Daniel and Kelly’s Extraordinary Universe - Rabies

Episode Date: February 10, 2026

Daniel and Kelly talk about rabies, which results in very few deaths in the United States but is a neglected tropical disease - taking approximately 60,000 lives globally each year.See omnystudio.com/listener for privacy information.

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Hey there, Extraordinaries. Heads up. Today's episode is about rabies, so we'll be touching on topics related to death and animal testing. Please decide if that content sounds like a good fit for you or for any children that might be hanging out in earshot. Thanks. In 2025, rabies made the news in the United States. A kidney transplant recipient had passed away from rabies, and it was determined that their organ donor had had an undiagnosed case of rabies.

Humans rarely transmit rabies to each other, and organ and tissue transplants are pretty much the only way it happens. But how does someone end up with undiagnosed rabies? Well, the man who would go on to become the organ donor was holding a kitten in an outbuilding when a skunk came in. The skunk approached the man who perceived that the skunk was trying to kill the kitten because the skunk was very hungry. The man knocked the skunk unconscious, they're made of pretty stern stuff out in the country, and got a scratch on his shin in the process.

In hindsight, he should have thoroughly washed out that wound and immediately gone to see a doctor for rabies treatment. But he dismissed the scratch and didn't think he had been bitten. He just chalked it all up to an unfortunate interaction with a hungry, but not necessarily rabid skunk. Five weeks later, he began hallucinating, he had trouble swallowing, and two days after that, he appeared to have suffered a cardiac arrest. He never regained consciousness and was eventually declared brain dead.

His family did report the skunk interaction, but cardiac arrest seemed a more likely cause of death. His kidney and three cornea tissue grafts were eventually given to recipients, and as you now know, the kidney recipient passed away. When it was determined that the kidney recipient had rabies, some sleuthing determined that the organ donor had originally died of rabies as well. At that point, the cornea tissue grass were removed, and all three recipients were given treatment for rabies.

Thankfully, they all remained symptom-free. This scenario where an organ donor transmitted rabies to organ and tissue recipients has only happened four times since 1978 in the United States. But it makes the news in the United States because rabies deaths are so incredibly rare here. But globally, they're not rare. Around 60,000 people die each year from rabies and many of them are children.

And these deaths happen despite the fact that we have a vaccine that could save them if only it was administered soon after the initial rabies exposure. So today we're going to talk about rabies. How you can get it, how you can avoid it, the history of vaccine development, and what vaccines we have available today. Welcome to Daniel and Kelly's rabid universe. I'm Daniel. I'm a particle physicist, and I expected, based on childhood cartoons, to worry a lot about quicksand and rabies when I was growing up. Hi, I'm Kelly Weiner-Smith. I study parasites and space.

And yeah, I also thought that quicksand was going to be a much bigger problem as an adult than it ended up being. All right. Well, then my question for you today, Kelly, is have you ever stepped in quicksand or had a serious concern about getting rabies? I never stepped in quicksand, although I did almost get stuck in a salt marsh once in some mud. I had a moment where I was out there by myself and I was like, am I going to be able to get my foot out? Or is this the end as the tide is coming in? And it wasn't the end because here I am. Well, probably in that case, it's just bye-bye boot, right? Yeah, yeah. I did. I did lose that boot. Whatever. You donated it to future archaeology is what you did.

Yeah, yes. Or I polluted that estuary with some microplastics. I'm so sorry. No, in 5,000 years, some PhD student is going to write a whole thesis about the ritual processes surrounding your boots. Okay, sure. I wouldn't want to read that thesis, but I hope they pass. Well, what about rabies? Yeah, so when we moved to this property, there were two barn cats on the property, and the woman was moving to a place that didn't have a barn,

and so we offered to keep the barn cats. And every once in a while, they'll catch a bird. And when they catch a bird, I keep it. This is the Weiner-Smith family equivalent of poop in the fridge. My husband is not thrilled when I do this, but I do it. And so I reached down once because I thought the birds, and this was on my birthday, I reached down. I thought the cats had caught a bird.

And as soon as I picked it up, I shouted an expletive because I realized they hadn't caught a bird. They had caught a bat. And I had picked up that bat. with a bare hand. And so immediately I was like, oh, no, do I need to go get a rabies vaccine? And so I called the poison control center and they ended up deciding, no, it's probably fine. You probably don't need a vaccine. And I was like, I don't want to hear the word probably. I want to hear a hundred percent. There is zero chance you're going to get rabies. You're talking to a warrior here, people. That's right. I know I did say. I was like, look it, I have severe anxiety. If the answer isn't 100 percent,

I want to come in and get the rabies shot. And they're like, lady, you're fine. And I was like, all right. Speaking your language. That's right. That's right. What about you? Well, I didn't have to worry about rabies.

But growing up in northern New Mexico, you do have to worry about the plague. And I remember one time seeing a dead squirrel and poking it and then going home excitedly telling my mom how I saw this dead squirrel and played with it. And she was like, uh, you what? Oh, no. And from then on, I was sure that I was going to get the bubonic plague, which existed. you know, medieval Europe and New Mexico. Yeah, well, and in like mountains in California. What?

We don't talk about that. No, oh, I do. I do. But for both of these, there are treatments if you catch it pretty soon. There's antibiotics for the plague that does not plague us anymore. And we have vaccines for rabies, which we'll be talking about today. Well, that's why we joke that New Mexico is home of the flea, land of the plague. Oh, yeah, that doesn't make me want to move there.

No. No. The land of entrapment. Anyway, there's a lot of wonderful things about New Mexico, but you don't really appreciate them growing up there as a teenager. I felt the same way about Ohio, but I guess I feel the same way as an adult about Ohio. I'm so sorry. Well, speaking of not appreciating things, I don't appreciate getting rabies, but I do appreciate our listener's curiosity. Yes, me too. And we got a request for an episode topic from Gertit. They wanted to know about rabies. And so I was happy to oblige because rabies isn't. absolutely horrible topic, but also fascinating. And so that is Kelly's Venn diagram of favorite

things to talk about. That's right. We don't exploit true crime on this podcast, but we do talk about gooey biological pain and suffering. We do. And I came across what I thought was a fun fact while I was doing the research, which is that an old treatment that did not work, so treatment is in quotes here, an old treatment for rabies was you would take the hair of the dog that bit you and put it on the wound, and you would hope that that would save you from actually getting the disease. Is that the origin of the phrase?

