LOS ANGELES — It wasn’t exactly an emergency, but Michael Reed, a security guard who lives in Watts, had back pain and ran out of his blood pressure medication. Unsure where else to turn, he went to his local emergency room for a refill.

Around the same time, James Woodard, a homeless man, appeared for his third visit that week. He wasn’t in medical distress. Nurses said he was likely high on meth and just looking for a place to rest.

In an overflow tent outside, Edward Green, a restaurant cook, described hearing voices and needing medication for his bipolar disorder.

The three patients were among dozens who packed the emergency room at MLK Community Hospital, a bustling health care complex in South Los Angeles reincarnated from the old hospital known as “Killer King” for its horrific patient care. The new campus serves the 1.3 million residents of Willowbrook, Compton, Watts, and other neighborhoods — a heavily Black and Latino population that suffers disproportionately high rates of devastating chronic conditions like diabetes, liver disease, and high blood pressure.

Arguably, none of the three men should have gone, on this warm April afternoon, to the emergency room, a place intended to address severe and life-threatening cases — and where care is extremely expensive.

But patients and doctors say it is nearly impossible to find a timely medical appointment or receive adequate care in the impoverished community, where fast food is easy to come by and fresh fruits and vegetables are not. Liquor stores outnumber grocery stores, and homeless encampments are overflowing. A staggering 72% of patients who receive care at the hospital rely on Medi-Cal, the state’s Medicaid program for low-income people.

“For some people, the emergency room is a last resort. But for so many people who live here, it’s literally all there is,” said Dr. Oscar Casillas, who runs the department. “Most of what I see is preventable — preventable with normal access to health care. But we don’t have that here.”

The community is short 1,400 doctors, according to Dr. Elaine Batchlor, the hospital’s CEO, who said her facility is drowning under a surge of patients who are sicker than those in surrounding communities. For instance, the death rate from diabetes is 76% higher in the community than in Los Angeles County as a whole, 77% higher for high blood pressure — an early indicator of heart disease — and 50% higher for liver disease.

But dramatic changes are afoot that could herald improvements in care — or cement the stark health disparities that persist between rich and poor communities.

Gov. Gavin Newsom is spearheading a massive experiment in Medi-Cal, pouring nearly $9 billion into a five-year initiative that targets the sickest and costliest patients and provides them with nonmedical benefits such as home-delivered meals, money for housing move-in costs, and home repairs to make living environments safer for people with asthma.

The concept — which is being tested in California on a larger scale than anywhere else in the country — is to improve patient health by funneling money into social programs and keeping patients out of costly institutions such as emergency departments, jails, nursing homes, and mental health crisis centers.

The initiative, known as CalAIM, sounds like an antidote to some of the ills that plague MLK. Yet only a sliver of its patients will receive the new and expensive benefits.

Just 108 patients — the hospital treats about 113,000 people annually — have enrolled since January. Statewide, health insurers have signed up more than 97,200 patients out of roughly 14.7 million Californians with Medi-Cal, according to state officials. And while a growing number of Medi-Cal enrollees are expected to receive the new benefits in the coming years, most will not.

Top state health officials argue that the broader Medi-Cal population will benefit from other components of CalAIM, which is a multipronged, multiyear effort to boost patients’ overall physical and mental health. But doctors, hospital leaders, and health insurance executives are skeptical that the program will fundamentally improve the quality of care for those not enrolled — including access to doctors, one of the biggest challenges for Medi-Cal patients in South Los Angeles.

“The state is now saying it will allow Medicaid dollars to be spent on things like housing and nutritious food — and those things are really important — but they’re still not willing to pay for medical care,” Batchlor said.

Batchlor has been lobbying the Newsom administration and state lawmakers to fix basic health care for the state’s poorest residents. She believes that increasing payments for doctors and hospitals that treat Medi-Cal patients could lead to improvements in both quality and access. The state and the 25 managed-care insurance plans it pays to provide health benefits to most Medi-Cal enrollees reimburse providers so little for care that it perpetuates “racism and discrimination,” she said.

Batchlor said the hospital gets about $150, on average, to treat a Medi-Cal patient in its emergency room. But it would receive about $650 if that patient had Medicare, she said, while a patient with commercial health insurance would trigger a payment of about $2,000.

The hospital brought in $344 million in revenue in 2020 and spent roughly $330 million on operations and patient care. It loses more than $30 million a year on the emergency room alone, Batchlor said.

