David E Bratt, MD

So what hap­pened next? It's 40 days since the first symp­toms of ChikV ap­peared and I've been OK for the last two days. OK? OK, but just. Not good but OK. It's been a tri­al, a hard six weeks.

Here are some ex­cerpts from my di­ary.

Day 7: Woke quite well. Stiff but not a sick stiff, more of a post-ex­er­cise stiff­ness, high waist, back-of-thighs-aching sort of thing. Head clear, very slight dizzi­ness, rash fad­ed 90 per cent with some itch­ing. Will of­fice to­day...Not bad, took two ibupro­fen, saw a cou­ple of kids quite com­fort­ably then came home and im­me­di­ate­ly col­lapsed on the bed.

Rash on and off itch­ing a lot tonight. Gen­er­alised stiff­ness when get­ting up.

Day 9: Woke up achy all over and itch­ing quite a bit. Not a bad day but very tired af­ter of­fice, came home and slept cou­ple hours and have lit­tle en­er­gy. Rash on and off but quite itchy. Head con­gest­ed, oc­ca­sion­al­ly light-head­ed, dizzy and nau­seous.

Day 12: Good night's sleep but still uri­nat­ing a lot at night. Good en­er­gy lev­el for once al­though head still feels con­gest­ed and light­ish. Stretched a cou­ple times dur­ing morn­ing walk around house with Madame, my pothong Box­er-Dober­man, and ac­tu­al­ly sweat­ed a bit and felt good. Itch still there. Bet­ter day.Saw kid­dies fair­ly well. Came home and did not have to sleep. Have not tak­en ibupro­fen for past 48 hours and this morn­ing took on­ly two parac­eta­mol be­fore of­fice.Itch­ing still in evening. Pig­ment­ed rash per­sists but not itchy.

14th day: Sun­day. Best day so far! Woke at 4.45, usu­al stiff­ness and nasal stuffi­ness, bit headachy, walked sa­van­nah and felt pret­ty good. Went out to see ba­by at 10 and did re­turn achy and not feel­ing well, so slept an hour or so and woke up the best I have felt so far. Did take two parac­eta­mol at 9 am but it is now 3.16 and feel­ing good, no headache, loose, rest­ed. Itchy rash gone, pig­ment­ed re­mains.

21st day: En­tire week have been hav­ing on-and-off feel­ings of im­mense weari­ness, low­er-back ache, light­headi­ness, nasal con­ges­tion and a de­sire to do noth­ing but lie down.Stom­ach rum­bling, bit ten­der. Times when I feel re­al­ly good and think, Aha! Over! Lasts min­utes, oc­ca­sion­al­ly hours, then re­laps­es. Move­ment seems to help.Still sleep­ing one to two hours per af­ter­noon, af­ter of­fice and keep wak­ing up with mild headache. But the worst thing is the ap­a­thy! No en­thu­si­asm for any­thing.

4th Tues­day, four weeks af­ter got chikun­gun­ya, woke this morn­ing un­able to straight­en up be­cause of pain in right low­er back and right heel. Move­ment and stretch­ing has helped the back pain but the heel still hurts nine hours lat­er. Stom­ach is al­so a bit queasy de­pend­ing on the food I eat, eg bread, dairy or cur­ry seem to make me feel nau­se­at­ed.How­ev­er for the first time since that Tues­day four weeks ago I feel quite en­er­getic and ready to work and came home at 3pm and do not feel to sleep. Def­i­nite­ly im­proved com­pared to a week ago. Or even 48 hours.

In 1983, Dr SW Brighton pub­lished a three-year fol­low-up of just over 100 doc­u­ment­ed cas­es of chikun­gun­ya in the South African Med­ical Jour­nal. His find­ings were alarm­ing. About 90 of the cas­es had re­cov­ered com­plete­ly. Of those 90, how­ev­er, some 35 had re­cov­ered with­in "a mat­ter of weeks." An­oth­er 40 or so "stat­ed they had re­cov­ered slow­ly over a pe­ri­od of up to a year." The re­main­der said the re­cov­ery pe­ri­od was two to three years!

These are the ones who "re­cov­ered"? More than half of the pa­tients took at least a year for body pains to re­solve!Age seemed to be a fac­tor in re­cov­ery. Most of those who re­cov­ered quick­ly were un­der the age of 17.What about the oth­ers who had not re­cov­ered? Four peo­ple con­tin­ued hav­ing "oc­ca­sion­al" stiff­ness of the joints of the wrist and knees. The youngest was 45 and the old­est 60. The stiff­ness ap­peared to be ex­ac­er­bat­ed by ex­er­cise. An­oth­er three had "con­stant" stiff­ness in sim­i­lar joints, es­pe­cial­ly in the morn­ing for the first hour or so. Their ages were 55, 60 and 65 years.

The last six peo­ple had per­sis­tent joint "pain." They were liv­ing with pain three years af­ter get­ting ChikV. All ex­cept one 16-year-old girl were over 50.

How are they now? I e-mailed the hos­pi­tal in South Africa to see if the good doc­tor was still there but have not re­ceived a re­ply.What seems to be clear is that ChikV is not a mere acute dis­ease, a nasty three-day fever with mus­cle and joint aches and an itchy rash. It has the po­ten­tial to be­come a chron­ic ill­ness. The fig­ures above sug­gest that around 60 per cent of peo­ple who get ChikV will con­tin­ue to suf­fer from joint pains for at least sev­er­al months and about ten per cent are in pain for years. If these fig­ures stand up, and there are around 1,000,000 cas­es in the Caribbean to­day, how will that im­pact on our economies?

Nov 11: First day since Oc­to­ber 7 that I have got up with­out pain and am walk­ing around not bent over, not even a bit, just some resid­ual very mi­nor and healthy sore­ness in low­er back from ex­er­cise (jog and walk Sa­van­nah 48 hours ago).Don't trust this ChikV though, let's see what to­mor­row brings.

Nov 13: Third day that I am al­most back to my­self, en­er­gy good, mi­nor pains in low­er back and heels from time to time, ie wak­ing up in morn­ing, get­ting up from desk af­ter long time sit­ting, get­ting out of car af­ter sit­ting in traf­fic jam.En­thu­si­asm for life is back.Is it over?