What chikungunya teaches us about COVID-19
Authors: Fabrice Simon, Hugh Watson, Jean-Baptiste Meynard, Vincent Pommier de Santi, Jean-Nicolas Tournier
Journal: The Lancet Infectious Diseases (2021)

Since December, 2019, the COVID-19 pandemic has generated huge challenges, numerous breakthroughs in research and care, and innovations in public health. 1 year after its emergence, the world is discovering that late clinical consequences of the disease are an increasing problem for patients. For a substantial proportion of SARS-CoV-2-infected adults, the disease appears biphasic, with long-lasting clinical disorders (so-called long COVID).1The LancetFacing up to long COVID.Lancet. 2020; 3961861Summary Full Text Full Text PDF PubMed Scopus (150) Google Scholar This post-COVID status might comprise multiple mental or somatic disorders, especially among adults. The prevalence, profile, and determinants of these chronic manifestations remain to be described and understood for appropriate case management. Assessment of clinical disability, quality of life, and fitness for work is required to provide a better view of the real burden of disease and improve our response to the pandemic. There is a cognitive bias when examining the COVID-19 burden. Considering its mode of transmission (airborne), its clinical influenza-like presentation, and the explosive shape of the epidemic curves, the main comparison for COVID-19 in human history is the influenza pandemic of 1918. Most political and public health leaders are reasoning with the image of influenza in mind. However, by contrast with COVID-19, influenza has no long-term clinical burden. An acute viral infection with chronic sequelae is not unprecedented. Following our experience with post-chikungunya status, we were struck by the similarities between the long-lasting manifestations after COVID-19 and those after chikungunya virus infection, especially for general and mental disorders, impaired quality of life, and medico-social consequences. Post-chikungunya consequences might account for about 70% of disability-adjusted life-years following a chikungunya outbreak.2Krishnamoorthy K Harichandrakumar KT Krishna Kumari A Das LK Burden of chikungunya in India: estimates of disability adjusted life years (DALY) lost in 2006 epidemic.J Vector Borne Dis. 2009; 46: 26-35PubMed Google Scholar, 3Puntasecca CJ King CH LaBeaud AD Measuring the global burden of chikungunya and Zika viruses: a systematic review.PLoS Negl Trop Dis. 2021; 15e0009055Crossref PubMed Scopus (79) Google Scholar It took about 10 years to describe the post-chikungunya disorders and propose guidelines (still not evidenced-based).4Simon F Javelle E Cabie A et al.French guidelines for the management of chikungunya (acute and persistent presentations). Nov 2014.Med Mal Infect. 2015; 45: 243-263Crossref PubMed Scopus (155) Google Scholar Despite multi-continental outbreaks, there are still fewer than five well designed randomised-controlled trials, and no management strategy exists for patients who have been suffering post-chikungunya consequences for years. One reason for this neglect of the chronicity of chikungunya is a tendency to consider it a simple, short-lived infection like dengue. A simple comparison of the global burdens of COVID-19, influenza, chikunguna, and dengue fever distinguishes roughly two biphasic infections (chikungunya and COVID-19) and two monophasic ones (influenza and dengue). In a sense, COVID-19 is much closer to chikungunya than to influenza or dengue. We support calls for urgent research on long COVID to avoid having millions of adults with long COVID left behind, with an inestimable social and economic impact. The lessons from post-chikungunya should be learnt.5Barnay JL Cabie A Simon F A novel framework for the treatment of arboviral diseases.Lancet Infect Dis. 2018; 18: 1178-1179Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar FS reports being the chief executive officer of RISK&VIR, on a data and safety monitoring board for Valneva, and a senior consultant on chikungunya to PAHO/WHO. HW reports shares in Sanofi. All other authors declare no competing interests. Facing up to long COVIDMultiorgan symptoms after COVID-19 are being reported by increasing numbers of patients. They range from cough and shortness of breath, to fatigue, headache, palpitations, chest pain, joint pain, physical limitations, depression, and insomnia, and affect people of varying ages. At the Lancet–Chinese Academy of Medical Sciences conference on Nov 23, Bin Cao presented data (in press at The Lancet) on the long-term consequences of COVID-19 for patients in Wuhan, and warned that dysfunctions and complications could persist in some discharged patients for at least 6 months. Full-Text PDF