More gruel
And Now, Rabies

And Now, Rabies

Last August, a man in the Chicago suburbs woke to find a rabid bat on his neck. He declined treatment over fear of vaccines and died a few weeks later. He was the first Illinois resident to die of rabies since the 1950’s. Unfortunately, he was not alone.

Five Americans died in 2020 from rabies, an unprecedented toll for a disease that has been well managed for decades. Human cases of rabies are so rare in the US that the CDC publishes a summary of each individual case. Though the disease carries a mortality rate near 100%, almost no one dies from it here if they get treatment. Four of the five victims did not receive the rabies vaccine, two because they were unaware of their exposure.

There have been about 20 deaths from rabies in the US since 2009, half a result of travel to developing countries where rapid treatment was unavailable. To have five in a single year is a landmark.

What does this mean? Maybe nothing, but it does fit into a larger picture. Rabies deaths are a strong measure of public health infrastructure. No one has even contracted rabies in France since 1924. Japan hasn’t had a domestic rabies case since 1957. New York has had one rabies case since 1954, during a broader outbreak of rabies among raccoons in 1993. Though endemic among wild animals and absolutely lethal in humans, rabies can be prevented almost entirely with competent public health initiatives.

Constant monitoring of wild populations, careful efforts to control feral dogs and cats, aggressive pet vaccinations and public awareness campaigns are all necessary to contain rabies. When those efforts are in place, rabies almost entirely disappears. When those efforts cannot be maintained, the disease blooms.

On average, about two people die every week from rabies in Haiti. On the other side of the same island, in the Dominican Republic, they see about seven deaths a year. Rabies deaths are rare in Europe and the developed countries of Asia while Russia suffered seven rabies deaths last year.

Where is the US on public health?

Republicans are seizing on COVID paranoia to wreck the keystone of public health – vaccine requirements. Alabama just banned all new vaccine requirements in schools. Republicans in Florida are pushing a “review” of all pediatric vaccine requirements. Republicans in Montana just banned all vaccine requirements for employment. Four years of Republican looting have destroyed the world’s leading disease control institution, the CDC. 2020 saw a record number of rural hospital closings. And insurance executives are pointing to some worrying statistics from last year, suggesting that “excess deaths” ranged more than 40% higher than published figures among working-age people. We are not well.

Like tuberculosis, pellagra and hookworm, rabies is a barometer of political health, a disease of politics. Our political sickness is spreading.


  1. Also consider the new phenomenon of covid orphans. Given that anti-vaxx idiocy tends to run in families, it’s not a surprise that covid deaths also tend to run in families. There is now a growing cohort of children who have lost both parents to covid — not to mention extended family who might have taken them in:

    One would think that, if you have lost a spouse, and you have young children, that maybe you should swallow your quest for freedom and liberty, take down your MAGA hat, and get the f’n vaccine, knowing that your children’s future now depends solely on you. But I guess owning the liberals is a higher calling than taking care of your children. I really feel bad for them: many will end up in foster care or become wards of the state, where they’ll get a rude, first-hand knowledge about the strained safety net their parents (likely) railed against and tried to destroy while they were still living…

  2. Hi Chris, I find it hard to get too concerned about three rabies deaths in the US in 2020 (discounting the two people who did not know they were infected). While the 2020 deaths roughly doubled from the 10 year average, the absolute number is small.

    I could not find a statistic for the number of people who got the rabies shot(s) and were saved. That would be a useful statistic to compare against.

  3. This is all so demoralizing. Medical students in the US often spend a month or two in places like India and Africa in order to see diseases that they’ve only read about but are no longer seen in the US, like polio, rabies, advanced syphilis, etc. How long before Indian and African medical students start coming to the US for the same reason?

    (FWIW, we’re already there for trauma. The military sends their surgeons in training to inner city hospitals to get the training in gun shot wounds, stabbings, and other traumas before heading to field hospitals in warzones. Apparently Cook County Hospital and its public hospital peers do a pretty good job duplicating the mix of major trauma and resource constraints that military surgeons will face in tent hospitals in Iraq…)

    I’m at the point where I think the best way forward is to decouple. The rural parts of this country are doing their damnedest to replicate the Taliban’s Afghanistan. Perhaps we should withdraw and let them succeed, with appropriate evacuation procedures in place for those who want to escape their little patch of hell.