That is the origin of the phrase. Now mostly used to justify mimosas at brunch. Yes, right. And we will see that many of our extraordinarily have an extraordinary desire to continue drinking in the morning. I see. Okay.

So let's go ahead and see what the extraordinary's had to say when we asked, the phrase, hair of the dog, came from an ineffective treatment, for what disease? Branchosis.

Branchosis. Wow, what a good question. I'm going to be ignorant and say alcoholism. I've never heard the phrase before. Hmm. What disease would be associated with dog hair? I'm going to say Lyme disease due to ticks. The hair of the dog originally refers to the prevention of rabies and is, of course, false.

Probably has something to do with the old principle of light cures like, and a myth would spread very rapidly in an environment of wishful thinking and despair. With dog in the phrase, I'm going to go with rabies. I guess it's probably something related to tuberculosis. Basically a hangover, and it's so shameful that you have to walk home, and then you find a dive bar on the way home, and you make even more terrible life choices. It might be a reference to rabies, the hair of the dog that bit you.

based on magical thinking, like cures like or some such. Pity it doesn't work. In these parts, it means if whiskey caused the hangover, whiskey will sort it. But I think it refers to an old cure for rabies. Since Hair of the Dog refers to a hangover remedy, maybe alcoholism, but for some reason I'm thinking tuberculosis,

and I don't know why, but I'm sure it hasn't always referred to that Bloody Mary the next morning. I'm thinking the ineffective treatment of being hung over by drinking more. I don't know. Soriasis or something. Right. So it seems like there was a pretty nice split here between folks who were definitely like, this has to do with alcohol and folks who were like, yeah, alcohol maybe, but definitely rabies.

And so did you go down a rabbit hole and figure out if whiskey is actually good in the morning if you have a hangover? I did not. I'm guessing that just delays the inevitable. But I know I didn't look into that. That was a little too far afield of the topic of the day. So for those of you looking for a scientific reason to day drink, you're not going to find it on the show today. I'm not helping you with that. No, that's not what I'm here for.

You are here to tell us all the gooey details about rabies. So what is rabies anyway other than a reason for cartoon dogs to froth at the mouth? Yeah. So rabies is a viral disease that we think has been plaguing us for at least 4,000 years. There are these 4,000-year-old tablets that we found in Iraq that has a law written on it that essentially says, if a dog becomes rabid and the ward authority makes that known to its owner, but he does not watch over his dog so that it bites a man and it causes his death. The owner of the dog shall pay 40 shekels of silver.

If it bites a slave and causes his death, he shall pay 15 shekels of silver. Kelly, I love your Old Testament audiobook voice. That's awesome. Well, here you can see that for 4,000 years, we've been putting dollar values on the value of human, or shekel values on the value of human life. And we have been ranking the value of human beings. Not a good look for humanity. But the point is rabies has been, you know, a thing that we have been aware of for a really long time. But in this case is the word rabid, obviously a translation, describing behavior of a dog?

Or was it already understood that the dogs were ill? And that's where the word rabid comes from. Yeah, that's a great question. So I was listening to, you know, to research this, I was listening to a bunch of different, like, history podcasts, veterinarian podcast, blah, blah, blah. And almost everybody referenced this story. But I was able to find, like, you know, history reference

that was dealing with this exact quote. And it said that another translation, instead of translating it as rabid, translated it as, like, furious or angry. So, like, is it really saying, if your dog is a jerk and we tell you your dog's a jerk and you need to like chain that dog up. You know, we're going to find you if that dog bites somebody.

But references from the same time period note that it seems to be that people recognize that it is saliva that is transmitting something that will kill people. So it suggests to me that they do recognize that there is some disease that is being passed by the dog through a bite and saliva has something to do with it, which sounds like it's not just there's a dog that's angry and they realize some dogs are jerks and jerks should be tied up. They actually recognize that some dogs carry diseases and those diseases get transmitted. Before we understood the microbiology of it all, of course. Yes. I'm noting that the Oxford English Dictionary says that the earliest use of the word rabid is from the late 1500s by George Chapman. And so obviously the Iraqis didn't use the word rabid itself, but the idea is translated to the modern word rabid. Fascinating.

Yeah, yeah. And if you look throughout time, you know, from 4,000 years ago onwards, there are lots. lots of different cultures who have things where you're like, well, it really sounds like they're talking about rabbit animals from the point that dogs were domesticated onwards. That was my other question. Is this a disease that arises because of domestication, urbanization of civilization, the way many diseases come from, like, you know, animals in close quarters? Or is this something that existed and exists among, like, wild wolves? Yeah, great question. This is a disease that exists in the wild and has probably existed

in the wild long before animal domestication. So, for example, in the wild. So, for example, in the United States. It's very common in bats, skunks, raccoons, and foxes. You can find it in coyotes sometimes also. So it's in a lot of wildlife. It happens to also do really well in dogs when they aren't vaccinated. And so when we started living with dogs, we were bringing it closer to us and in contact with us more often. But this is definitely something that you could have gotten from wild animals, for example, when you were hunting before that. I see. So if it's an ancient disease, there must be a lot of hilarious ancient treatments for it. Yeah, right. So Herod the dog was one of them. Another one that it came across was you would take a rooster. You would pull the feathers

off of the rooster's anus. It's still alive while you're doing this? Yeah. Yeah. And I'll note it's actually, you know, it's called an anus, but it's actually a cloaca, which is a word for sewer, because for chickens, everything comes out of the same hole. But anyway, and then you would put it on the bite, and if the anus swelled up, you could assume that, like, the poison had been sucked out by the anus. This didn't. not work. Right. What do you put on the bite? The feathers or the anus? The anus. Yeah. Oh, wow. I totally misunderstood that. Yeah, right. And so now maybe you have like whatever bacteria was on the chicken's butt in your wound, which doesn't sound good.

How long do you have to have the chicken butt on your wound? I don't know. As long as it takes for it to swell up, I guess. I don't know. And there was another one that unfortunately was like, oh, if the dog bit you, you have to like take some of the dog's brain and put that in the wound. And so like, if you didn't have rabies before, you probably have rabies now. So that's unfortunate. But some of these methods probably seemed to work because, first of all, not every angry animal that bites you has rabies. And so maybe you get bit. You try the thing. You don't get rabies. And you're like, oh, that's great that, you know, the chicken butt thing worked. But like, you weren't going to get rabies anyway because that dog was just a jerk. It didn't have rabies. And not every bite

or scratch actually probably has enough rabies virus in it to give you rabies. These are not randomized controlled trials. So they're very hard to interpret, yeah. Yes, right, right. Yeah. But I mean, you know, you can laugh and be like, oh, ha, ha, ha, what idiots. How could they ever think the chicken butt thing would work? But, you know, there were probably a couple instances where they were like, hey, you know, Fred got bit by a dog. And then he didn't get rabies after he did the chicken butt thing.

