The Costs of Not Dying From Rabies

On Sept. 22, I collided with a bat while riding my bike near Montauk, N.Y. a little after 7 p.m. I’m talking about the winged mammal (I’ve had to specify this often. Is hooliganism on the rise?). It passed over my left hand and slapped my bare skin, just above my tank top’s neckline, and whipped around, likely stunned, or pinned by wind before falling to the pavement. So far, the cost of this incident totals over $16,600. Bills are still coming in.

I was too spooked to stop. I was on the last few miles of the annual bike ride my friends and I do. Our group had gradually separated, leaving me alone in the middle—the many-geared miles ahead, the single-geared miles behind. The final, rolling stretch of the Old Montauk Highway is eerily quiet after dusk, too far above the shoreline for any white noise. I heard only my tires, my breath, and maybe 30 yards later, another bat’s wings just inches from my right ear.

After a truncated celebration at the “Welcome to Montauk” sign, I stripped in front of a lamp at the Lido motel, where we had booked four rooms for the night and examined myself. There were no apparent bites or scratches, but the area was red, so my girlfriend called Animal Control in East Hampton (they were closed) while I scrubbed my nipples raw in the shower. I had a beer. I let Google do what it does best—horrify.

Here’s what I learned:

1. Bat contact often results in micro-abrasions—bites and scratches you can’t see. Rabies can be transmitted this way, but it’s rare.

2. About 1 in 100 bats have rabies.

3. Still, if you’ve made contact or even possibly made contact with a bat, you have 72 hours to begin a multi-course vaccination: rabies post-exposure prophylaxis (RPEP).

4. Because without RPEP, rabies is almost 100% fatal.

5. The alternative, a ketamine-induced coma called the Milwaukee protocol, has saved just 6 people (out of 41 or 42) that missed the RPEP window.

6. RPEP costs a flippin’ ton. This site, the first Google result for “cost of rabies vaccine,” offers a poor estimate of “anywhere from $2,000 to $7,000+ per person.”

7. If you’ve trapped or have access to the bat/animal, immediately get it tested. RPEP might be unnecessary. (In hindsight, bagging the bat would have only cost me a backpack: $42.)

On Monday, I called NYC’s Animal Bite Unit. They issued me a 9-digit bite/”hit” number, and referred the case to the city’s Bureau of Communicable Diseases, who, in turn, recommended RPEP.

Here, I had to confront a second problem. I’d been approved for health insurance (through my girlfriend’s employer) just days prior to the ride. Her employer would cover a percentage of the monthly health care costs, and I’d pay $325 a month for my part. Approval was retroactive to Sept. 1, but I didn’t have an insurance card yet to show care providers. Still unfamiliar with my policy and coverage, I wondered if I’d be dropped. If, through some loophole, I’d be left with the “$2,000 to 7,000+” tab. But ultimately: If I’d die.

Or worse. Back at the motel, my friend Kelsey had read her favorite rabies symptoms aloud. There was the obvious: hydrophobia, a paralysis of one’s swallowing muscles. Coupled with dehydration and throat spasms, hydrophobic patients can sound as if they’re barking. Then there was hypersexuality, an uncontrollable sex drive triggered by a patient’s swelling brain. I pictured myself dying, surrounded by family, a barking, compulsive masturbator.

So on Tuesday, 65 hours after exposure, I took a ferry ($4 each way. Worth it, should nausea assuage your fear of needles) to NYU-Langone for the Day Zero course of RPEP, a series of 6 injections: rabies vaccine in one shoulder, tetanus in the other, and “heat-treated rabies immunoglobulin” in each glute and quad. I passed out between the 5th and 6th shots—the ones in my ass.

Since you can’t make clinic appointments for the RPEP follow-up courses, I returned to the ER on Days 3, 7, and 14, and went through registration, triage—the whole bit—each time. (Helpful note: On Day Zero, a sympathetic doc gave me the ER lowdown: Avoid Mondays. Arrive at 9 a.m. to skip the shift change delays at 8 a.m., and if you must come after 4 p.m., triage is faster through the Urgent Care “next door.” I never found said Urgent Care, but I found many doors.)

One shot per follow-up course, for a total of 9. This is the bill for the Day Zero course of RPEP, which included both $1,200 for the ER visit and a $1,300 “patient surcharge.” The immunoglobulin alone counts for $12,000, half of which, again, went into my butt.

The Day 3 bill totaled $1,330. Kisses to Day 3’s nurse, Rose, who made no attempt at sincerity when she targeted my ass and winked, “It’s easier for me.” Day 7 totaled just $332. They’ve yet to send anything for Day 14. A few days ago, the Day Zero doctor billed me an additional $268 for an “emergency department visit.” The math is easy, the lesson hard. In short: the cost of RPEP is considerable, often compulsory, and yet another argument for health insurance. Even if I’m billed a co-pay for each ER visit, I’ll have saved a good $16,000.

 

Michael Dempster is from Tacoma.

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23 Comments / Post A Comment

olivia (#1,618)

Thank you for expounding on my worst nightmare. I’m never leaving the house again.

But I’m glad you’re okay and you have insurance!

lemonadefish (#3,296)

@olivia My upstairs neighbor was bitten by a bat that was laying in his dryer. You’re not even safe in your own home! (Trapped the bat, took it for testing, didn’t need shots.)

@olivia IN HIS DRYER?? Excuse me, I need to go home and never leave my bed again. Unless the bats are there too. My god.

Oh jesus. I went hiking two weeks ago and we encountered a bat on the trail in broad daylight. It was flying jerkily back and forth in the open space between the trees, and I don’t know if it was sick or just disoriented in the daytime. But my companions didn’t know about the rabies risk and were all set to merrily walk right under it if I hadn’t stopped them.