    1. “Perhaps we should withdraw and let them succeed, with appropriate evacuation procedures in place for those who want to escape their little patch of hell.”

      They will then set as their next goal the re-annexation of the territories they lost, particularly because of those territories’ financial, technological, and infrastructural resources.

      The difference between them fighting these regions now and them fighting these regions later is that there’s still the impression of getting the liberal cities and states ‘over to their way of thinking’ under a shared constitution (not the one we have actual written, but the one they perceive in their ideological fondness for guns and abortion control). Officially become a ‘different country’, and now there’s no need to fight a culture war, there is only conquest and nothing short of it.

      Secession and annexation are difficult things on any level of society. They’re pretty much literally the result of every other option falling out, not the option you take to prevent fighting the other battles.

    2. “The rural parts of this country are doing their damnedest to replicate the Taliban’s Afghanistan. Perhaps we should withdraw and let them succeed,”

      Trouble is, the RWNJs are all abut local control and laboratories of democracy, except when it’s a Blue urban area trying it, and there are too many of them in the state legislatures. Local officials in TX cities are still fighting Gov. Abbott over mask mandates. So far they are winning. In WI (IIRC) GOP state legislators are proposing a bill that would ban cities from restricting no-knock police raids. All while pushing more guns! And stand your ground! In Houston we are still waiting for a trial over the botched Harding St. raid, an unnecessary police killing of a married couple and their dog brought to you by the asinine combination of a no-knock drug raid (for bonus badness, based on false evidence and a corrupt cop) and the castle doctrine.

      Personally, I’d keep the castle doctrine in a limited form (you can use deadly force to defend against someone breaking into your residence), and severely restrict no-knock raids (as in stop a violent crime in progress).

  4. You could consider vaccines to be victims of their own success in a way. I am a member of the last generation to be vaxxed for smallpox- the scar on my left arm is still visible. This is the biggest of many vaccine successes- diseases that took a horrendous toll on humanity are extinct or exceedingly rare. But people forget and we’re in danger of giving the bugs another go at us.

    It would be nice to have a time machine viewer so that everyone could be reminded of just how much people suffered from these now preventable diseases. But given the manufactured hysteria over CRT, I now how well anything that showed inconvenient truth would be received.

    I am out of patience and compassion for these anti-vax folk. There is no good excuse for their willful ignorance and elected officials who ought to know better are even worse. IIRC it was Israeli prime minister Golda Mier who summed up a major underlying cause of the Israeli-Palestinian conflict as “hating the other side more than you loved your own children”. We are afflicted with that disorder here. We have too many people who value pigheaded political tribalism and triggering the libs over the welfare of their own children. It will end badly for them; the only suspense is what level of damage the rest of the country takes from their suicide pact.

    I’m seriously thinking of eschewing the rural areas/small towns. I’ve been spending less and less time there, but they are starting to look like no-go zones.

  5. You just left Chicago, albeit hardly a great place, for Austin Texas, one of the more liberal islands in a sea of fascism, religious fanaticism, and anti-science, because of friends and family.

    Maybe a smarter bet was to move to NY State, or Mass, or somewhere else in the NE Bloc, where civil society and democracy in the U.S. will make its last stand.

  6. I used math heavily in my career. Including statistics. Producing volumes of data from lab test and observation then interpreting them. In complex chemical matrices. No we are not a well society right now. And the data supports that. Not just what was in this essay either. In fact we are starting to destabilize. The outside world is very worried. If we are to move beyond this we have to get engage and find comradery (allies) . Especially politically. In our communities we can have a real impact. I have often influence people because of long time association . They know I am intelligent , well informed and hold rigidly to Christian ethnics. Often in opposition to authority in the wrong. That includes church authority. Time to use your association with people to maybe hold back some who are leaping over the cliff following false leaders who are just conning them. In some ways it is a number game. Authority including fascism depends upon belief. Like many things (money for example) it is all in our collective heads. If we can convince enough people to say no the authority disappears.

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