And you could be like, well, you know, it's worth a shot. Anytime something good happens after a human does something weird, you like create some mythology. And you're like, better put a chicken butt on your wrist before you go outside. If you want gold to fall from the tree or whatever, it's amazing. how these things just reinforce themselves. We are, like, bad at statistics natively. Well, I mean, what's the downside? Right.

I guess if you ask the chicken, there'd be a pretty clear downside. Wow. You know, I haven't been to Virginia in a while, but the culture there has really gone off the deep end. We got rid of our chickens, so we're not so into that kind of stuff, but... Got rid of, wow. Well, we gave them to our brother and sister-in-law.

I see. We had enough gold falling from the sky after doing the chicken butt thing, So we moved on. As one does. Yeah. So rabies is a disease. What does it cost by you?

You said it's a virus. It's a virus. And in the United States, we are pretty lucky. This virus is not something humans need to worry about so much. So about less than 10 people in the United States die from rabies every year. Oh, wow. That's pretty good odds. That's like fewer than shark attacks.

Yeah. Yeah. I guess I don't actually know how many shark attacks there are. But that sounds about right. It's close to shark attacks. Or like struck by lightning or something. It's like, that's very rare. Yeah.

Super rare, but about 100,000 people every year are vaccinated after they have a potential rabies exposure. And so these are probably people like veterinarians who had a stray cat brought in that then went on to bite them, animal control people who had to go out and get an animal that was presumed to be rabid, something like that. So there are a lot of people exposed to animals that might be rabid. But because we have great control measures and great vaccines, very few people die from this. Right. And those two numbers are closely linked, right? It's not like, why are we doing this. Hardly anybody dies. It's like, oh, we're not feeling the rain because we're holding an umbrella. The reason few people die is because we vaccinate people, right? Right. And that's not

true around the world. So globally, 60,000 people die of rabies every year. And this is considered a neglected tropical disease because there are parts of the world that can't afford vaccines or can't handle the kinds of mass vaccination efforts you need to keep cats and dogs that are around people vaccinated year after year. And so we are very lucky. Science has a solution to this. And in the United States, we have the infrastructure and the money to make sure it gets where it needs to go. But in other parts of the world, that's not the case. So we vaccinate all the pets. And then humans, if they've been exposed, we vaccinate them. We don't just vaccinate humans across the board. Yeah. So it depends on who you are. So we have a vaccine that you can give to people who are likely to get

exposed. So if you are a veterinarian, you probably get a prophylactic vaccine. Veterinarians get it. Vet techs get it. People who work in animal control get it. If you like to go spulunking, I think in the United Kingdom, this is called potholing. What? No, pot holling? Oh, my gosh. Let's go for an afternoon in that pothole. That's right. Nobody ever. Well, unless you're in the UK. Said plenty of UK people, I think. And the idea there is that caves are places where you find a lot of bats. And bats could be spreading rabies either through bites or through, you know, like saliva. You could breathe it in in an aerosolized sort of way. If you're a hunter, you might want to consider getting vaccinated, depending on what kind of animals you're going after. Because

when you are skinning those animals, if you have a cut, you can maybe get some stuff in that cut that could transmit rabies to you. So there are certain activities that can increase your risk and you are able to get vaccinated for rabies ahead of time. And then if you engage in another behavior where you think, okay, this time I was definitely exposed to rabies, you'll go in and get some more vaccines to boost your immunity. And what kind of infrastructure is required? Is rabies one of the vaccines that, like, needs to be chilled and it's really complicated? And that's why it's not easily available everywhere. Yeah. So the way that we make this vaccine now, and we can talk about the history of the vaccine later, but the way that we make the vaccine now is we

essentially grow it in human cells in the lab. Or we can grow it in like chicken embryos in the lab. Either way, we're not like growing this in live animals or anything like that. You extract the virus, you kill it, and then you suspend it. And it is kind of expensive. That is part of it. But I think a bigger problem with the vaccine is that this vaccine does have some side effects. So, for example, some people will have a reaction called anaphylaxis where you, you know, have trouble breathing. Some people have like an allergic sort of response to it. The rate of these reactions is pretty low. And what you really need to know here is that once you start showing symptoms for rabies, you are nearly 100% sure to die from rabies. And so if you are exposed to an animal that has rabies,

the risk of any of these issues pales in comparison to your risk of dying of rabies. And so you are definitely going to go ahead and get the vaccine. I see. Okay. So this is not the gun of vaccine. You just give everybody because there are side effects. But if you've been exposed, then it's definitely a gamble worth taking. Yes, right. So between the costs and the potential side effects, we don't want to go and vaccinate everyone, especially because in the United States, most of us probably are not going to encounter a rabbit animal. So it seems not worth the risk. But for people in risky professions, it might be. So I was surprised by what you said earlier about exposure. Like just going for a

hike in a cave where there are bats that have rabies might be enough, like aerosolized. I thought you had to get bitten by some cartoon animal. Yeah. Well, so let's take it. Take a break, and when we come back from the break, we'll go through the various ways that you can get infected by rabies. What do you do in the headlines don't explain what's happening inside of you? I'm Ben Higgins, and if you can hear me, is where culture meets the soul, a place for real conversation. Each episode, I sit down with people from all walks of life, celebrities, thinkers, and everyday folks, And we go deeper than the polished story.

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The thing I would say to my younger self is congratulations. You get to marry Priyanka Chopra Jonas. And also, you know, your daughter is incredible. That's beautiful, man. Yeah. Thank you. That's so beautiful. I can see that got you a little.

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So tell us, Kelly, how does one get exposed to rabies? What do we have to watch out for, spalunkers and potholers alike? Well, the most common way, let's start with the most common way that you get exposed to rabies. through bites and scratches from rabbit animals. And in the United States, the most common way you're going to get exposed

to a bite or a scratch from a rabbit animal is by interacting with a bat. And so if you are in the sort of unlucky situation where a bat accidentally ends up in your house and you, that bat bites you when it's trying to get out or you wake up in the middle of the night and there's a bat in your room. What, Kelly, you can't just drop that.

