February 2015

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David Bratt is well known, not just as a paediatrician, but as a columnist and author. It was one of his columns which made me realize that the effects of the Chikungunya virus might be much more prolonged than I had thought, and that there was even the possibility that it might lead to chronic conditions, especially of an arthritic nature.

He had begun keeping notes on his experiences with ChikV, and I asked him if he would share it. Three months into it, he had this to say.

“Like many others, I am still suffering with musculo-skeletal pains and a rash. Every morning I get up stiffish and achy. I limp around for the first five to ten minutes (it depends) because of pain in my right heel. Some weeks ago it was my left heel. After about half an hour, the stiffness goes but the heel pain persists throughout the day, without the limp. Getting up from the desk after sitting for more than 15 to 20 minutes is still an occasional problem because of tightness in the lower back, which eases with stretching or movement. No other joints involved. The flat copper-coloured spots on my arms have not gone away but there is no itching,” he reports.

It is a marked improvement from what he had first written of his ChikV experience in his weekly column, when he had noted that he got up many times in the night and felt sudden waves of exhaustion during the course of the day, making him feel that all he wanted to do was lie down.

Now, his note ends, “Energy level is good. No need to rest in the afternoon.”

Dr Bratt seems to be past the worst of it.

I can identify with almost everything he describes, except for the rash which I have not had, though I still have fairly regular bouts of a kind of prickly itchiness in my palms and soles, particularly at nights.

I have had “unconfirmed” Chikungunya (that is, two negative blood tests, though there has been a clinical diagnosis), since the middle of October 2014, and although the joint pains have subsided considerably in terms of severity, they persist, and the exhaustion sets in suddenly and overwhelmingly often. That might be exacerbated by the fact that I entered 2015 with dengue (for the third time), and I might be extra tired because of the double whammy.

I’ve had swollen fingers, which are still pudgy, painful and given to regularly feeling as if the circulation has gone awry. I’ve had swollen feet and ankles; dreadful pains in my shoulders, elbows and knees, and I’ve had a generally arthritic kind of buzz going on all the time.

Several people have told me they’ve shared these experiences. The most similarities come from those of about 45 years and over who are really having a hard time with the joint pains.

It seems that the ChikV is not quite so malingering or severe in younger people, and they are coming out of it relatively unscathed, with very mild after effects. One young man in his mid-twenties said that it was in and out of him within days, but now, months later, he finds himself experiencing pains in his knees and elbows when temperatures fall.

Dr Bratt said he had not seen ChikV in anyone under age six, “perhaps three from six to twelve and about 30 to 40 from 12 to 18.” He noted that, “All, except one 14-year-old boy, recovered in a fortnight, he says he occasionally gets a pain in one knee.”

And that seems to be the common youth story: occasional twinges in the joints, intermittent bouts of itchiness, a little numbness in the digits here and there.

But for older folk, it has been far more invasive. Many of the people I know over 60, have found the joint pains to be so debilitating that they have been driven by frustration and depression to seek corticosteroid injections on the sites. (These are not cheap; around $200 a pop.)

I’ve spoken with maybe 30 to 40 people of various ages who have been carrying these symptoms, and their complaints are very similar, but the intensity and duration vary quite arbitrarily.

According to Dr Bratt, “In the most recent follow-up study, published in 2013, from the La Reunion outbreak of 2005-2006, three quarters of a group of 346 adults (over age 15) with clinical and laboratory confirmed ChikV, still had musculo-skeletal symptoms two years after the attack! 43% had a continuous type of pain. 32% had an intermittent type of pain.”

The truth is, by the time you’ve spent months trying to cope with that persistent pain, the memory of the first few days of the excruciating “brukk up” feeling pales pretty much in the way labour pains do.

But you have to continue with the daily grind – go to work, function as best as you can – because precious few of us have the luxury of caregivers or people who can relieve the routine demands on our minds and bodies for prolonged periods.

And this is where I think Chikungunya is going to make its biggest impact.

Persistent pain with no clear trajectory that says well, okay for two or three days now, there has been some relief so I must be healing – persistent pain like that is bound to bring your spirits down. You have good days that make you optimistic and then wham, the pain and exhaustion hit again and you feel there’s been no progress. This is where the long term effect of Chikunguyna is going to make itself felt, particularly in the workplaces. I asked a psychiatrist if there had been any cases being presented of Chikungunya-related depression at Mt Hope Hospital, and he said there were none as far as he was aware, but he agreed that the prolonged and incapacitating features of ChikV would cause people to get depressed.

Dr James Hospedales, Executive Director of the Caribbean Public Health Agency, told me that the National Insurance system in Jamaica has been under pressure because of the extra demands caused by ChikV. The head of the Private Sector Organisation of Jamaica had reported that a survey of their members (81 companies) showed they were feeling the impact of employees taking up to four days off work weekly due to the virus. Its CEO, Dennis Chung, said in October 2014 that feedback from members indicated that some places reported 60% of staff affected.

Jamaicans have been very vocal about the impact of ChikV on their lives. And true to the Caribbean penchant for finding humour in even the direst of times, there have been several comedic skits and songs conceding the might of ChikV and its mosquito agent.

“You could have a dozen M-16 / Mi only fraida chikungunya / Mi no care you a which bad man / Neither which garrison you come from / You coulda spar wid a million don / Mi only fraida chicken gunman!” is one gem from Beenie Man and the Astronauts, and there are at least half a dozen on the subject.

It is the raw Jamaican coping mechanism at work and the volume alone tells you how deeply ChikV has etched itself into public consciousness. Michael Abrahams’ version of Every Breath I Take (Since Me Get ChikV) is a funny but apt description of ChikV sufferation.

I have not yet heard any calypsos on the subject, but I am sure ChikV is going to be a significant factor in Trinidad and Tobago’s Carnival 2015. It only stands to reason.

If, as Dr Hospedales warns, the region has been virgin territory for the virus with no immunity – despite unconfirmed figures, there is a 30% attack rate – it suggests that a large number of potential masqueraders and feters might have been hijacked by ChikV pains.

Principal Medical Officer, Dr Clive Tilluckdharry, did not think it was going to create a significant absence in the festivities, reminding me that a large proportion of participants are visitors. But the tourism figures are bound to be affected because there are many advisories posted for visitors to the Caribbean urging protective measures against mosquitoes (and other villains).

With all the concern about whether Carnival should have been allowed in the context of Ebola, it would be something, wouldn’t it, if the show was allowed to go on, but everyone is too brukk up to play a mas?