Is it wrong that I wish this would happen to Mitt and Paul (just the contact, not the rabies), just so they could see the bill?

@whateverlolawants Hahahahah you think Mitt Romney ever sees his bills?

@stuffisthings Well, that was the optimistic part. No.

My friend was jogging on a bike path in Boston and a bat flew into her face! They didn’t round up the bat for testing, but the doctor told her that since it didn’t break the skin, she didn’t need shots.

swirrlygrrl (#2,398)

Wow. I am horrified. I have a savings account with enough money to cover more than three months living expenses in case I am laid off….but it’s not enough to cover potential rabies exposure (in the US at least).

Blondsak (#2,299)

I contracted rabies from the family cat when I was three. No idea what the cost was for the treatment. I don’t recall the incident at all, but I do remember being completely terrified of getting my booster shots two years later (they used to treat the disease by poking needles into your stomach for days on end… gah).

blair (#1,962)

I want to option “The Milwaukee Protocol” as a bat-fueled action movie in the “Contagion” vein (no pun intended)

BadUncle (#449)

Please do a companion piece on the costs of not dying from a cobra bite.

themegnapkin (#444)

My friend and her husband had to go through this, after they discovered bats in their new house. Their doctor told them that the bats could be flying through their bedroom while they slept, and could have bitten them without their even waking up!

jquick (#3,730)

@themegnapkin Oh good God. Thanks, doc!

halluu (#2,526)

A bat fell out of a folded-up patio umbrella onto my shoulder a couple years ago. I was babysitting and had to physically hold the kids back from the angry, hissing creature that clawed its way across the patio table and took off. I am so glad that rabies didn’t cross my mind, because I am the world’s biggest hypochondriac and would have likely gone in for treatment. Clearly I didn’t die of rabies. I’m sorry for your ordeal!

probs (#296)

Suuuuucks. My sister had a bat land on her at night. As I recall, she had to get shots in her abdomen. Still freaks me out.

Caitlin (#2,601)

OK, I don’t know where this person is getting their information, and I wonder what NYU was thinking.

Short story: http://www.immunizationinfo.org/vaccines/rabies

The protocol for administration of the rabies vaccine has changed throughout the years as the technology has evolved, which is the reason that you still hear horror stories about having to get agonizing shots in the abdomen.

In 2002, I was bitten by a bat. Stupidly, I was rescuing it. After I proudly told my mother the next day what I had done (I was in college), I had to go to the doctor. It was within two days of the bite. I to get three shots in the upper arm (the “deltoids”) and was done.

That is it. That is ALL.

Exposure to bats is very common. Stories like these are HARMFUL because they discourage people from going to the doctor after an encounter with a bat. While “only” 1 in 100 bats have rabies, the bats that people tend to encounter have higher rates of rabies – that’s why people encounter them – the animals are sick and are not avoiding people like they should/usually do.

rayray (#2,604)

@Caitlin the link you posted confirms his story, not your 10yo experience.

Caitlin (#2,601)

Respectfully, I stand semi-corrected.

As per my previous link: “Previously unvaccinated people should receive the vaccine intramuscularly at 0, 3, 7, and 14 days. For adults the vaccine is given in the deltoid area…”

While this link:

http://www.mayoclinic.com/health/drug-information/DR601183/DSECTION=proper-use

states that the vaccine can also be given in the hip area, (something I admit that I did not know), I would like to state that my pain and discomfort (and that of many other people) is minimal. A story that presents a personal anecdote that insinuates that the person’s experience is typical, while describing it as a horrifying experience (so painful that he fainted) is misleading at best, given the near-urban-legend status that rabies vaccination now enjoys.

For those who are thinking of foregoing the treatment after a bat encounter, a Cape Cod resident was bit by a bat in his sleep and subsequently died of rabies last year.

Well, shoot. Last summer, I was awakened by something brushing against my toe in a way that seemed certain not to be my girlfriend, and found two bats doing loops around my small bedroom (the window screen was broken at the time). I just got up, trapped them in a bath towel one at a time (they flew right into it – it’s as if they were blind!), and tossed them out the window. Rabies never even occurred to me, so I went about my business and didn’t die. It’s like that cartoon where Bugs Bunny doesn’t fall down when he ought to because he “never studied the laws of gravity.”

beccasgonebatty (#6,946)

READ THIS IF YOU ARE SCARED TO GET THE VACCINATION

My mother and I were not actually bitten by a bat but because of the fear that we had possibly come in contact with the saliva my mother and I decided to get rabies shots (god only knows what the bill will be when it gets here as no one in the hospital could tell me when I asked and I asked everyone we encountered; no one had an answer) .

This guy is being DRAMATIC. I do NOT have a high tolerance for pain and I had to get four shots, one for immunoglobulin, then three others which the dosage depends on your weight (I’m 130 pounds, 5’2). The first did NOT even hurt and was given in the upper arm, the next two were in the butt and not pleasant but nothing horrible, like regular shots. The fourth was up higher on my butt and relatively painless for the most part. Then my mother and I have to go back for one shot on ’3 specific dates which will each be in the upper arm like the first.

It is NOT agonizing, as many want /lead you to believe. It really wasn’t bad. The worst part is the COST, I don’t even want to see our medical bills when they get here…

I guess maybe some of it depends on the person, but again, I have LOW pain tolerance and did quite well. My mom, who is very skinny, did fine also. Do NOT be afraid to be vaccinated. It is better safe than sorry, believe me, and not painful as a lot of others claim.

I’m going through this now and my experience is like the author’s. The bill for the first day in the ER (no tests, just sitting around waiting for my shots) is almost $14k. The shots themselves have not been more painful than any other shots, but the cost is shocking.

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