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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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Difference Between Sadness and Depression: Understanding Normal Emotions vs Mental Illness

Feeling low or unhappy is a part of being human. However, not all low moods are the same. Many people confuse sadness with depression, which can delay proper support and treatment. Understanding the difference between sadness and depression is crucial for mental health awareness, early intervention and reducing stigma.

In India, mental health conditions are often misunderstood, with emotional distress frequently dismissed as temporary sadness.

What Is Sadness?

Sadness is a normal human emotion.

It usually occurs due to:

loss or disappointment
relationship issues
failure or stress
temporary life challenges

Sadness serves a psychological purpose, allowing individuals to process emotions and adapt.

Key Characteristics of Sadness

Sadness is:

situational
temporary
emotionally painful but manageable
responsive to support and positive events

A person experiencing sadness can still function, enjoy moments and feel hopeful.

What Is Depression?

Depression is a medical condition classified as a mood disorder.

It affects:

emotions
thinking patterns
behaviour
physical health

According to WHO, depression is one of the leading causes of disability worldwide.

Core Symptoms of Depression

Depression involves a combination of symptoms such as:

persistent low mood
loss of interest or pleasure
fatigue
sleep disturbances
appetite changes
feelings of worthlessness
difficulty concentrating

These symptoms last at least two weeks or longer.

Duration: A Key Difference

One major difference lies in duration.

Sadness:

lasts hours or days
improves with time

Depression:

lasts weeks or months
persists despite positive events

Duration helps distinguish emotional response from illness.

Impact on Daily Functioning

Sadness:

allows continuation of work and relationships
may reduce motivation temporarily

Depression:

interferes with work, studies and relationships
reduces self-care and productivity

Functional impairment is a defining feature of depression.

Emotional Experience: Sadness vs Depression

Sadness:

allows emotional range
moments of joy still occur

Depression:

creates emotional numbness
joy and interest disappear

People with depression often describe feeling empty rather than sad.

Physical Symptoms in Depression

Depression is not only emotional.

Physical symptoms include:

chronic fatigue
body aches
headaches
digestive issues

ICMR mental health studies highlight the physical burden of depression.

Thought Patterns and Self-Perception

Sadness:

thoughts remain realistic
self-worth is preserved

Depression:

negative self-talk dominates
feelings of guilt and worthlessness increase

These cognitive changes deepen emotional suffering.

Risk Factors for Depression

Factors increasing depression risk include:

chronic stress
trauma
family history
medical illnesses
hormonal changes

NFHS-5 data indicates rising mental health concerns among young adults.

Can Sadness Turn Into Depression?

Yes, prolonged or unresolved sadness can progress into depression.

This is more likely when:

stressors are ongoing
support systems are weak
coping mechanisms are limited

Early emotional support can prevent progression.

When to Seek Professional Help

Seek help if:

low mood lasts more than two weeks
daily functioning is affected
sleep and appetite are disturbed
thoughts of self-harm occur

Early care leads to better outcomes.

Treatment Differences

Sadness:

improves with rest, support and time

Depression:

requires psychotherapy
may need medication
benefits from structured care

WHO emphasises early treatment to reduce disability.

Role of Social Support

Support systems help both conditions but are essential for recovery.

Depression recovery improves with:

understanding family
supportive workplaces
accessible mental healthcare

Stigma reduction is key.

Mental Health Awareness in India

Mental health remains underdiagnosed in India.

NITI Aayog reports:

limited access to mental health services
low awareness
high stigma

Education helps bridge this gap.

Importance of Early Recognition

Recognising depression early:

prevents worsening
reduces suicide risk
improves quality of life

Delay increases suffering and complications.

Supporting Someone With Depression

Helpful actions include:

listening without judgement
encouraging professional help
avoiding minimising feelings

Compassion is more effective than advice.

Conclusion

Understanding the difference between sadness and depression is essential for emotional wellbeing and mental health care. Sadness is a natural, temporary response to life events, while depression is a serious medical condition that affects thoughts, emotions and daily functioning. Recognising the signs early and seeking appropriate help can prevent long-term suffering and promote recovery. Mental health deserves the same attention and care as physical health.

References

World Health Organization (WHO) – Depression and Mental Health Disorders
Indian Council of Medical Research (ICMR) – Mental Health Research and Burden
National Family Health Survey (NFHS-5) – Mental Health Indicators
Lancet – Depression, Disability and Public Health
NITI Aayog – National Mental Health Policy and Awareness Reports
Statista – Global and Indian Mental Health Trends

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