Medicaid is generally the lowest payer in health care, and California is among the lowest-paying states in the country, experts say.

“The rates are not high enough for providers to practice. Go to Beverly Hills and those people are overdosing on health care, but here in Compton, patients are dying 10 years earlier because they can’t get health care,” Batchlor said. “That’s why I call it separate and unequal.”

Newsom in September vetoed a bill that would have boosted Medi-Cal payment rates for the hospital, saying the state can’t afford it. But Batchlor isn’t giving up. Nor are other hospitals, patient advocates, Medi-Cal health insurers, and the state’s influential doctors’ lobby, which are working to persuade Newsom and state lawmakers to pony up more money for Medi-Cal.

It’ll be a tough sell. Newsom’s top health officials defend California’s rates, saying the state has boosted pay for participating providers by offering bonus and incentive payments for improvements in health care quality and equity — even as the state adds Medi-Cal recipients to the system.

“We’ve been the most aggressive state in expanding Medi-Cal, especially with the addition of undocumented immigrants,” said Dustin Corcoran, CEO of the California Medical Association, which represents doctors and is spearheading a campaign to lobby officials. “But we have done nothing to address the patient access side to health care.”

———

The hospital previously known as Martin Luther King Jr./Drew Medical Center was forced to shut down in 2007 after a Los Angeles Times investigation revealed the county-run hospital’s “long history of harming, or even killing, those it was meant to serve.” In one well-publicized case, a homeless woman was writhing in pain and vomiting blood while janitors mopped around her. She later died.

MLK Community Hospital rose from its ashes in 2015 as a private, nonprofit safety-net hospital that runs largely on public insurance and philanthropy. Its state-of-the-art facilities include a center to treat people with diabetes and prevent their limbs from being amputated — and the hospital is trying to reach homeless patients with a new street medicine team.

Still, decades after the deadly 1965 Watts riots spurred construction of the original hospital — which was supposed to bring high-quality health care to poor neighborhoods in South Los Angeles — many disparities persist.

Less than a mile from the hospital, 60-year-old Sonny Hawthorne rattled through some trash cans on the sidewalk. He was raised in Watts and has been homeless for most of his adult life, other than stints in jail for burglary.

He hustles on his bike doing odd jobs for cash, such as cleaning yards and recycling, but said he has trouble filling out job applications because he can’t read. Most of his day is spent just surviving, searching for food and shelter.

Hawthorne is one of California’s estimated 173,800 homeless residents, most of whom are enrolled in Medi-Cal or qualify for the program. He has diabetes and high blood pressure. He had been on psychotropic medicine for depression and paranoia but hasn’t taken it in months or years. He can’t remember.

“They wanted me to come back in two weeks, but I didn’t go,” he said of an emergency room visit this year for chronic foot pain associated with diabetes. “It’s too much responsibility sometimes.”

Hawthorne’s chronic health conditions and homelessness should qualify him for the CalAIM initiative, which would give him access to a case manager to help him find a primary care doctor, address untreated medical conditions, and navigate the new social services that may be available to him under the program.

But it’s not up to him whether he receives the new benefits.

The state has yielded tremendous power to Medi-Cal’s managed-care insurance companies to decide which social services they will offer. They also decide which of their sickest and most vulnerable enrollees get them.

One benefit all plans must offer is intensive care management, in which certain patients are assigned to case managers who help them navigate their health and social service needs, get to appointments, take their medications regularly, and eat healthy foods.

Plans can also provide benefits from among 14 broad categories of social services, such as six months of free housing for some homeless patients discharged from the hospital, beds in sobering centers that allow patients to recover and get clean outside the emergency room, and assistance with daily tasks such as grocery shopping.

L.A. Care Health Plan, the largest Medi-Cal managed-care insurer in Los Angeles County, with more than 2.5 million enrollees, is contracting with the hospital, which will provide housing and case management services under the initiative. For now, the hospital is targeting patients who are homeless and repeat emergency room visitors, said Fernando Lopez Rico, who helps homeless patients get services.

So far, the hospital has referred 78 patients to case managers and enrolled 30 other patients in housing programs. Only one has been placed in permanent housing, and about 17 have received help getting temporary shelter.

“It is very difficult to place people,” Lopez Rico said. “There’s almost nothing available, and we get a lot of hesitancy and pushback from private property owners not wanting to let these individuals or families live there.”

Patrick Alvarez, 57, has diabetes and was living in a shed without running water until July, when an infection in his feet grew so bad that he had several toes amputated.

