Existing drug may downgrade COVID threat to common cold level — Jerusalem study

Hebrew University professor says he’s worked out what makes the raging virus so vicious, and how to fix it using an anti-cholesterol med; no human testing done yet

By Nathan Jeffay 14 July 2020, 7:19 pm 9

• 
  
• 47,646 shares

Illustrative: A man holds a bottle of pills (outline205; iStock by Getty Images)

An existing medicine can “downgrade” the danger-level of coronavirus to that of a common cold, a Jerusalem researcher is claiming, after testing it on infected human tissue.
Prof. Yaakov Nahmias says that his research shows that the novel coronavirus is so vicious because it causes lipids to be deposited in the lungs, and that there is a solution to undo the damage: a widely-used anti cholesterol drug called fenofibrate.

“If our findings are borne out by clinical studies, this course of treatment could potentially downgrade COVID-19’s severity into nothing worse than a common cold,” Nahmias said.

Get The Start-Up Israel's Daily Start-Up by email and never miss our top stories Free Sign Up

Unlike remdesivir, which is being lauded for its effect on coronavirus patients, fenofibrate, sometimes sold under the brand name Tricor, is already accredited by America’s Food and Drug Administration and is in plentiful supply. Remdesivir is in short supply and is also still pending full approval by regulators like the FDA.

Prof. Yaakov Nahmias of the Hebrew University of Jerusalem (right) (courtesy of the Hebrew University of Jerusalem)

Nahmias, director of Hebrew University’s Grass Center for Bioengineering, reached his conclusion in joint research with Dr. Benjamin tenOever at New York’s Mount Sinai Medical Center. Their paper has gone live on an online portal run by Cell Press, publishers of biomedical journals, for research that hasn’t yet been peer reviewed.

Nahmias and tenOever performed lab tests on human lung cells infected with SARS-CoV-2.

Nahmias said they arrived at the idea that a cholesterol drug could help after studying the way in which the novel coronavirus “hijacks” the human body.

He told The Times of Israel: “The question is why this new coronavirus is so different from its close relatives that just cause a common cold. What we see is that this virus really changes lipid metabolism in the human lungs. The new coronavirus causes tiny lipid droplets to accumulate in the lungs, something you don’t normally see in the lungs in any significant quantity.”

 

The chemical composition of the fenofibrate cholesterol-lowering drug. Atoms are represented as spheres with conventional color coding: hydrogen (white), carbon (grey), oxygen (red), chlorine (green) (iStock)

Similar processes, hinging on the virus depositing fats, seem to take place in other parts of the body too, such as the liver, said Nahmias.
He believes that the virus does this in order to perpetuate itself in the host, and that if this process can be stopped, it will halt the onset of problems with organs — normally the lungs — that cause the virus to badly affect patients.He said the virus interferes with the ability of the body to break down fat, and fenofibrate jump-starts this process. “The interesting thing about our study is that fenofibrate actually binds and activates the very site on the DNA that the virus shuts down — a part of our DNA that allows our cells to burn fat,” he stated.

“Virus infection causes the lung cells to start building up fat, and fenofibrate allows the cells to burn it.”

The restart of the process is swift, he said, comparing it to “when the plug is removed from the bath tub.”

Nahmias said that the high danger level from coronavirus isn’t caused by its infectiousness or the body’s general ability to rid itself of the virus, but rather by the unique symptoms it causes. “Your body can easily deal with the virus, all we need to do is deal with the symptoms,” he said.

“We need to give the body time to clear the virus without going into respiratory failure. And it’s by doing this that I think we can transform it into something far less serious, something like the common cold.”

Fenofibrate (brand names: Antara, Fenoglide, Lipofen, Lofibra, TriCor, Triglide) is a fibrate drug used to treat high cholesterol and high triglyceride (fatty acid) levels. Fenofibrate is a generic drug.

Side Effects of Fenofibrate 40 mg/ 120 mg (Fenofibrate ...