That has happened to me. What? I know. I didn't know at the time, but you might, in those situations, might want to call a medical professional to be like, I found a bat in my room. I was listening to a podcast of people who are studying for their medical boards. And they noted that in that instance, you're supposed to give people vaccines for rabies because you can't be sure they didn't get bitten while they were sleeping. And I was like, oh, man, I didn't call anyone when that happened. I just like opened the window and shooed the bat out. But anyway, I'm still here. So that's good news. Does the fact that that happen? Is that the origin of, like, vampire myths? You know, like vampires fly in on the wings of a bat and bite you and then fly out again? Could be, but there are also like vampire bats that actually suck human blood when they have trouble getting access to other mammals. Oh, boy. I'm guessing that's. So you could wake up in the middle of night with a bat on your face or what else?

But we hope not. But you could also. So if that animal bites you, it's saliva gets into your body. And that's one way that the rabies. virus can get into you. Also, if an animal scratches you, you know, maybe they like licked their hand and then they scratch you and that gets the virus in your body, bats, skunks, raccoons, and foxes, which we talked about already in the United States. Those are animals that are most frequently found to have rabies. That doesn't mean that most of those animals in the wild have rabies. But in the United States, the animals that are most likely to have rabies are those four kinds of animals. And is rabies a kind of virus that doesn't last very long in saliva outside the body? Like, if the bat spits on a rock and then you lick that rock like a week later, are you okay?

Or is that rock like dangerous forever? Yeah, right. That is a question only, Daniel would ask. And that is, and you would probably be fine. And I'm under the impression that that is why I was told I didn't need to get a rabies vaccine when I picked up that dead bat. I think they were like, that bat's probably been long dead. You're probably fine. Fascinating.

It's amazing to me when viruses are so fragile and yet so able to spread anyway. It's incredible. It is. It is. And I just want to really highlight here, I am not a medical doctor. So if you're like, oh, Kelly said that that bat had been dead for a while that she touched. So I don't need to call the doctor. Always call the doctor. If you have any question about rabies, if you've been exposed to anything that puts you at risk of rabies, call your doctor. And I don't suggest licking any rocks. I'm also not a medical professional. Yeah, yeah. No, actually, you should probably never do anything, Daniel suggests. It's just a bad idea. I keep telling my kids that also. Yeah, yeah. Well, so if you live in Africa,

and Asia, you're most likely to get rabies from dog bites. People encounter dogs a lot. There's in a lot of countries, there's not good programs to regularly vaccinate dogs. And unfortunately, the majority of the bites happen to children who just want to pet a dog and then they get bit. Oh. I know. And so, yeah, so saliva from rabbit animals is the most common way. Now, it's worth noting that livestock animals like horses can also get rabies. And so you want to be careful and vaccinate as many animals as you're able to. Right. Very rarely the virus can be aerosolized for short periods of time.

And so that's why, you know, if you're spulunking or potholding in a cave and there's a bunch of bats and there's not a lot of sunlight in there. So sunlight is something that kills the rabies virus pretty quickly. You might be able to breathe in some of the rabies virus. And that is why sometimes spalunkers will get vaccinated or if they're going into an area with a lot of bats and they're worried they're going to get bit, then they'll get vaccinated as well. and a very rare way that does sometimes result in rabies is organ transplants if it was missed that a donor had rabies and then you can transmit it that way. Again, very rare. We talked about that in the opening. So there's no way to get rabies by like listening to a podcast about rabies.

Our listeners are safe. That's right. That's right. And you know, I actually, I feel like the more you learn about this kind of stuff, like yes, it's scary initially. But once you understand how it's transmitted, you can say, okay, I know what I need to worry about. and then I know when I need to call a medical professional. Yes, I still worry because I am me, but I feel like, you know, the scope of my worrying has narrowed a little bit because now I understand when I need to worry and why I need to worry,

and I feel like that gives me a little bit of control over the situation. Yeah, although, you know, statistics doesn't help anxiety. I mean, you can look at the numbers and be like, well, on average, that's pretty rare. It doesn't happen to very many people, these terrible scenarios, et cetera, et cetera. On the other hand, you're like, yeah, but there are 10 people out there who do die. of rabies every year. And those are real people who also look to the numbers. And they were like, yeah, I'll probably be fine.

So the sort of two ways to look at it, you know, from a public health perspective on average. And then also from the like, am I that one outlier case perspective, which is the one I always use as a warrior. Yeah, okay. I do see your point. But like, so in the intro, we talked about a guy who got scratched by a skunk and bled. Presumably what he thought was, it's just a scratch. I probably didn't get bit. And I think this skunk was just trying to eat the kitten.

and wasn't actually rabid. And so they made some choices that if you knew enough about rabies or if you were enough of a worrier, could have caused that person to have made a different decision, to at least call the doctor and been like, I don't know, what do you think? I got scratched by a skunk that was angry and was willing to approach me to try to eat a kitten.

What would you do? I suspect that doctor would have said, we're going to go ahead and give you some shots because rabies is 100% fatal, so let's not take any risks. Yeah. Although if you are a warrior and you want to be informed, by statistics, as you just suggested, then you would be shocked at like how dangerous it is to

drive anywhere. And you should probably just never get in a car and how dangerous household accidents are. So you shouldn't, for example, try to do your kitchen by yourself. But we don't want Kelly to become a shut-in. So we're going to talk about what happens once the virus gets in your body. Daniel, what are you trying to do here? I'm just saying statistics-informed decisions are not the way we live our lives. Yeah, you're right. You're right. But anyway, tell us. is about the microbiology here. What happens when the virus gets in your body, Kelly? All right. So the virus gets in your body and it gets into your muscle tissue. And what we've talked about how viruses replicate, they essentially hijack the machinery inside your cell and they tell

these cell that it needs to start replicating the virus's genetic material and start making proteins for the virus. So it essentially, the cell becomes like a little factory that starts making more viruses. And then it spits the viruses out and the viruses go out to infect more cells. So that's generally how viruses work. If this sounds familiar to you reminiscent of how like computer viruses work, that's not an accident. That's why they call computer viruses viruses, not the other way around. Biological viruses didn't steal this idea from hackers. Yes, and keep that in your head because we're going to come back to that comparison a little bit later.