The hospital sent him to a rehabilitation and recovery center, where he is learning to walk again, receiving counseling, and looking for permanent housing.

If he finds a place he can afford, CalAIM will pay his first month’s and last month’s rent, the security deposit, and perhaps even utility hookup fees.

But the hunt for housing, even with the help of new benefits, is arduous. A one-bedroom apartment he saw in September was going for $1,600 a month and required a deposit of $1,600. “It’s horrible, I can’t afford that,” he said.

Hawthorne needs help just as badly. But he’s unlikely to get it since he doesn’t have a phone or permanent address — and wouldn’t be easy for the hospital to find. The homeless encampments where he lives are routinely cleared by law enforcement officials.

“We have so many more people who need help than are able to get it,” Lopez Rico said. “There aren’t enough resources to help everyone, so only some people get in.”

———

L.A. Care has referred about 28,400 members to CalAIM case managers, roughly 1% of its total enrollees, according to its CEO, John Baackes. It is offering housing, food, and other social services to even fewer: about 12,600 people.

CalAIM has the potential to dramatically improve the health of patients who are lucky enough to receive new benefits, Baackes said. But he isn’t convinced it will save the health care system money and believes it will leave behind millions of other patients — without greater investment in the broader Medi-Cal program.

“Access is not as good for Medi-Cal patients as it is for people with means, and that is a fundamental problem that has not changed with CalAIM,” Baackes said.

Evidence shows that basic Medi-Cal patient care is often subpar.

Year-over-year analyses published by the state Department of Health Care Services, which administers Medi-Cal, have found that, by some measures, Medi-Cal health plans are getting worse at caring for patients, not better. Among the most recent findings: The rates of breast and cervical cancer screenings for women were worse in 2020 than 2019, even when the demands that COVID-19 placed on the health care system were factored into the analysis. Hospital readmissions increased, and diabetes care declined.

“The impact of COVID is real — providers shut down — but we also know we need a lot of improvement in access and quality,” said State Medicaid Director Jacey Cooper. “We don’t feel we are where we should be in California.”

Cooper said her agency is cracking down on Medi-Cal insurance plans that are failing to provide adequate care and is strengthening oversight and enforcement of insurers, which are required by state law to provide timely access to care and enough network doctors to serve all their members.

The state is also requiring participating health plans to sign new contracts with stricter quality-of-care measures.

Cooper argues CalAIM will improve the quality of care for all Medi-Cal patients, describing aspects of the initiative that require health plans to hook patients up with primary care doctors, connect them with specialty care, and develop detailed plans to keep them out of expensive treatment zones like the emergency room.

She denied that CalAIM will leave millions of Medi-Cal patients behind and said the state has increased incentive and bonus payments so health care providers will focus on improving care while implementing the initiative.

“CalAIM targets people who are homeless and extremely high-need, but we’re also focusing on wellness and prevention,” she told KHN. “It really is a wholesale reform of the entire Medicaid system in California.”

A chorus of doctors, hospital leaders, health insurance executives, and health care advocates point to Medi-Cal reimbursement rates as the core of the problem. “The chronic condition in Medi-Cal is underfunding,” said Linnea Koopmans, CEO of the Local Health Plans of California.

Although the state has restored some previous Medi-Cal rate cuts, there’s no move to increase base payments for doctors and hospitals. Cooper said the state is using tobacco tax dollars and other state money to attract more providers to the system and to entice doctors who already participate to accept more Medi-Cal patients.

When Newsom vetoed the bill to provide higher reimbursements primarily for emergency room care at MLK, he said the state cannot afford the “ tens of millions ” of dollars it would cost.

MLK leaders vow to continue pushing, while other hospitals and the powerful California Medical Association plot a larger campaign to draw attention to the low payment rates.

“Californians who rely on Medi-Cal — two-thirds of whom are people of color — have a harder time finding providers who are willing to care for them,” said Jan Emerson-Shea, a spokesperson for the California Hospital Association.

For Dr. Oscar Casillas at MLK, the issue is critical. Although he’s a highly trained emergency physician, most days he practices routine primary care, addressing fevers, chronic foot and back pain, and missed medications.

“If you put yourself in the shoes of our patients, what would you do?” asked Casillas, who previously worked as an ER doctor in the affluent coastal city of Santa Monica. “There’s no reasonable access if you’re on Medi-Cal. Most of the providers are by the beach, so emergency departments like ours are left holding the bag.”