Brand Name

Brand Name	Composition	Company
fenolip 145 tab	Fenofibrate (nanotablet formulation) 145mg	cipla
finate cap	Fenofibrate 160mg	franco indian
finate cap	Fenofibrate 200mg	franco indian
lipicard cap	Fenofibrate 160mg	usv

7 more rows

FENOFIBRATE - MEDLINE INDIA

AN INC42+ STORY
4. Inside India’s $5.4 Bn Telemedicine And Remote Healthcare Gold Rush

The regulatory grey area and resistance to newer technologies kept telemedicine as an add on for most startups. Only few such as Practo, Medibuddy, DocsApp have been offering telemedicine as a core model. And, within that, the revenue involves other avenues as well. For instance, Practo has a Saas model which makes software products that helps healthcare providers in digitising their hospitals and clinics at a monthly subscription rate. Lybrate has an ecommerce platform called Goodkart, that offers healthcare products. Besides these startups also offer lab tests, preventive health checks as well.

Help Koalas, help ourselves

Vaccine trials being run in Australia to protect koalas from chlamydia could help lead to a human vaccine, too. Chlamydia is ravaging the animals’ population (aided by habitat destruction and road kill). Animal- and human-health researchers are working together on projects that benefit both species. “You’re better off doing a bad experiment in koalas than a good experiment in mice,” says microbiologist Peter Timms. “We don’t need a vaccine for mice.”

The New York Times | 10 min read

How Vietnam protected every life

Vietnam has a population of 97 million people, limited health-care capacity and a border shared with China. Yet it has had fewer than 400 confirmed cases of COVID-19 and no deaths. Analysts from the Johns Hopkins Center for Health Security look at how Vietnam achieved it: preparedness, an early and aggressive response, good public communication and an emphasis on testing, tracing and quarantine.
Outbreak Observatory | 5 min read

Pig hosts can repair damaged human lungs

Some 80% of donated lungs have to be discarded because of damage. But after researchers connected rejected lungs to pigs, the lungs recovered and were fit for transplant. The method revived lungs that ex vivo lung perfusion, the normal method of maintaining and repairing lungs outside the body, had failed to fix. “All of a sudden, [the lungs are] attached to a functioning liver, a functioning gut,” says thoracic surgeon Matthew Bacchetta. “We used a fairly standard immunosuppressive regimen and took these rejected lungs and showed that we could actually sustain them and make them better.” Researchers say the effect could work just as well if the lungs were connected to a human — allowing a person in need of a lung transplant to heal the lungs they require, themselves.

STAT | 6 min read Reference: Nature Medicine paper

Notable quotable

“Just before the patient died, they looked at their nurse and said ‘I think I made a mistake, I thought this was a hoax, but it’s not.’”

Physician Jane Appleby shares the last words of a person in their 30s who died after attending a ‘COVID-19 party’ to catch the virus on purpose. Appleby, a health official in San Antonio, Texas, hopes to raise awareness of the disease in the city, which has 18,000 reported cases. (WOAI News | 2 min read)

If We Get a Vaccine, the Politics Could Be Messy

Even if scientists find a vaccine, two Science articles argue it may not spell an easy end to Covid-19. For one, tricky ethical decisions lie ahead over who should be vaccinated first, Jon Cohen writes. “Nobody’s going to debate health care workers and first responders—people who are putting themselves at risk for others and keeping things moving,” former US National Vaccine Program Director Bruce Gellin, now of the Sabin Vaccine Institute, tells Cohen. “After that is when it gets complicated.”

Warren Cornwall expects anti-vaccine politics to get in the way, noting an online uptick. “In May, a documentary-style video, ‘Plandemic,’ purporting that COVID-19 related deaths were exaggerated and a vaccine could kill millions, got more than 7 million views on YouTube before it was removed because of its unsubstantiated claims,” he writes. “Other outlandish claims include that vitamin C can cure COVID-19 and that the disease is a conspiracy involving philanthropist Bill Gates.”

take drug testing out of the hands of manufacturers.

Corruption and the pharmaceutical industry

In their new book, child psychiatrist Jon Jureidini and philosopher Leemon McHenry dispute the assumption that all approved drugs and medical devices are safe and effective. They warn that when clinical science is hitched to the pharmaceutical industry’s dash for profits, the scientific method is undermined by marketing spin and cherry-picked data. Their proposed solution is inspired by philosopher of science Karl Popper: take drug testing out of the hands of manufacturers.