All right, so it starts by getting into like muscle tissue near the site of the bite. And for reasons we don't totally understand, it has the period where it replicates sort of slowly in those muscle tissues. And thank goodness for that, because that means there's a period where we can sort of get a leg up on the virus. And this is why we're able to give people a vaccine after they get bitten that can still save their life. And this is another part of why we don't need to mass vaccinate everybody because it still works if you just give it to someone afterwards, which doesn't work quite as well with some other things that we vaccinate against. That seems pretty unusual, right? In almost all cases, you have to vaccinate first for it to take effect, right?

Yeah, no, we are amazingly lucky that this virus has this period where it, like, sort of sluggishly replicates in muscles for a while before it starts heading for the nervous system. But eventually it will start finding nervous system cells, and it will start following nerves to your spinal cord, and then start moving up to your brain. And when it starts getting towards its final location, you are going to start getting symptoms like fever, flu-like stuff, gastrointestinal symptoms. and sort of eerily, the location that you got bit will start like tingling or having a prickly sensation. And the reason that's eerie is that this is usually happening about two months after your exposure to the virus. So that site has like long since healed. And now all of a sudden you're starting to feel tingling there again. By the time you start having these symptoms, which again, like take two months for the virus to go from that bite site up to the point where, you know, essentially it's too late.

When you start getting those symptoms, there's more or less no way to stop the virus at that point. It's in your central nervous system and we don't have good treatments for it. At that point, rabies enters one of two forms. The furious form, which is about 80% of the cases, average survival time for this is about six days. Symptoms include like you kind of come in and out of consciousness. Sort of strangely, you become very afraid of water. So this is called hydrophobia. there are some videos online that I've got to admit,

I don't recommend looking up. I watched them once a couple years ago, and they're just incredibly upsetting to watch. But someone will try to take a drink of water because they're very thirsty, but they'll start having these like gagging reflexes, and it's like they're really afraid of the water, and they kind of can't figure out why.

It's like they're being, you know, like they've been hijacked, which essentially, you know, their brains have been. They start to hallucinate. And so help me understand what's happening here. This is all due to, to brain inflammation as the immune system responds to the rabies, or is this something rabies is doing to your brain directly? Yeah. So one of the interesting things about doing the research for this is that places like the World Health Organization say that there's a bunch of inflammation in the brain and that death occurs due to cardio respiratory arrest and, you know, you go into coma and essentially things shut down.

But other sources that I read were like there's surprisingly little inflammation happening in some of these cases. And so we seem a little bit confused. It looks like there's, or maybe not confused, but maybe there's a couple different ways that rabies can lead to death. It seems like there's a couple different competing hypotheses. It might depend on exactly what rabies is doing. It seems to take a couple different forms

and maybe it depends on what part of the brain the rabies ends up in. And in just a second, we're going to talk about a hypothesis that relies on there not being inflammation in the brain. So hold that thought for just a second. We will circle back to that. There's another form of rabies that happens about 20% of the time called paralytic. We're essentially starting at the scratch or bite site, the muscles start to become essentially paralyzed,

and that gradually spreads over the course of the body, and over about 11 days, the person tends to go into a coma and they die. This form tends to be misdiagnosed as a bunch of other things, so it might be underreported. But one way or another, a rabies death is really an unpleasant death, and we don't. have a really good way of treating people once symptoms start showing. But you may remember around 2004, a long time ago, there was in the news this Milwaukee protocol where a young girl who started showing symptoms of rabies was brought back from rabies. Do you remember hearing about this? No, tell me. Okay, so there was this girl who was at church and there was a bat flying around the church and it like was trying to get out the window, but it couldn't get out the window. I think

somebody hit it with a broom and it kind of fell down and the girl was trying to help. And so she, like, picked it up and kind of tried to fling it out the window and it bit her on the way out. But she didn't think anything of it. She didn't end up going to see a medical professional to get the rabies vaccine or anything. And, like, weeks later, she started, like, going down the tube. You know, all of your stories here, which aren't very dramatic are also substantiating a lot of mythology. You got, like, bats in bedrooms. Now you've got bats in Belfreys.

Like, maybe these cartoons were accurate. I don't know. Maybe. So what happened to this girl? Yeah. So she started showing a bunch of symptoms and the doctors just, like, could not figure out what was happening. And her mom at one point, like, you know, she was having a chat with the pediatrician. And her mom thought to mention, like, maybe it was that bat.

There was a bat that bit her. And I guess the pediatrician, like, just went pale when the mom said something about, like, oh, there was the bat that bit her. And the pediatrician was like, I'll be right back and made a phone call. And it was confirmed pretty soon after that it was. was rabies. And I know. And so they talked to this other doctor and I listened to an interview with the doctor and the doctor was like, okay, so while we were waiting for the results, I started going through a bunch of case reports for rabies. And there were a bunch of folks who were saying

that actually, surprisingly, a bunch of brains didn't show evidence of massive inflammation. The brains looked pretty good, even in people who were dead. So if you do an autopsy, it was kind of amazing how good the brain looked. And so there were some folks who were guessing that actually actually what was happening wasn't that the virus was like smashing the brain to pieces. Like, you know, I know the brain gets compared to a computer a lot and that metaphor falls down in a lot of ways. But we're going to go with it here. We're going to go with the computer and the virus metaphor. You know, it's not like the virus is smashing the computer with a bat and totally destroying it.

It's more like the virus is messing up the way the computer communicates with the different parts of the computer. And it's sort of messing up the way that it, you know, runs. And so what if you could essentially put somebody on life support to get them through a period where the immune system has a chance to catch up? Because some other autopsies found that there wasn't a lot of virus left in the brain, which suggested that the immune system was starting to catch up. But it just didn't have enough time. Oh, interesting. If you could get someone through, then, you know, maybe their immune system would catch up and they'd be okay. So they ended up putting this girl in a chemical induced coma and they put her on life support.