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(KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation. This story is part of a partnership that includes WLRN, NPR and KHN.)

©2022 Kaiser Health News. Visit khn.org. Distributed by Tribune Content Agency, LLC.

They have prevented countless heart attacks and strokes and probably saved the lives of millions in the process.

And despite being heralded as game-changers when they were first rolled out to the masses in the 1980s, statins have got a bad rap in recent years.

On their way to becoming one of the most prescribed drugs in the world, a host of research began linking them to a wide range of debilitating side effects — from memory loss to muscle pain, migraines and even diabetes.

It is estimated that as many as half of users stop taking them entirely or don’t use them properly because of the supposed risks, which severely limits their cholesterol-lowering powers.

But a growing number of studies have started pushing back against claims statins are the true culprit behind all of the side effects, which many experts suspect are just as prevalent among people not on the drugs.

Yesterday, a landmark Oxford University study revealed muscle pains are no more common in people on statins, despite being listed as an official symptom by the NHS and health chiefs around the world.

That research, on more than 150,000 people, concluded that the symptoms are in fact caused by the natural effects of ageing. 

A similar theory might also explain why the drugs — taken by 8million Britons and 32million Americans — are constantly linked to memory and sight problems. 

Professor Sir Nilesh, medical director at the British Heart Foundation, told MailOnline: ‘Statins are an important and proven treatment for preventing coronary heart disease.

‘But their use has been clouded by the perception that they cause significant side effects, like muscle aches but also memory loss, sleep disturbance and erectile dysfunction. 

‘However, these complaints are not uncommon in the general population for a whole variety of reasons. Therefore when patients take a statin and develop such symptoms, they understandably attribute them to the statin when it may not be the cause.’

Statins are a group of pills that stop the liver producing ‘bad’ cholesterol, known as low-density lipoprotein (LDL) cholesterol. Over time, its build-up can lead to hardened and narrowed arteries and heart disease — one of the world’s leading causes of death.

People are currently prescribed statins if they have been diagnosed with the disease, or have a family history of it. The tablets, which cost just 20p a pill and are proven to be life-savers, are taken once a day.

Here, MailOnline breaks down the biggest myths around statins and their potential side effects: 

Millions are able to live normal lives thanks to the cholesterol-busting effects of statins but the drugs have been linked to numerous side-effects that put some off the medication. However, many of these supposed symptoms — including memory loss, diabetes and headaches — may actually be a result of other lifestyle factors, experts have found

Statins are the most widely prescribed drugs in the world, with around 8million Britons and 32million Americans taking them every day to cut their risk of heart complications due to high blood pressure

Muscle pain

The NHS lists muscle pain as one of the ‘common side effects’ of statins and also suggests weakness can be caused by the drugs.

But a review by Oxford University published in The Lancet on Monday suggests the aches and pains may actually be just the natural signs of old age. 

Researchers looked at rates of the side effects in 155,000 patients who took statins or placebos in 23 randomised trials. 

The history of statins

1976

Japanese biochemist Akira Endo isolates mevastatin — the first statin drug — from a fungus.

Animal trials showed the drug lowered cholesterol in dogs, rabbits and monkeys.

However, the drug was never marketed after rat trials showed it could be toxic.

1978

Alfred Alberts discovered lovastatin while working at Merck Research Laboratories.

It was also discovered independently by Dr Endo for the Sankyo company within a year. 

Merck began clinical trials in 1980, but were paused after Sankyo tests of the chemically similar mevastatin found it was toxic in animals.

But trials on lovastatin found no similar issues and in 1983 clinical development was restarted by Merck. 

1987 

Lovastatin becomes the first statin to be approved by the US Food and Drug Administration (FDA).

It reached sales of more than $1billion (£858million) in its first year.

1997 

Atorvastatin is approved. It is sold by Pfizer as Lipitor and is the most popular statin in use today.

It followed the approvals of pravastatin in 1991 and fluvastatin in 1994.

2012

FDA introduces safety warnings on statins stating a small increased risk of higher blood sugar levels and type 2 diabetes diagnosis. 

In total 27.1 per cent of patients on the drugs reported muscle pain or weakness, compared to 26.6 per cent of those who were given the placebo.

After the first year of treatment, there was no difference between those given statins and those given dummy tablets.

The researchers found stronger doses carried a slightly higher risk of muscle issues, but most cases are mild.

They said the results will help patients and doctors ‘make informed decisions’ when considering if they should stop taking their pills — and should continue taking them unless the drugs are proved to cause the pain.