Nature | 6 min read

Notable quotable

“They literally gained nothing… it’s a self-inflicted wound, and they have no economic gains.”

Economic researcher Jacob Kirkegaard responds to numbers showing that Sweden’s light-touch lockdown approach to the pandemic has cost many lives without protecting its economy. (The New York Times | 9 min read)

Remarkable” HIV treatment sparks hope A man referred to as the São Paulo Patient has been free of HIV for 66 weeks, following an aggressive course of antiretroviral drugs and nicotinamide (vitamin B3). Five people received the treatment in a trial, and he was the only one whose HIV didn’t return after treatment stopped. Two other people have been cleared of HIV — both through bone-marrow transplants that they needed as part of their cancer treatment. The São Paulo Patient did not require a transplant. Other hopeful examples of people, including babies, who have appeared to become free of HIV have seen the virus return after prolonged absences. Science | 6 min read

Bridging the gap in mental healthcare

Jaipur-based Felicity helps people connect with psychologists online for video therapy sessions and audio and text chats to help them take care of their mental health.

Pharmas make billions on people's sufferings

World

Coronavirus: Wealthy nations compete for remdesivir supplies

The world's wealthiest countries are competing for remdesivir, despite assurances that they would work together to develop drugs that treat COVID-19. Pharmaceuticals giant Gilead Sciences is in an enviable position.

Zolgensma, a gene therapy medicine for treating spinal muscular atrophy in children under the age of two, is now available in Germany. However, a single treatment of the drug, which is produced by Swiss pharmaceuticals company Novartis, comes at the steep price of €1.9 million ($2.1 million).
The manufacturer argues that this is a reasonable price considering that without it, it costs between €2.5 and 4 million to treat the degenerative disease over a lifetime.
Gilead Sciences, which has developed remdesivir, takes a similar line of argument, saying that the drug, which is viewed as a promising tool in the fight against COVID-19, could save costs in the long run.
In an open letter earlier this week, Daniel O'Day, chairman and CEO of Gilead Sciences, wrote: "Taking the example of the United States, earlier hospital discharge would result in hospital savings of approximately $12,000 per patient. Even just considering these immediate savings to the healthcare system alone, we can see the potential value that remdesivir provides."
"We have decided to price remdesivir well below this value," he continued. "To ensure broad and equitable access at a time of urgent global need, we have set a price for governments of developed countries of $390 per vial. Based on current treatment patterns, the vast majority of patients are expected to receive a 5-day treatment course using 6 vials of remdesivir, which equates to $2,340 per patient."
Read more: Remdesivir is no miracle cure

A single treatment of Zolgensma, produced by Swiss pharmaceuticals firm Novartis, costs €1.9 million

What is fair drug pricing?
The editor of the German specialist magazine Arznei-Telegramm, Wolfgang Becker-Brüser, is not convinced. He told DW that the costs of treating COVID-19 without remdesivir had been calculated at random.
"There is an attempt to give the impression that the price is fair," he said. "However, if there wasn't a pandemic and so much public attention they might have set the price much higher."
The Association of Research-Based Pharmaceutical Companies (vfa) refused to comment. "The vfa does not comment on the pricing schemes of individual companies," it said in a statement to DW.
But in the past, the vfa has called on the pharmaceuticals sector to show responsibility with regard to consumers and demanded that affordable medicine and vaccines be made available.
An analysis by British researchers cited in the Germany weekly Der Spiegel came to the conclusion that it probably cost about €8 to produce one dose of remdesivir.
However, it is normal for the sale price to be much higher than the production price, considering companies invest huge sums into development.
Read more: How lab animals have fared in the coronavirus crisis

Gilead Sciences claims that it invested about $1 billion into remdesivir. This is actually at the lower end of the vfa's scale for developing a new drug. The association told DW that companies tended to invest $1 to 1.6 billion in a new product.
For Wolfgang Becker-Brüser, this is "fantasy."
"If the development costs are calculated to be so high then it is easy to demand higher prices," he told DW.
For Alexander Nuyken, a pharmaceuticals expert at the consulting firm EY, there is a reason that development costs are so high: they encompass the risk of failure. "It has to be possible to add a premium for the risks incurred from the development of a drug to its approval," he said.