So her brain didn't have to worry about, you know, breathing or, you know, making her heartbeat or anything like that that. That was all done with machines. And amazingly, she lived. How does going into a coma help the immune system catch up? Why does the coma slow down the virus, but not the immune system? As far as I understand it, it's not that it's slowing anything down. It's just that the brain no longer has to worry about keeping the girl. alive. That's all being done by a machine. And so even if the brain is no longer like communicating

like it's supposed to, that's okay. Machines are taking care of all of that. So the immune system can just have the time that it needs to catch up. Oh, I see. The machines are playing the role of the brain until the brain is cleared of the virus. And without the virus, the brain will start acting normal again. And I guess his biggest fear was that she might end up with like Lockton's syndrome where she would sort of never quite be the same again or might never be able to communicate again, but she'd still be kind of locked in inside of there. But she ended up making an almost complete recovery. Wow. And so this was heralded as maybe we finally figured out a way to save people from rabies. And this made the news and was absolutely huge. But in the approximately

20 years since... Here comes Kelly's wet blanket. Yeah, I know. Of course, right. How could it be any other way? Loads of attempts have been made using this protocol. And now you see papers called things like the demise of the Milwaukee protocol because it doesn't seem to work in most cases. And it looks like the girl for which this worked, her immune system had started making some antibodies to rabies pretty early on. And we're not quite sure why it looks like maybe there's some variability. Some people, I don't know, maybe she got exposed to something,

rabies-ish early in her life. Like there's some subset of people who just seem to be able to mount a quick response. And maybe she just was one of those people and putting her on life support might have given her a little bit of an edge. But it looks like it just doesn't help the majority of people. And so it's possible that this protocol

takes the probability of death once symptoms for rabies start and brings it from 100% to like 99.5%. And I guess I'll be honest, if my kids got rabies and they were like, what do you think about going to extraordinary measures to increase their probability by 0.5 percent, I'd be like, yes. Smash that button. Yeah, I don't have to think about that. Let's do it. But, you know, the problem is,

you know, this is going to come up like maybe 10 times a year in the United States. And for those families, no doubt, you know, that would be important to have some options. But in areas, you know, the areas where you're getting those 60,000 cases of rabies death, it's not really feasible to do these kind of procedures. It's not even feasible in a lot of cases to have vaccine available for these people. And so, you know, I think if in general we're worried about trying to reduce the number of people who die globally from this disease, what we want to be focusing on is getting vaccines, you know, affordable and distributed throughout the world. So there's some people still working on tinkering with this protocol. Hopefully this can be used to bring the numbers of rabies deaths

to zero. But there's a lot of people who don't believe in this technique anymore. And Kelly has wet-blanketed her way through segment two. And it is time for a break. And when we come back, we'll talk about the history of the rabies vaccine. What do you do in the headlines don't explain what's happening inside of you? I'm Ben Higgins. And if you can hear me, is where culture meets the soul, a place for real conversation. Each episode, I sit down with people from all walks of life, celebrities, thinkers, and everyday folks, and we go deeper than the polished story. We talk about what drives us, what shapes us, and what gives us hope. We get honest about the big stuff, identity when you don't recognize yourself anymore, loss that changes you, purpose when success isn't enough, peace when your mind won't slow down, faith when it's complicated.

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I can see that got you a little. Yeah, for sure. Our daughter, she came to the world under sort of very intense circumstances, which I'd not really talked about ever. Growing up on Disney in front of a million. How did that shape your sense of self? I went blank. I hit a bad note, and then I couldn't kind of recover.

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Right. Thanks, honey, bear. Because remember, only you can prevent wildfires. Brought to you by the USDA Forest Service, your state forester, and the Ad Council. All right, we're back, and we're talking about rabies today. Kelly, we ended the last segment with a little bit of a wet blanket about the prospects for surviving rabies. So let's make everybody feel good by talking about

another glorious story of vaccine development, science in and... action-saving lives. How did this all happen? When did we get started trying to make a vaccine against rabies? Okay. Yay science. All right. So around the early 1800s, we started to figure out that saliva was important for transmitting the virus from organism to organism. And that was important because that meant we could start keeping this virus in labs and in lab animals. And if you are not comfortable with animal research, you might want to skip the last part of this episode. So Louis Pasteur starts working in his lab in the 1880. and they decide that they're going to tackle a rabies vaccine.

They had already developed two different vaccines. One was for foul cholera. I didn't realize that chickens got cholera. But maybe that's because we've got a vaccine for it now. And another for anthrax. So there were some other vaccines. They had experience with that. And at the same time, Emil Rue,

do you know how to say that, Daniel? I think you said that correctly, yes. Nice. All right. Emil Rue had developed a technique for inoculating dogs with rabies. Did it start with butter and flour all mixed together into a thick sauce? That was a food joke, of course.

A delicious food joke. Everything delicious starts with a rue. That's what I learned. Yeah. No, I'm not going to go into too many details because what it involved was much less appetizing than that. But he found a way to keep a series of animals with rabies in the lab and a technique for starting to dry up. out the virus. As you noted earlier, if the virus dries out, it sort of stops being able to infect people. And actually, we had a series of really great questions from the extraordinaries where

they sent us emails and they're like, well, in the polio episode, you were saying that there was a live virus version and a dead virus version. But then in another episode, you told us that viruses aren't even alive. So what do you mean by that? Good question. Yeah, such a fantastic question. Got me to rethink, you know, the way I was explaining it and the way it gets explained. in like the, you know, literature in general. And so I think essentially what it means is like viruses are able to infect you, but if you mess them up a little bit, they lose some function that allows them to infect you. And one way that you can mess up the rabies virus is by drying it out.

And whether we understand what's happened to the virus or not, once you've dried it out a little bit, something that it was able to do before, it now can't do. so it can't complete the process of getting into one of your cells, forcing your cells to make copies of it, and then getting out of the cells so that it can go and infect additional cells. Something about that no longer works when it gets dried out. But the virus still looks virus enough. Like enough of it is still sort of like present to be recognizable by your immune system.

So your immune system can produce antibodies so that the next time it sees it, it can attack it. Does that make sense? Yeah, that makes sense. Okay. So Emil Rue had figured out how you can keep animals in the lab with rabies and how you can start drying out parts of these animals after you euthanize them. They call it attenuating the virus.

So essentially start making it so that the virus can't infect people as well anymore. And I mentioned this just because Pasteur often seems to get credit for like coming up with the rabies vaccine as though nobody had done any prior work at all. But just like just about all scientific advances, he was building on. the work that other people were doing at the time. Right. Okay, so Pasteur gets to work, and he starts working in rabbits because working with rabid dogs is probably absolutely petrifying, and working with rabid rabbits is probably much less

petrifying. And so he creates a series of rabbits that have rabies. He works on this system where essentially he takes out the rabbit's nervous systems. He dries them out for different lengths of time, and now he essentially has virus that has been inactivated because he has the nervous system cells that the rabbit had, and he has dried them out to kill the virus. And how does a rabbit react? I mean, anybody who has seen Monty Python, for example, knows to be terrified. Right, that they can jump at your neck and they know where the jugular is, and you're like, ah! Is that also medically accurate?