Lead researcher Professor Colin Baigent, an epidemiologist at Oxford, said if a patient on statins suffers muscle pain, it is ‘most likely due to other causes’.

Cataracts

Statins have also been linked with an increased risk of developing cataracts.

Cataracts are when the lens, a small transparent disc inside the eye, develops cloudy patches. Over time these patches usually become bigger causing blurry, misty vision and eventually blindness.

Around 330,000 surgeries for the condition are performed every year in England alone, making it the most common operation in the country. They affect around 24.4million adults aged over 40 in the US.

A series of studies over the past two decades have suggested statins may significantly raise the risk of cataracts.  

But research by cardiologists at Peking University First Hospital in Beijing, China, concluded ‘there is no clear evidence showing that statin use increases the risk of cataracts’ in humans after a major review in 2016.

The review, published in the Journal of the American Heart Association, looked at 17 studies in the US, UK, Canada, Australia, Europe and Asia, with a total of more than 313,000 patients included.

Six of the papers compared cases in people given statins or placebos and all 17 investigated the risk of cataracts with statin use. Patients were aged from 30 to 85.

Overall, there was a 13 per cent increased risk of developing cataracts in six of the long-term studies that followed statins patients for at least five years.

Interestingly, the risk was actually 11 per cent lower in more rigorously controlled studies.

Writing in the journal, the authors said: ‘Based on the present meta‐analysis of these studies, we could only conclude that there is no clear evidence showing that statin use increases the risk of cataracts. 

‘The most likely case is that there is no association between statin use and cataracts. Because of the considerable benefits of statins in cardiovascular patients, this issue should not deter their use.’

Sir Nilesh told MailOnline: ‘The most likely case is that there is no association between statin use and cataracts. Because of the considerable benefits of statins in cardiovascular patients, this issue should not deter their use.’

Memory loss

The NHS lists memory problems as an ‘uncommon’ side effect of statins, while the US Food and Drug Administration (FDA) warns ‘some people have developed memory loss or confusion’ on the drugs’ labels.

WHAT ARE STATINS? 

Statins are a group of medicines that can help lower levels of ‘bad cholesterol’ in the blood.

Having too much of this type of cholesterol — called low-density lipoprotein (LDL) cholesterol — can lead to the thickening of the arteries and cardiovascular disease.

Statins work by stopping the liver from producing as much LDL.

Previous studies have found that the drug will prevent one heart attack or stroke for every 50 people taking it over five years.

The drug comes as a tablet that is taken once a day.

Most people have to take them for life, as stopping will cause their cholesterol to return to a high level within weeks.

Some people experience side effects from the medication, including diarrhoea, a headache or nausea.

People are usually told to make lifestyle changes in a bid to lower their cholesterol — such as improving diet and exercise habits, limiting alcohol consumption and stopping smoking — before being prescribed statins.

The medicines watchdog issued the warnings because some people on the drugs reported suffering with problems after starting the medication.

But researchers have found no evidence the drugs actually cause the issue, with studies in fact showing they can help reduce the chance of developing dementia in the long-term. 

High cholesterol is one of the main risk factors for the memory-robbing condition.

Experts at John Hopkins University in Baltimore, Maryland, reviewed 16 studies of more than 23,000 patients that measured people who were and weren’t taking the drug’s memory, attention and problem-solving.

The review, published in Mayo Clinic Proceedings in 2013, only included patients with no history of cognitive decline.

Three studies found there was no association between using statins and dementia, while five found the drugs actually improved the chances of staving off the condition.

Overall, people given statins had a 29 per cent lower incidence of dementia. 

Study author Dr Kristopher Swiger, a cardiologist at JHU, said: ‘All medications, including statins, may cause side effects, and many patients take multiple medicines that could theoretically interact with each other and cause cognitive problems. 

‘However, our systematic review and meta-analysis of existing data found no connection between short-term statin use and memory loss or other types of cognitive dysfunction. 

‘In fact, longer-term statin use was associated with protection from dementia.’ 

Researchers said it ‘makes sense that statins could be protective in the brain against dementia’ because reducing bad cholesterol improves blood flow to the brain.

This helps prevent vascular dementia particular, which is usually caused by blockages in small blood vessels in the brain.

Headaches

Statins have been widely linked to headaches since they first exploded on the scene.

But Sir Nilesh said the symptom may not actually be being caused by the drugs themselves.