Watch video 03:16

What is Remdesivir?

Becker-Brüser said that in general drugs were becoming more expensive. "The number of prescriptions for new patented drugs is the same but their price is going up," he said. This was already the case before the COVID-19 pandemic, as indicated by a report by the German health insurance company AOK from last year, according to which insurance companies are paying an increasingly high proportion of their medicine budget on particularly expensive drugs. Drugs as pricey as Zolgensma are only the tip of the iceberg.
Read more: Is the US-China rivalry tangling a coronavirus vaccine with geopolitics?
With regard to remdesivir, however, there had been some expectation that the cost per course of treatment would actually be higher. The Institute for Clinical and Economic Review, a US-based nonprofit organization that analyzes drug prices, had suggested that a reasonable price would be $2,800, while others had recommended $4,000.
But considering that remdesivir is practically a waste product, which Gilead Sciences originally developed to treat Ebola, without major success, Becker-Brüser presumes that the company opted for a compromise in view of the public pressure.
It could turn out to be a win-win situation for the company. Its share price rose when the price of remdesivir was announced earlier this week and orders have gone through the roof.

After being ineffective against Ebola, Gilead Sciences drug remdesivir is getting a second chance against COVID-19

Global competition
According to media reports, the US has already secured the entire stock of projected production for July and 90% for August.
Germany, too, has apparently secured supplies. Health Minister Jens Spahn has been applying pressure. He said that he expected "Germany and Europe to have access to supplies to such a drug." The British government has also said that it has enough reserves.
So far, remdesivir has not been fully approved in any country and there has not been enough research into how effective it really is against the novel coronavirus. But apart from Dexamethason, it is the drug that seems to have the most potential for treating patients with SARS-CoV-2 and limiting the disease's course.
Read more: Is dexamethasone the game changer in COVID-19 treatment?
Alexander Nuyken said that it was not surprising that the world's wealthy nations were all eager to get hold of supplies. "That's why it is particularly important that we find common solutions in international alliances."
There are already several international forums in which this is being attempted and a European vaccine alliance has been formed with the WHO.
However, the problem, as with the global fight against the climate emergency, is that if the US does not play by the same rules, the attempts of other states will be curbed.
Those who benefit, said Becker-Brüser, are the pharmaceuticals giants, "which are in a position to aim higher."
It will soon become clear how high Gilead Sciences is prepared to go. Right now, the European Union is negotiating with the US company and trying to ensure that all 27 states have supplies in the coming months.

Nature Briefing

View this email in your browser Tuesday 30 June 2020

Hello Nature readers, Today we read about a swine-flu strain with human pandemic potential found in pigs, ponder whether cosmic rays explain the handedness of life, and learn that quantum computers work better when no one’s around.

Habitat destruction is one of the main drivers of species loss. (Robin Moore/National Geographic)

Speaking in the name of nature Earlier this month, Elizabeth Maruma Mrema was appointed executive secretary of the United Nations Convention on Biological Diversity. She is the first woman from Africa to lead the intergovernmental body, and will oversee the creation of a global biodiversity agreement for the next decade. Mrema spoke to Nature about how the coronavirus pandemic has influenced negotiations, and the challenges ahead. “One could say that I have been appointed at a bad time for biodiversity, considering that the whole world is just emerging from, or still in, lockdown,” she says. “But at the same time, I see it as a major opportunity, as biodiversity is being discussed more than ever before.” Nature | 6 min read

Pigs in China carry risky swine-flu strain Scientists carrying out routine monitoring of influenza strains in China have found that pigs are widely infected with a virus with the potential to trigger a pandemic. The strain, called G4, is a genetic blend of three lineages. These include the H1N1 virus that caused the 2009 pandemic, suggesting that it might be able to adapt for human-to-human transmission. Antibody tests showed that more than 4% of humans surveyed had been exposed to G4. In its current form, the virus is not considered dangerous, but scientists warn that, given the unpredictability of influenza viruses, a vaccine should be developed. “We need to be vigilant about other infectious disease threats even as COVID is going on because viruses have no interest in whether we’re already having another pandemic,” says evolutionary biologist Martha Nelson. Science | 6 min read Reference: PNAS paper

