It’s also a death “no-one should go through,” according to Dr. Ramesh Masthi, a physician in Bengaluru, the capital of Karnataka. The rabies virus is uniquely deadly: in the absence of vaccination, it has a 100% fatality rate. “It’s a very painful death, a very tragic death. The person is almost conscious until the time of death,” says Masthi, who specialises in human rabies. Signs of infection usually show up within 90 days of exposure, but can take as long as 2 years. In almost every case, exposure is an animal bite, which introduces the virus via infected saliva to the human nervous system. Once there, it can travel unobstructed up the nerves towards the brain. By the time a patient exhibits the classical symptom of hydrophobia, he or she has only a matter of days left to live, usually spent under heavy sedation to control the renowned “rabid” aggression.
It’s a bleak prospect with one saving grace: the vaccines are good. Though individuals with a high risk of exposure, like Yale, receive the human vaccine preventively, most people are immunised against rabies as part of a course of post-exposure prophylaxis (PEP). Correctly and rapidly administered PEP – which includes wound-care and rabies immunoglobulins as well the vaccine – is close to 100% effective. Where there is adequate awareness and access to PEP, rabies deaths are vanishingly unlikely, explains Professor Dr. MK Sudarshan, the founding president of the Association for Prevention and Control of Rabies in India (APCRI).
But access has taken a hit during the pandemic, says Sudarshan, over the phone from his home in Bengaluru. “This COVID-19 has superseded rabies for the last 11 months.” He should know: since April 2020, Sudarshan has led Karnataka’s technical advisory committee on COVID-19, work which has taken him away from the business of rabies control, but hasn’t quite stopped him from keeping a watchful eye out on his specialism. First came the lockdown, he says – a period in which problems of access may have been balanced by reduced exposure. “Then there was a wave of COVID pandemic, the hospitals were crowded and clinics were closed – doctors were not available. From March to October – this period was most disrupted for rabies prophylaxis.”
In Goa, Yale recalls a moment of fear that the spike in dog rabies cases could lead to a human case, bringing an end to the state’s zero-human-rabies streak. But each animal diagnosis presents its own opportunity to save human lives.
In February 2021, after a month without a positive diagnosis, the Mission Rabies team identified a rabid puppy in the town of Arambol. As they always do, the yellow-shirted Mission Rabies workers filtered out into the public, equipped with photos of the puppy and an urgent message: if you’ve been exposed, get vaccinated now. They’re thorough, says Yale. “We cannot have a human death. That’s my pep talk to my staff: you have to find everyone.”