Much like with muscle pains, headaches are an everyday occurrence that become more prevalent in old age, when people are more likely to start taking statins.

He told MailOnline: ‘Headaches are not uncommon symptom in the general population for a whole variety of reasons.

‘Therefore, when patients take a statin and develop such symptoms, they understandably attribute them to the statin when it may not be the cause.’

In fact, some researchers suggests the drugs should actually be prescribed to people who suffer a certain type of migraine.

Although it may sound counter-intuitive, they believe people who suffer migraines with aura could benefit more from taking the drugs because of their greater risk of heart attacks and stroke.

Around one in five women and one in 15 men suffer migraines, with a severe headache preceded by an ‘aura’ affecting vision balance and coordination in about 30 per cent of cases.

Writing in the British Journal of GPs in 2015, Dr David Kernick, a GP at the Exeter Headache Clinic, argued statins should be prescribed to people who suffer the condition earlier than the rest of the population.

But other experts say more evidence is needed before any rule change.

Professor Peter Weissberg, consultant cardiologist at the Addenbrooke’s Hospital in Cambridge and medical director at the BHF, said: ‘We would need more evidence, from randomised clinical trials or case controlled studies, that prescribing statins for people with migraine would indeed bring about a reduction in heart attacks and strokes before changing guidelines.

‘This may be because the processes underlying heart attacks and strokes are different in migraine sufferers from the rest of the population, in which statins have been shown to be beneficial.’

Diabetes

Health chiefs introduced safety warnings on statins bottles in 2012 due to concerns they may cause a small increased risk of higher blood sugar levels.

This can lead to type 2 diabetes, in theory.

However, the reality is not quite as clear-cut as that.

A paper by experts at the Albert Einstein College of Medicine in New York in 2017 found pre-diabetics are 36 per cent more likely to be diagnosed with the condition after taking statins.

But critics insisted the results, published in the British Medical Journal, did not conclusively show the cheap pills increase the risk of developing the full-blown condition in people with normal blood sugar levels.

Medics also insist the benefits of statins still outweigh the slim odds of developing diabetes – even for patients on the brink of being diagnosed.

Sir Nilesh told MailOnline: ‘The risk of developing diabetes is small.

‘And for the vast majority of patients in whom statins are recommended, the benefits far outweigh the risks.

‘Existing guidelines on who should be recommended a statin reflect the risks of possible side effects with the cardiovascular benefit to patients.’

Grapefruit 

Finally, many statin users are warned not to eat grapefruit because of the fruit’s effect on how the body processes the drug.

Grapefruit contains chemicals called furanocoumarins, which block an enzyme in the intestine that normally breaks down statins and some other drugs.

This means the statins build up in the bloodstream rather than being processed properly, which can increase the risk of other side effects.

But grapefruit only appears to have a large effect on certain statin medications, with others seeing little to no problems.

Atorvastatin, sold as Lipitor, lovastatin, sold as Mevacor, and simvastatin, sold as Zocor, are the only drugs known to be particularly affected by the chemicals, according to Dr Jorge Plutzky, an associate professor of medicine at Harvard Medical School.

In contrast, there appears to be no interaction in people taking fluvastatin (Lescol), pitavastatin (Livalo) pravastatin (Pravachol) and rosuvastatin (Crestor).

Sir Nilesh said: ‘If you take simvastatin, you shouldn’t drink grapefruit juice as it increases the concentration of the drug in the blood stream, increasing the risk of side effects. 

‘If you take another type of statin, limit your intake of grapefruit juice to very small quantities or you may want to avoid it altogether.’ 

PALO ALTO, Calif., Aug. 17, 2022 (GLOBE NEWSWIRE) — Scilex Holding Company (“Scilex”), a commercial biopharmaceutical company focused on developing and commercializing non-opioid therapies for patients with acute and chronic pain, today announced the signing of a Product Distribution Agreement (“Agreement”) for certain designated territories with CH Trading Group LLC (“CH Trading”), an international import, export and trading company focused on the Middle East and North Africa (MENA) Region and other markets, to distribute Scilex’s lead non-opioid commercial pain management product, ZTlido®. Scilex is a nearly 100% (or over 99.9%) majority-owned subsidiary of Sorrento Therapeutics, Inc. (Nasdaq: SRNE, “Sorrento”).