A cosmic origin for the handedness of life Nineteenth-century biologist Louis Pasteur speculated that life’s preference for using certain organic molecules but not their mirror-image counterparts is “one of the links between life on Earth and the cosmos”. Now, two astrophysicists have a new interpretation of that connection. They say that the never-ending bombardment of Earth by cosmic rays could have led to DNA that is unerringly right-handed and amino acids that are nearly always left-handed. Cosmic rays that hit the upper atmosphere produce new particles, some of which are endowed with a preferred handedness caused by the weak nuclear force, the only fundamental force known to distinguish left from right. Over eons, that asymmetry could have trickled down to organic matter. Quanta | 6 min read Reference: Astrophysical Journal Letters paper

COVID-19 coronavirus update (Cergios/Shutterstock) The state of the vaccination race The race to develop a vaccine has been going on for almost six months. Who’s in the lead? Chemistry World offers a plain-language update on the vaccine pipeline. Its pick for leader is US biotech company Moderna’s messenger RNA-based vaccine. But it would be the first RNA vaccine for any disease to ever make it to market. Chemistry World | 8 min read How to decide who gets the vaccine Organizations including the World Health Organization and the US Centers for Disease Control and Prevention are debating the thorny problem of who should be the focus of the first waves of vaccinations for COVID-19. Young and healthy people — who are least at risk themselves, but might tolerate a vaccine better than older people, creating a ring of protection? Or maybe pregnant women, in whom the risk to mother and baby must be carefully weighed? Or perhaps priority should be given to people from specific ethnic groups, who are dying at a disproportionate rate? “These are tough decisions, because everybody can make a case for why somebody should be ahead of somebody else in line,” says vaccine specialist Bruce Gellin. “Nobody’s going to debate health care workers and first responders — people who are putting themselves at risk for others and keeping things moving. After that is when it gets complicated.” Science | 6 min read Doctors flag fevers and rashes among children Two studies have revealed the progress of multisystem inflammation syndrome, a dangerous side effect of COVID-19 that occurs in children and looks similar to a condition called Kawasaki’s disease. Of the nearly 300 children in the studies, 6 died. On the whole, children seem to be less susceptible to COVID-19 than are adults, and to experience milder symptoms if they do fall ill. But the researchers recommend that carers look out for fevers and rashes in children who have recently had COVID-19, or who live in areas with a lot of infections. STAT | 5 min read Reference: The New England Journal of Medicine paper 1 & paper 2

Notable quotable “Oh my goodness, this is one of us.” Physician Luis Lobon recognized his colleague, hospital worker Marie Deus, when he treated her for COVID-19. She was the first employee to die of the disease at the hospital in Boston, Massachusetts, where she worked. The moving story of her life and death weaves together how racial inequality and job insecurity contribute to the risk for many front-line workers. (STAT | 18 min read)

Features & opinion

How to put the fun into virtual conferences Organizing a virtual conference changed how sustainability researchers Christina Bidmon, Cristyn Meath and René Bohnsack think about academic exchange. “When COVID-19 hit, we optimistically thought, ‘We will take our conference virtual’,” they write. “In the process, we’ve found that, instead of thinking of online conferences as replacements-by-necessity for physical conferences that should resemble the ‘real thing’, we should try to accept them as an entirely different model of academic exchange.” They share their tips for using a conference platform, helping participants mingle and maintaining the fun factor. Nature | 4 min read

To improve quantum computers, keep away Christopher Monroe and his team spent three years setting up their quantum computer to be operated remotely. When the COVID–19 pandemic struck, those efforts paid off in an unexpected way: quantum computers work best without humans walking around the lab and producing vibrations or temperature fluctuations. Their machine “has kept running — all day, every day”, Monroe writes. “And the data have been excellent because the campus has been a ghost town.” The bigger lesson is that a remote mode of operation could hasten the development of these potentially revolutionary machines, Monroe says. Nature | 4 min read