Yeah, probably. Yeah, and, you know, the way the night was able to survive with, like, no limbs. Yeah. That's what Pasteur looked like when the experiments were done. I would love to have been a science consultant for Monty Python. Oh my gosh. Me too. Me too. I read a variety of different sources and I did not find descriptions of how the rabbits were behaving.

I think they were much less interested in rabbit behavior and much more interested in just accessing something they could use for a vaccine. Sure. And so they actually were able to show that if you gave a dog some of this material from the rabbits, that had been dried out, and then you exposed the dog to rabies, a dog would not get rabies. And so they were like, holy cow, this vaccine thing seems to be working. This works in dogs. But they were not ready to start testing it in people. In June of 1885, a child who was already starting to show signs of rabies, which we've already said,

it's too late at that point, was brought in, they tried to give her the vaccine, she passed away. That didn't work. That wasn't a great sign, but they kept doing the work. And then a little bit later in 1885, a boy named Joseph Meister came in. He was a nine-year-old boy. He was bit by a rabid dog a bunch of times, like more than 10 times. This kid had initially been brought to Emil Rue, who we talked about a little bit earlier. And Emil was like, I do not feel comfortable giving this kiddo the vaccine.

He wasn't 100% clear about his reasons, but based on what he wrote in other places, we think that it's because he was like, look, I've tested it in dogs. my vaccine seems pretty good in dogs, but I just don't feel comfortable giving it to people yet. It could be way too dangerous. Yeah. That's a terrifying decision to have to make. Yes, absolutely, right?

Because you know if this kid was actually bitten by a rabid dog, you might be the only one who can save his life. But if he was just bitten by some dog that's a jerk, you might kill him with your vaccine. Oh, boy. And so he passed, but Pasteur's lab decided to go for it. Pasteur was a chemist, so he couldn't do the injection. But his colleague, Jacques José,

Grancher, why couldn't it just be people with boring English names that make scientific advances? I don't know, but my apologies to the French-speaking world. Anyway, he administered the rabies vaccine they had been working on, and then he gave this kid 12 additional doses that had a vaccine that had been dried for less and less time. So essentially, he gave him stronger and stronger versions of the virus each time. And this kid survived. Oh. He's the first person we know of to survive being exposed to rabies, get a vaccine, and now he lives, which is amazing. And then they pulled this trick off again a little bit later with a kid who was a shepherd.

Around at this point, they also had the first what we call prophylactic vaccine, which is where you get a vaccine before you get exposed. And this was essentially because while they were administering the vaccine, somebody accidentally injected themselves with the vaccine. And they were like, well, now we're going to see how that goes. I guess now we know about that. Accidental experiment. That's right. But that turned out okay. And so that was the start of our vaccine procedure with rabies.

And then a bunch of labs around the world came to see how this worked. And they started growing rabbits in their labs and trying this procedure. And then the rabies vaccine, you know, a bunch of different labs popped up around the world that produced these rabies vaccines. And that's how it started. My favorite thing is when science. can develop a treatment that helps save children's lives. You know, like how many children were bitten by dogs or scratched by dogs and then died a horrible, painful, excruciating death of rabies?

Like, any time when we can reduce childhood suffering, yay science. Yes, and that's part of like why this story also makes me so upset, because there are children dying around the world in the tens of thousands. Yeah. That shouldn't be because science has the solution. Yeah. But we haven't found a way to get them access to it. It's a political or a financial or an engineering issue.

Yeah, right. And that stinks when science has the answer and it's not getting to them. So let's go ahead and talk real quick about what happens today. We talked about how if you have a job where you know you're going to get exposed regularly to animals that might have rabies, you can get the vaccine ahead of time. So the vaccine is grown up in cell cultures. So you don't need like whole humans. We just have figured out how to keep some subsubes. of human cells alive in like a petri dish or some, you know, chicken embryos alive. We grow up the virus in there.

Right. We extract the virus. We kill it. And then you get that vaccine. That starts giving you some immunity. Then if you subsequently get exposed to rabies, you'll get some boosters. Wait, I just realized, I didn't understand something basic. When my dog gets a rabies vaccine, it's not the same vaccine as I get, is it?

Is there a human in a dog version or is it the same thing? I did not do extra research on the dog version. I do know that there's a couple different versions of vaccines. So, for example, sometimes if there's a lot of rabies in a wild population, they will put some vaccines in food and essentially drop the food from planes and like feed coyotes. And that is a totally different version than what humans get because it's way less regulated. And so I know that depending on what animal the vaccine is getting, there's different regulations. and so they can give different kinds of vaccines. But the same principle should apply, right?

That if you have this weakened vaccine, it should help a dog's immune system or a human's immune system, even if those immune systems and the biology are different. Yeah, I mean, they might grow it up in dog cell cultures rather than human cell cultures so that you don't get, like, allergic reactions or something, but probably the idea is pretty similar. But again, I want to reiterate,

I didn't actually research how those vaccines are made. I was focusing on human stuff for this episode. Okay, so if you're a veterinarian, you got your vaccines ahead of time, then you get bit by a rabid cat. You'll get a couple extra vaccines after you know you've gotten bitten just to boost your immune system.

And that is almost 100% effective and you are very unlikely to die from rabies in that situation, which is absolutely amazing. Yay, science. Okay, if you have never gotten a rabies vaccine before, we do something a little bit different. And this is pretty awesome, I think.

So we have something called rabies immune globulin. So essentially what they do is they, immunize either people or horses with the rabies vaccine. Okay. And then they draw blood and they extract the plasma. We've talked about plasma before when we were talking about making synthetic blood and stuff. In the plasma, you have antibodies.

We've talked about antibodies. They bind to something on, in this case, the rabies virus and they inactivate it. For example, maybe they make it so that the virus can no longer bind to a muscle cell and get into it. And so they essentially make it so that the virus can't do what it needs to do to replicate. Right. And they neutralize it in some way. And so they take out the antibodies that the human or horse immune system made.