“Our Agreement with CH Trading is another significant step in our continuing efforts to expand our global presence with our portfolio of innovative non-opioid pain management products, to address unmet medical needs. We are extremely pleased to collaborate with CH Trading, whose deep expertise and relationships will help us build a solid foundation in key MENA Region and other markets,” said Henry Ji, Ph.D., Executive Chairman of Scilex and Chairman and Chief Executive Officer of Sorrento.

“We are pleased to work with CH Trading to help support us through the processes of obtaining global Halal certification as well as regulatory approval in the overseas designated territories, so that we may continue to fulfill our mission to address patient pain management needs with ZTlido®,” said Jaisim Shah, Chief Executive Officer of Scilex.

“We are delighted to work with a non-opioid pain management leader like Scilex for distribution of ZTlido® into these markets,” said Elsayed Zayan, CEO of the CH Group family of companies, which include CH Trading. “Our mission is to promote healthy, ethical and productive lifestyle, including bringing innovative products to people throughout the OIC countries and the GCC and MENA Regions. Aligning with Scilex’s global ambitions means that together we can help more patients, partners, and public health systems collectively benefit.”

Scilex Holding Company and Vickers Vantage Corp. I (Nasdaq: VCKA) (“Vickers”), a special purpose acquisition company sponsored by Vickers Venture Fund VI Pte Ltd and Vickers Venture Fund VI (Plan) Pte Ltd, have entered into a definitive business combination agreement (“BCA”) on March 17, 2022. Upon the closing of the transaction, the combined company (the “Combined Company”) will be renamed Scilex Holding Company, and its common stock and warrants to purchase common stock are expected to be listed on Nasdaq under the ticker symbol “SCLX” and “SCLXW,” respectively. The boards of directors of each of Vickers, Scilex and Sorrento have unanimously approved the proposed transaction. The closing of the transaction, which is expected to occur by the third quarter of 2022, is subject to the approval of Vickers’s shareholders and the satisfaction or waiver of certain other customary closing conditions.

About CH Trading Group

CH Trading Group LLC (“CH Trading”) is part of the CH Group family of companies ( www.chgroupus.com ). CH Group constitutes a diversified conglomerate targeting eight economic “Sectors”: healthcare, pharmaceuticals, food, finance, cosmetics, tourism, fashion, media/entertainment. Spanning a variety of multi-national products, services and solutions, its world mission involves connecting, developing and promoting, from Local to Global and throughout the world, all aspects of a wholesome, healthy and productive lifestyle.

CH Trading focuses on international import/export and trade, prioritizing the countries of the Organization of Islamic Cooperation (OIC) and Middle East North Africa (MENA) and Gulf Cooperation Council (GCC) Regions. It has responded to worldwide demands for identifying and securing supply chains by introducing innovative products, including from the US, and developing a robust distribution network for goods.

About Scilex Holding Company

Scilex Holding Company, a nearly 100% (or over 99.9%) majority-owned subsidiary of Sorrento Therapeutics, Inc., is an innovative revenue-generating company focused on acquiring, developing and commercialization of non-opioid pain management products for treatment of acute and chronic pain. Scilex is uncompromising in its focus to become the global pain management leader committed to social, environmental, economic, and ethical principles to responsibly develop pharmaceutical products to maximize quality of life. Results from the Phase III Pivotal Trial C.L.E.A.R. Program for SEMDEXA, its novel, non-opioid product for the treatment of lumbosacral radicular pain (sciatica), were announced in March 2022. Scilex targets indications with high unmet needs and large market opportunities with non-opioid therapies for the treatment of patients with moderate to severe pain. Scilex launched its first commercial product in October 2018, in-licensed a commercial product in June 2022, and is developing its late-stage pipeline, which includes a pivotal Phase 3 candidate and one Phase 2 and one Phase 1 candidate. Its commercial product, ZTlido® (lidocaine topical system) 1.8%, or ZTlido®, is a prescription lidocaine topical product approved by the U.S. Food and Drug Administration for the relief of pain associated with postherpetic neuralgia, which is a form of post-shingles nerve pain. Scilex in-licensed the exclusive right to commercialize Gloperba® (colchicine USP) oral solution, an FDA-approved prophylactic treatment for painful gout flares in adults, in the U.S. Scilex is planning to commercialize Gloperba® beginning in the first half of 2023 and is well-positioned to market and distribute the product. Scilex’s three product candidates are SP-102 (injectable dexamethasone sodium phosphate viscous gel product containing 10 mg dexamethasone), or SEMDEXA, a Phase 3, novel, viscous gel formulation of a widely used corticosteroid for epidural injections to treat lumbosacral radicular pain, or sciatica, with FDA Fast Track status; SP-103 (lidocaine topical system) 5.4%, a Phase 2, triple-strength formulation of ZTlido®, for the treatment of low back pain; and SP-104, 4.5 mg Delayed Burst Release Low Dose Naltrexone Hydrochloride (DBR-LDN) Capsule, for the treatment of chronic pain, fibromyalgia in multiple Phase 1 programs expected to be initiated this year. For further information regarding the SP-102 Phase 3 efficacy trial, see NCT identifier NCT03372161 –  Corticosteroid Lumbar Epidural Analgesia for Radiculopathy – Full Text View – ClinicalTrials.gov.

