We have a saying in our house: If you don’t want fur in your mouth, then stop kissing the dog. This isn’t an old colloquialism, like, “If you lie down with dogs, you’ll wake up with fleas.” It is a simple statement of fact. We have a furry dog and some of us just can’t stop kissing him.
Last week there was no fur in our mouths for four days. Last week, Nathan the border collie was caught up in a frightening rabies scare and was put under home quarantine. We were advised not to let him lick us and to wash our hands after contact. This left him understandably a bit more peevish than usual, and he has a high baseline for general peevishness even under ordinary circumstances.
Nathan attends an open-run dog day-care facility twice a week, part of our futile effort to occupy his lively mind and tire him enough that he hasn’t the energy to devise new stratagems and wiles for the destruction of our peace. Last week, we received notice that another dog who had been at the same facility in mid-July had contracted rabies and been euthanized. All dogs who visit the facility must have rabies shots, as had the dog that died. Suddenly, the city health and animal authorities were on high alert, dogs that had had contact with the sick dog were placed on home quarantine and revaccinated for rabies, and the staff who’d had contact with the sick animal began a complicated, unpleasant and relatively expensive series of shots as a precaution. Once the rabies virus is established in a dog or a human — usually through a bite or saliva that makes it into a scratch, into a wound or through the mucous membranes — it is usually fatal, and the way the disease progresses is terrifying.
After subsequent testing by the Centers for Disease Control and Prevention, it was determined that the first test of the afflicted dog was a false positive and the District Department of Health lifted the 45-day home quarantine. The past four days, however, have been a crash course in rabies, in viruses and in amateur epidemiology. It is a huge relief to know that our dog wasn’t in contact with the rabies virus, and our vacations are back on track. But it has been sobering, too, with lessons about how we relate to medical and scientific authorities, how we process risk, how we deal with uncertainty and unknowns, and how we might face up to a genuine public health scare.
We are at a particularly volatile moment in this country’s centuries-long debate about the proper role and competency of government. A prompt response to a public health scare — with notifications, tracing of contacts, and recommendations for prophylactic and other medical responses — is high among the things that government, and only government, can effectively do. But even while almost every sane person will be thankful that there are authorities watching out for things like rabies outbreaks, officials in charge of the problem will not necessarily be popular. Quarantines are a severe but necessary infringement on our liberties, and they test a fragile, odious but essential clause of the basic social contract: Our willingness to submit, on occasion, to authority.
We were told by our veterinarian to watch Nathan for signs of abnormal behavior. With rabies, the classic symptoms are aggression, fear of light and water, and excessive salivation; but they also include more general behavioral changes, such as irritability and over-excitability. If you’ve lived with a border collie, watching for signs of abnormal behavior is futile; they are a bundle of oddities, quirks and obsessions. Our dog invents new crazy every day. Even the ordinary morning routine is odd: He jumps in bed, licks my face until I get up, herds me downstairs with his snout and then, when I have my shoes on and the leash in hand, hides behind the table as if his morning walk is the last thing he will condescend to indulge. That happens reliably every morning, except when it doesn’t.
We are often delegated by authorities to monitor things. Doctors tell us, “Watch that, and if it gets bigger, call me.” Every day, on the Metro and other public places, we hear: If you see something, say something. Fear changes how we see and often makes us paranoid. When Nathan dreams, it sounds a bit as if he’s swallowed a sack of tiny wolves that are howling at the moon. One night it sounded more like muffled whale song. Was that an indication of yet another possible rabies indicator — a change in the tone of the bark?
Fear exacerbates the ugly in us. Were we being told everything? Should we get the human rabies prophylaxis? My doctor concurred with the other authorities and said there was no reason. The risk wasn’t zero, but it was very small. But it was easy to find enough bits and pieces of disconnected data on the Internet to wonder otherwise. After the first test for rabies came back positive, it looked as if there might be a bad batch of rabies vaccine, or that the vaccine isn’t as effective as we were led to believe (in fact, vaccines aren’t 100 percent effective, though mass vaccinations are highly effective at reducing risk throughout a population). We worked out several scenarios in which we might be infected: Nathan contracted the virus through saliva in his eyes or an open scratch we didn’t know about; he transmitted the virus to us during those morning face licks even though he wasn’t yet symptomatic with a disease that can have a long incubation time.
A veterinarian for the city reassured us that if our dog was vaccinated (he was) the risk of transmission was small, and as for all that dog kissing that goes on chez nous: “Rabies virus . . . only starts transmitting a few days before the clinical signs of rabies are displayed.” Working through the timing of when he was in contact with the sick dog, the days that had passed, along with the fact that he showed no signs of the disease, meant we didn’t need to be worried about our own risk.
But we worked through these timetables and risk factors a hundred times in our heads, at night in bed, during idle hours, and the distraction was immense. I talked myself into the disease and out of it, and wasn’t proud of an impulse I had and resisted several times: To head to the hospital and insist on a costly and unnecessary set of shots just to set my mind at ease.
In a serious pandemic, in a country full of people not just skeptical about scientific consensus but also deeply hostile to government authority, what chance is there that people will abide by basic public health mandates during an emergency? What if the Ebola virus scare of 2014 happened today and was managed from the White House by tweet? Even if you understand the idea of risk intellectually, the words “There’s a very low risk” aren’t comforting when it’s your health in the balance, which is one reason it is so difficult to contain costs in our medical system.
Throughout the whole scare, which is now over, Nathan was his usual peevish self, sublimely unaware of our anxiety, though we detected a bit of depression, perhaps because he wasn’t receiving his usual adoration. His ignorance of the things we were trying left him indifferent to the whole affair. That too, has public health implications. It may be easier to manage crises in states where the public doesn’t have ready access to information, and where individuals don’t feel empowered to think through the risk themselves.
There is a famous line of poetry by Alexander Pope that is almost always quoted out of context: “A little learning is a dangerous thing.” The following lines are: “Drink deep, or taste not the Pierian spring:/There shallow draughts intoxicate the brain/And drinking largely sobers us again.” It comes from his “Essay on Criticism,” essential reading for all critics, but also for everyone who wants to learn to think and judge things sensibly. It is a poem about wisdom, for which both modesty and independence of mind are essential. It also applies to how we approach science and medicine, which can be uncertain and subjective as well.
Nathan is drinking deeply and has been throughout the scare. He shows no signs at all of hydrophobia.