And then they inject that into you near the bite site. So essentially, you outsourced the initial immune response from some other organism. Right. And that gives you a head start. So while your immune system is responding to the vaccine and is trying to make its own research, response to rabies, you're borrowing someone else's immune response to give you a head start. You know, maybe that will do the trick. Maybe that will bind to all of the viruses that are trying to get into muscles initially. And then just in case, you know, your body will start making your

own antibodies. And you'll get a series of, I think it's something like three vaccines. It used to be you'd get a bunch of vaccines in like your abdominal region. And I think there's a little bit of folklore where people used to think it was like 20 vaccines that all had to go through your abdominal into your stomach and it was super painful. And it wasn't like that. Like it was painful. It was like in your sort of tummy region, but it didn't need to go like into your stomach

through your abdominal wall. But now it is way less uncomfortable. It's like two or three shots, usually in like the muscle in your arm. We also have like a version that goes just like right under your skin now. Way less painful. Yes, the next day you probably feel pretty sore, especially after the third shot.

But you're probably not going to die. of rabies. So yay. Definitely worth it. Definitely worth it. Yeah. So those are our treatments. But so in the United States, about 100,000 people need to get those series of shots after they get exposed to an animal that might be rabid.

But the main thing that we do that protects us is we have this system where each state has a series of laws where you have to vaccinate your dogs and your cats. And that's the main thing that protects us because globally, most of the people who get bit are getting bit by dogs.

Not by bats in their bedroom. Not by bats in their bedroom. Yeah, dogs are a much bigger risk. And so if we could just have similar programs where everybody had to vaccinate their dogs and maybe there's some cultural problems, you know, cultural difficulties, hurdles to get across. But I think a lot of it is like having the infrastructure, the ability to get the vaccines there, the ability to like make sure that you've got records so that you're giving the vaccines every single year. But if you could get that stuff in place, we could have a lot fewer deaths. and the few times that people do get bit by rabbit animals, if you could have the human vaccines available,

we wouldn't have to have about 60,000 people every year dying from this horrible disease. Yeah, let's hope that the folks in charge of that, figure it out. Yeah, I hope so. So should we end for anybody who I know we've discussed statistics, isn't how we live our lives, but do we want to end on a couple notes about how to try to prevent rabies in your life? Yeah, exactly.

Other than vaccinating your pets and closing the windows in your bedroom, what should you do to avoid rabies? All right, well, so I'll note, this was a little bit surprising. You're supposed to vaccinate your cats and dogs, also your ferrets. There are some places that have rules about vaccinating ferrets.

You can also vaccinate things like horses. My recommendation, anything you can vaccinate, vaccinate. Keep your pets from interacting with wild animals. So, you know, maybe don't just let your animals run wild. I am mostly talking to me. I live on a farm. Sometimes I just let my dog out. And I'm like, oh, have fun.

see you in a few hours. Maybe I should be more careful about that. Report stray animals to local authorities. You shouldn't touch wild animals. Like if you see a skunk that looks sick, call animal control or something. Don't touch them on your own. That poor animal could be rabid. They could give it to you. Keep bats out of your house. Make sure you have like screens on your windows if possible. If you are going to do a high risk activity like spulunking in a cave that has a lot of bats, consider trying to get the vaccine preventatively. You can talk to your doctor. and if you think you've been exposed to the rabies virus, wash the area thoroughly and then immediately go seek medical attention. And if you are ever unsure, call a doctor or go see a doctor.

For me, I think I'm supposed to call my local poison control center for advice. But like, call 911, figure out who you have to talk to. Don't worry about, you know, looking silly or something. This is a serious disease. Don't mess around. That's right. Don't worry about finishing this podcast before you call your doctor. Pause it right now.

and call your doctor. Yes, right. And Kelly is not a medical doctor. Kelly is not the kind of doctor that most people recognize as being a doctor. When they ask, is there a doctor on the plane? They don't mean me. So don't take medical advice from me. Talk to a medical doctor.

But thank you, Kelly, for the tour of the history of rabies. And thank you, Gertit, for sending us your curious question. If there are things you want to hear a deep dive about, please don't hesitate to write to us. We want to hear from you. Questions at Daniel and Kelly. Thanks, everyone. Have a good day. Avoid skunks. Daniel and Kelly's Extraordinary Universe is produced by IHeartRadio. We would love to hear from you. We really would. We want to know what questions you have about this extraordinary universe.

We want to know your thoughts on recent shows, suggestions for future shows. If you contact us, we will get back to you. We really mean it. We answer every message. Email us at Questions at Daniel and Kelly.org. Or you can find us on social media. We have accounts on X, Instagram, Blue Sky, and on all of those platforms, you can find us at D&K Universe. Don't be shy.

Write to us. You can scroll the headlines all day and still feel empty. I'm Ben Higgins, and if you can hear me, is where culture meets the soul. Honest conversations about identity, loss, purpose, peace, faith, and everything in between. celebrities, thinkers, everyday people, some have answers.

Most are still figuring it out. And if you've ever felt like there has to be more to the story, this show is for you. Listen to if you can hear me on my IHeart radio app, Apple Podcasts, or wherever you get your podcast. Over the last couple years, didn't we learn that the folding chair was invented by black people because of what happened in Alabama? This Black History Month, the podcast, Selective Ignorance with Mandy B, unpacks black history and culture with comedy, clarity, and conversations that shake the status quo. The Crown Act in New York was signed in July of 2019, and that is a bill that was passed to prohibit discrimination based on hair styles associated with race. To hear this and more, listen to Selective Ignorance with Mandy B from the Black Effect Podcast Network on the IHeartRadio app, Apple Podcasts, or wherever you get your podcast.

Hey, I'm Jay Shetty, host of the unpurposed podcast. On a recent episode, I sat down with Nick Jonas, singer, songwriter, actor and global superstar. I went blank. I hit a bad note, then I couldn't kind of recover. And I built up this idea that music and being musician was my whole identity. I had to sort of relearn who I was if you took this thing away.

Who am I? Listen to On Purpose with Jay Chetty on the IHart Radio app, Apple Podcasts, or wherever you get your podcasts. When segregation was a law, one mysterious black club owner, Charlie Fitzgerald, had his own rules. segregation and the day integration at night.

It was like stepping on another world. Was he a businessman? A criminal. A hero. Charlie was an example of power. They had to crush him. Charlie's Place from Atlas Obscura and visit Myrtle Beach. Listen to Charlie's Place on the IHeart Radio app, Apple Podcasts, or wherever you get your podcast.

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