Setting: Pseudo-mediaeval fantasy, climate about that of central Europe. I'm assuming malaria is not uncommon and is pretty recognisable to a physician, as the city is about a mile away from a sizeable stretch of marshy mosquito-infested peat bog, and it was once endemic in marshy areas of Britain and Europe. (People don't usually go out that way unless they have a good reason. OTOH, being sent to dig peat and get bitten to shreds by mosquitoes is a nice punishment for a seriously annoyed authority figure to have up their sleeve...) I don't envisage there being a specific (effective) treatment for it in setting, or prophylaxis beyond "Cover up well, the evil marsh spirits will get you and make you ill".
First question: To what extent, if any, is someone likely to feel ill between malarial paroxysms?
I'm looking specifically at vivax malaria, as the research I've done suggests that the malaria that was once endemic in temperate zones in Europe was probably vivax, from contemporary descriptions. Also it appears to be deeply unpleasant but not frequently fatal, which suits my purposes nicely. Because it's fiction and nicely dramatic, I'm likely to go for the classical "day or so of feeling a bit off --> shaking chills --> roaring fever --> drenching sweat" model with well-delineated paroxysms, as it's recognisable even if in practice not that many cases conform precisely. (Heck, I could lampshade it with the physician being impressed by how textbook it is. :P) The patient is probably malaria-naive, though that's tweakable if it turns out it needs to hit her less hard. A relapse is a possibility, but I'd sooner she didn't realise what was going on. I'm a sucker for nasty things, so I'd like to hit her hard if I can.
What's stumping me is what goes on between the paroxysms. Most sites don't seem to mention this at all, and the few that do tell me vaguely that "the patient may feel all right" between attacks. Are we talking actually all right, up and about normal activities? Or are we talking exhausted and fairly rotten but functional? Or lying around in bed sleeping a lot but not feeling too appalling? I'm guessing that anaemia would be making her feel weak and rubbish after a while of this, but what about soon after onset?
Second question: If this is her first attack, how long is she likely to be out of action for? Not talking combat or anything like that, just everyday non-strenuous things like reading, writing, meetings, walking around the place. I've read that the attacks get less severe over a period of a few weeks, but again, I'm having difficulty translating that into how practically functional she'd be.
Third question: During/immediately after the drenching sweat, how difficult will she be to wake? Highly subjective this, which I assume is why Google is failing me. The character is a very heavy sleeper in general, and I'm guessing that the exhaustion would make her hard to rouse. What I'm wondering is whether it's at all plausible that she'd be deeply asleep enough to be oblivious to, say, someone breaking down her door, or for a panicky layperson to leap to the conclusion that she's actually unconscious or catatonic in some way.
Fourth and final question: This character is a heavy smoker. Is this likely to garner anything additional from the malaria, besides probably getting the coughing her lungs up aspect? I've never smoked myself, so I have no idea how it interacts with illness. I ask because ISTR reading something about malarial patients who smoke having a strong aversion to smoking during the illness, but I can't for the life of me remember where I read that, and I can't seem to find it again or anything corroborating it...
Things I've tried: Googling for "vivax malaria", "malaria personal account", "malaria between paroxysms", "malaria smoking", "malaria smokers aversion" and combinations of them, and trawling endlessly through the results. I read an awful lot of online papers months ago, particularly one old 1949 paper about a study on the St Elizabeth strain of vivax, when I was looking specifically at relapses, but I've graduated from uni since then and have sadly lost my institutional login :(
I would especially love any personal or second-hand accounts on this - this is happening to a viewpoint character, so the more gory detail the better. Accounts on vivax would be amazing, but I'm interested in anything. (Falciparum is the one I'm least interested in, as it seems it presents usually as a quotidian fever, which kind of rules out gaps between paroxyms!) I realise it may well be a "how long is a piece of string" question, but anyone's experiences would be very valuable in the interests of realism. It's fantasy, I can fudge if I have to, but the medical tech forms a significant part of the story, so I'd like to keep it as real as possible.
Thanks for reading! :D