Infographic of the week

From electric vehicles to smart grids, the path to a greener future is paved with lithium-ion batteries — lots of them. That means we need better ways to keep them cool. But the task has been hindered by a lack of a standard way to judge their thermal performance. Five engineers propose the cell cooling coefficient, a measure for the rate of heat removal from battery packs that gives manufacturers a simple way to compare products. (Nature | 8 min read)

Sure, I’ve baked some lockdown bread. I’ve even made jam. But conservation biologist William Sutherland cooked an entire Babylonian meal from a recipe chiselled on a tablet in 1750 BC — the oldest known cookbook in the world. Share your favourite old family recipe — or any feedback on this newsletter — with me at briefing@nature.com. Flora Graham, senior editor, Nature Briefing With contributions by David Cyranoski and Davide Castelvecchi

Freak pains and half-broken lungs persist months later

‘It’s frightening’: Doctors say half of ‘cured’ COVID patients still suffer

Bnei Brak woman tells The Times of Israel that a month after testing negative she has severe fatigue and anxiety – and her husband is worse than he was when hospitalized

By Nathan Jeffay 28 June 2020, 11:09 pm 9

• 
  
• 6,207 shares

A medical team at the coronavirus unit, in the Ichilov hospital, Tel Aviv, Israel, May 4, 2020. (Yossi Aloni/Flash90)

Recovered COVID patients are baffling doctors with complaints of freak pains, lungs that just won’t get back to normal, and a range of incapacitating psychological issues.
“What we are seeing is very frightening,” Prof. Gabriel Izbicki of Jerusalem’s Shaare Zedek Medical Center told The Times of Israel. “More than half the patients, weeks after testing negative, are still symptomatic.”

Izbicki is working on a study that involves follow-up with patients who were in hospitals or coronavirus hotels, looking at the aftereffects of the virus and trying to understand why patients continue to suffer long after being confirmed negative. “There is very little research about the mid-term affect of coronavirus,” he said, adding that it is much needed to guide doctors.

Get The Times of Israel's Daily Edition by email and never miss our top stories Free Sign Up

In Bnei Brak, at Israel’s first community clinic, doctors have been seeing a spike in recent days in the patients with pains that appear to come from nowhere.
“It can appear in the arms, legs, or other places where the virus doesn’t have a direct impact, and if you ask about the pain level on a 1 to 10 scale, can be 10, with people saying they can’t get to sleep,” said Eran Schenker, director of the month-old clinic in Bnei Brak run by Maccabi Healthcare Services. “It’s something which we’re starting to see much more in the last week.”

Man coughing (iStock)

‘Broken’ by the virus

A patient from the clinic spoke to The Times of Israel on condition that her name is not published. She was diagnosed in March and tested negative a month ago. But the woman, a Bnei Brak resident in her 40s, still has severe fatigue and anxiety, and can only walk for a few minutes at a time.

Her husband, who also caught coronavirus in March and tested negative last month, now “feels like he’s broken,” she said. “He’s actually worse than he was when he was hospitalized.”

Her husband, 55, had some health problems before contracting coronavirus in March, but was active “from morning until night,” with plenty of energy. He is now extremely lethargic, can hardly walk, and has heart problems, she said.

This came as a particular shock to the family, as during his initial hospitalization in March and early April he did not require oxygen and X-rays showed no damage to his lungs. He was hospitalized again during April with pneumonia-like symptoms, and declared negative in May. But the man then developed pains and significant breathing problems, and has seen cardiologists, neurology experts, rehabilitation teams, and other professionals at the clinic.

This man was “one of the hard cases, but he’s not the worst and we have patients who suffer more,” according to Schenker.

He said that with all illnesses patients can be left reeling from long hospitalizations, and ventilators use can slow full recuperation — but COVID-19 is causing patterns that are not usually seen.

“We’re amazed that people aren’t just suffering from the things we expected, but things we just weren’t aware would have relevance,” he told The Times of Israel. “It’s not textbook.”

