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Published on: Nov 13, 2020
1 minute read
By: Dr Rajan ( Medical Second Opinion Cell)

Using The Cellular Handshake Against The Virus

Using the cellular handshake against the virus

In early November an interesting study was published in The Lancet Respiratory Medicine, describing the treatment of a severe COVID-19 patient with human recombinant soluble angiotensin-converting enzyme-2. By using the treatment, it was possible to see the disappearance of the virus swiftly from the patient's serum, nose, and lungs, as well as a reduction in the patients’ inflammatory markers. How was this achieved? And why is this so intriguing.

When we look at treating viruses, there are several strategies at work. You can prevent its spread by the use of social distancing or masks, you can use medications that prevent its replication (such as Tamiflu). Or you can stop the virus from entering the cells, the first step in viral replication.

SARS-CoV-2 appears to enter human cells through the ACE2 receptor. ACE2 is a protein in the cell membrane found across the human body, especially the lungs, heart, kidney and small intestine. It function is related to the Renin-Angiotensin System, a mechanism by which the kidneys control your blood pressure.

Angiotensin-Converting Enzyme converts angiotensin 1 to angiotensin 2, a hormone that causes blood vessels to constrict. ACE 2 instead converts it to a protein that causes dilation of blood vessels. This likely protects these critical organs and ensure they receive sufficient blood to perform their tasks. ACE2 is being investigated as a possible target for blood pressure medications.

The study used a genetically modified soluble form of ACE2 that mimics the protein found on human cell membranes. By increasing its availability in the blood, the SARS-CoV-2 virus binds to this protein, resulting in its inactivation, rather than entering lung cells and causing lung injury. Lab studies have shown that it can reduce viral growth by as much as 1000 to 5000 times, and phase 1 studies show it to be safe to use in people.

The actual described case was in a 45-year-old woman, hospitalized with COVID, suffering from severe shortness of breath, cough and fatigue. She was first treated with hydroxychloroquine and anticoagulants, but this proved ineffective, and the virus was causing increasing damage to her lungs. Nine days after her symptoms started, she received the ACE2 treatment for a week, with no side effects. This resulted in an increase in ACE2 activity (seen from her blood results), but also a marked decrease in multiple inflammatory markers associated with COVID-19, as well as a sharp decrease in COVID 19 numbers. Indeed, the viral load dropped from 32,000 per mL to just 270 per mL two days after treatment started. She was also able to produce antibodies against the virus, so this did not impair her from getting immunity.

It is certainly a very interesting case, though questions remain on how feasible it would be (as well as how expensive) to manufacture large quantities of this protein receptor for treatment use, as well as how it fairs in clinical trials.

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why fatigue should not be ignored

Feeling tired occasionally is a normal response to physical exertion, lack of sleep or emotional stress. However, when fatigue becomes persistent, overwhelming or unexplained, it should not be dismissed. Fatigue is one of the most common symptoms reported in healthcare, yet it is also one of the most frequently ignored.

Understanding why fatigue should not be ignored is essential because it often acts as an early warning sign of deeper physical or mental health issues.

What Is Fatigue?

Fatigue is a state of ongoing physical, mental or emotional exhaustion that:

lasts longer than expected
interferes with daily activities
does not improve with rest or sleep

Unlike ordinary tiredness, fatigue affects motivation, concentration and overall functioning.

Why Fatigue Is Commonly Ignored

Fatigue is often dismissed because:

busy lifestyles normalise exhaustion
symptoms develop gradually
people attribute fatigue to stress or ageing
rest temporarily masks the issue

Ignoring fatigue allows underlying conditions to progress unnoticed.

Common Medical Causes of Persistent Fatigue

Nutritional Deficiencies

Deficiencies in:

iron
vitamin B12
vitamin D
magnesium

can significantly reduce energy levels and cause weakness.

Anaemia

Anaemia reduces oxygen delivery to tissues, leading to:

constant tiredness
breathlessness
dizziness

It is one of the most common yet underdiagnosed causes of fatigue.

Thyroid Disorders

Both underactive and overactive thyroid conditions affect metabolism.

Symptoms include:

fatigue
weight changes
cold or heat intolerance

Thyroid-related fatigue often persists despite rest.

Chronic Infections

Low-grade or unresolved infections keep the immune system activated, causing prolonged fatigue.

Hormonal Imbalance

Hormones regulate energy, sleep and metabolism.

Imbalance may lead to:

exhaustion
poor sleep
low motivation

Poor Sleep Quality

Even with sufficient sleep duration, poor sleep quality can cause fatigue due to:

sleep apnea
frequent awakenings
stress-related insomnia

Mental Health Conditions

Anxiety, depression and chronic stress commonly present with fatigue as a primary symptom.

Mental fatigue is as real and impactful as physical fatigue.

Lifestyle Factors That Worsen Fatigue

Certain habits intensify tiredness:

irregular meals
excessive caffeine
dehydration
lack of physical activity
prolonged screen use

Lifestyle-related fatigue often coexists with medical causes.

How Fatigue Affects Daily Life

Persistent fatigue impacts:

work performance
concentration and memory
emotional regulation
physical activity
social relationships

Over time, quality of life declines significantly.

Warning Signs That Fatigue Needs Medical Attention

Seek evaluation if fatigue:

lasts more than two weeks
worsens progressively
occurs with weight loss or fever
is associated with breathlessness
interferes with daily tasks

These signs suggest an underlying issue.

Why Early Evaluation Matters

Early identification of fatigue causes:

prevents disease progression
simplifies treatment
improves recovery time
restores normal energy levels

Delayed care often leads to chronic complications.

Diagnostic Evaluation for Fatigue

Assessment may include:

detailed history
blood tests
nutritional screening
hormonal evaluation
sleep assessment

Testing helps identify root causes rather than treating symptoms alone.

Can Fatigue Be Prevented?

Some preventive measures include:

balanced nutrition
adequate hydration
regular physical activity
consistent sleep routine
stress management

However, prevention does not replace evaluation when fatigue persists.

Fatigue and Chronic Disease Risk

Long-term fatigue may be linked to:

cardiovascular disease
metabolic disorders
immune dysfunction

This makes fatigue an important early health signal.

When Rest Is Not Enough

If energy does not return after:

adequate sleep
reduced workload
lifestyle changes

medical evaluation is essential.

The Cost of Ignoring Fatigue

Ignoring fatigue can lead to:

delayed diagnosis
worsening health conditions
reduced productivity
emotional burnout

Listening to the body early prevents long-term consequences.

Conclusion

Fatigue is not merely a sign of a busy life—it is often the body’s way of signalling imbalance or illness. Persistent tiredness that does not improve with rest should never be ignored. Whether caused by nutritional deficiencies, hormonal changes, chronic stress or underlying disease, fatigue deserves attention. Early evaluation and timely care can restore energy, prevent complications and significantly improve quality of life. Listening to fatigue is an act of self-care and preventive health.

References

Indian Council of Medical Research (ICMR) – Fatigue and Lifestyle Health Report
World Health Organization (WHO) – Chronic Fatigue and Health Guidelines
National Institute of Nutrition (NIN) – Nutrient Deficiency and Energy Research
Lancet – Fatigue as a Marker of Chronic Disease Studie
Indian Journal of Medicine – Persistent Fatigue and Diagnosis
Statista – Fatigue, Stress and Health Trend Analysis

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