more than Jeanna’s life, in the developing world, tens of thousands of children and families are at risk. Dr Willoughby couldn’t do anything until he’d had confirmation, from the CDC, that Jeanna actually had rabies.
When the confirmation came, Dr Willoughby knew Jeanna only had hours left to live and threw himself into one last effort to create the cure that had eluded science for centuries. He already suspected that the key was the way rabies killed, hijacking the brain. His breakthrough was to realise that if he could shut down the brain, he could stop the virus in it’s tracks. Take Jeanna’s brain offline and, perhaps, he could buy her immune system time to rid her body of the virus. He’d put her into the deepest of comas, denying rabies the chance to kill Jeanna by, effectively, killing her himself.
Willoughby went ahead with his experimental protocol, unheard of in the treatment of rabies. On October 10th, Jeanna was put into a coma so profound that she was only a hair’s breadth from death itself. This is dangerous, even for a few hours, but Willoughby planned to keep Jeanna under for as long as it took.
He explained himself: “We’re trying to buy time for the immune system to catch up. The immune system takes around five to seven days to start an antibody response, and about ten days to have it be vigorous”.
But, even if Willoughby’s untried treatment didn’t kill Jeanna, was it actually doing anything to help her fight the virus? Had this procedure bought her the time to mobilise and fight back? All he and Jeanna’s parents could do was watch and wait and hope the virus wasn’t killing her quietly as she slept.
She would be in a chemically induced coma, perilously close to death, for up to six days.
After 7 days at the very edge of death, came the first signs that Jeanna’s immune system was making antibodies to fight for her life. It seemed Willoughby had pulled her back from the brink, but what he didn’t know was what damage the virus, or he himself, had already done to her.
He expressed his worries: “Our great fear was that we would end up with a person so heavily damaged that they wouldn’t be able to move, or do anything. Even worse, what we call a lock-in, where someone is there cognitively but has no muscle function and can see and hear, but can’t speak or swallow or do anything else. We took her out of the coma, she didn’t move, she didn’t respond to pain and I thought we’d, basically, created a very vigorous vegetable. That was the worst day of my life”.
Ten days after the treatment had been started, came a tantalising breakthrough, Jeanna opened her eyes. But was she conscious? Was she aware? To evaluate this, Dr Willoughby needed her to see a familiar image. Her mother came to her bedside and removed her surgical mask. If Jeanna’s eyes tracked her mother’s face then Jeanna was fighting her way back. Jeanna did recognise her mother!
Jeanna was alive, but she’d paid a high price. She had to learn to speak again, learn to walk, she was like a baby. Dr Willoughby explained: “Rabies unwires you completely and it appears now that it takes at least two years to fully rewire”.
After a year she was walking and talking better, and rediscovering her love of horse-riding. Her recovery has been remarkable.
Willoughby published details of his protocol on the Web where any doctor could use it. It became known as the Milwaukee Protocol.