He stressed that his patients are not all newly recovered. “Some of them had coronavirus in March, so they may have been recovered for months,” he said.

Gabriel Izbicki, head of the Pulmonary Institute at Jerusalem’s Shaare Zedek Medical Center (Shaare Zedek Medical Center)

Izbicki, director of Shaare Zedek’s Pulmonary Institute, also emphasized that many of his patients have long been declared coronavirus-free. One of the biggest surprises, he said, is that there is no predicting which patients will find the disease hard to shake, and which will not.
“There is no correlation between seriousness of disease during hospitalization and extent of symptoms afterwards,” he said, discussing preliminary results from his study on recovered patients who were treated in hospitals and coronavirus hotels.
“Within the symptoms that we checked for, we revealed general weakness among the majority of patients alongside shortness of breath, sustained cough, and other complex breathing and pulmonary issues,” he said, adding that he is also familiar with the freak pains that Schenker discussed.

These pains — seen in young patients and old alike — have doctors scratching their heads. Schenker said: “Painkillers block the pain but don’t relieve the source, but we don’t know how to address the source and you can’t be on painkillers the rest of your life.”

While the pains are excruciating for some, others describe the pains more as a major discomfort: burning sensations, tingling, or just a hard-to-place sense that a limb does not feel normal.

The patients with these pains do not normally raise red flags during the main medical examinations. Schenker said: “We check their lung and hearts and they have no disease, and they have no neurological issues. We do scans and can’t see anything, but they have this pain — we’re told about it again and again.”

Dan Oyero, deputy director of medicine in central Israel for Maccabi Healthcare Services (courtesy of Maccabi Healthcare Services)

Dan Oyero, Maccabi’s deputy director of medicine in central Israel, said that the overarching issue doctors are dealing with is the far-reaching change in people’s lives, for which doctors cannot predict an end point.
“The most distressing thing is that people compare how they feel now compared to how they were a few weeks ago before they were infected,” he said. “And they say they just can’t do the things they used to do.”
The sense of taste and smell, lost during the illness, sometimes does not return. When patients ask if it will come back, given that doctors have such limited experience of the disease, they cannot give a clear answer. “We just don’t know,” said Oyero.
When doctors can invoke a precedent from other illnesses, it can be bad news.

Elderly patients who were badly stricken by the coronavirus, even if they had no previous respiratory issues, can find their lungs working at half capacity, long after testing negative, said Schenker.

Eran Schenker, director of the clinic for recovered COVID patients in Bnei Brak run by Maccabi Healthcare Services (courtesy of Maccabi Healthcare Services)

“They have two lungs, but they are the equivalent of one, because each lung is working at 50% — and it could be like this for the rest of their lives,” he said. He draws this conclusion from the pattern of lung damage that is seen from some other diseases — but normally only affecting patients who had previous lung complications.
“The damage was not done by the virus, but by an inflammation process which, we know from other diseases, will not leave lungs with the capacity to exchange oxygen as before,” Schenker commented.
Izbicki said that in his experience, COVID-related lung damage can affect patients of all ages, and said he shares the concern that people will not regain full lung performance. “We don’t know if the lung function tests will become normal,” he said.
Some patients require physical therapy. Schenker said: “We’ve seen cases of weight loss that have been so extreme that people find it hard to walk.” Meanwhile, some who are physically able to move around just don’t have the energy or motivation to do so.

A recovered coronavirus patient sees a cardiologist at the special clinic in Bnei Brak run by Maccabi Healthcare Services (courtesy of Maccabi Healthcare Services)

Some of these patients are young and normally energetic, Schenker said.
“It’s amazing how many people went back to work — they can be educators, lawyers and in other professions — but when they sit for an hour they feel anxiety, feel insecure, and sometimes the people suffer from depression beyond what we expected.”

Oyero said:“The main complaints are actually fatigue, compacts [intense periods] of low energy — nothing we can give a name to. Many people say that they don’t have the energy they had before. They are more tired. Some say they don’t have the drive to do things. We can’t give the complaints a name or tell them they have a particular syndrome, but we’re trying to help them.”