Scilex Holding Company is headquartered in Palo Alto, California, with operations in both Palo Alto and San Diego, California. For further information please visit www.scilexholding.com.

About Sorrento Therapeutics

Sorrento is a clinical and commercial stage biopharmaceutical company developing new therapies to treat cancer, pain (non-opioid treatments), autoimmune disease and COVID-19. Sorrento’s multimodal, multipronged approach to fighting cancer is made possible by its extensive immuno-oncology platforms, including key assets such as fully human antibodies (“G-MAB library”), immuno-cellular therapies (“DAR-T”), antibody-drug conjugates (“ADCs”), and oncolytic virus (“Seprehvec”). Sorrento is also developing potential antiviral therapies and vaccines against coronaviruses, including Abivertinib, COVISHIELD and COVI-MSC; and diagnostic test solutions, including COVIMARK.

Sorrento’s commitment to life-enhancing therapies for patients is also demonstrated by our effort to advance (TRPV1 agonist) non-opioid pain management small molecule, resiniferatoxin (“RTX”), and SP-102 (10 mg, dexamethasone sodium phosphate viscous gel) (SEMDEXA), a novel, viscous gel formulation of a widely used corticosteroid for epidural injections to treat lumbosacral radicular pain, or sciatica, and to commercialize ZTlido® (lidocaine topical system) 1.8% for the treatment of postherpetic neuralgia (PHN). RTX has been cleared for a Phase II trial for intractable pain associated with cancer and a Phase II trial in osteoarthritis patients. Positive final results from the Phase III Pivotal Trial C.L.E.A.R. Program for SEMDEXA, its novel, non-opioid product for the treatment of lumbosacral radicular pain (sciatica), were announced in March 2022. ZTlido® was approved by the FDA on February 28, 2018.

For more information visit  www.sorrentotherapeutics.com

About Vickers Vantage Corp. I

Vickers Vantage Corp. I is a blank check company formed for the purpose of effecting a merger, share exchange, asset acquisition, share purchase, reorganization or similar business combination with one or more businesses or entities.

Important Information for Investors and Stockholders

This press release relates to a proposed transaction between Scilex and Vickers. This press release does not constitute an offer to sell or exchange, or the solicitation of an offer to buy or exchange, any securities, nor shall there be any sale of securities in any jurisdiction in which such offer, sale or exchange would be unlawful prior to registration or qualification under the securities laws of any such jurisdiction. In connection with the transaction described herein, Vickers has filed a Registration Statement on Form S-4 (the “Registration Statement”), which includes a document that serves as a prospectus and proxy statement of Vickers, referred to as the proxy statement/prospectus. After the Registration Statement is declared effective by the SEC, the proxy statement/prospectus will be sent to all Vickers shareholders as of a record date for the meeting of Vickers shareholders to be established for voting on the proposed business combination. Vickers will also file other documents regarding the proposed transaction with the SEC. This press release does not contain all of the information that will be contained in the proxy statement/prospectus or other documents filed or to be filed with the SEC. Investors and security holders of Vickers are urged to read these materials (including any amendments or supplements thereto) and any other relevant documents in connection with the transaction that Vickers files with the SEC when, and if, they become available because they will contain important information about Vickers, Scilex and the proposed transaction. Investors and security holders will be able to obtain free copies of the Registration Statement, the proxy statement/prospectus and all other relevant documents filed or that will be filed with the SEC by Vickers through the website maintained by the SEC at www.sec.gov.

Participants in the Solicitation

Vickers and its directors and executive officers may be deemed participants in the solicitation of proxies from Vickers’s shareholders in connection with the transaction. A list of the names of such directors and executive officers and information regarding their interests in the proposed business combination will be contained in the proxy statement/prospectus when available. You may obtain free copies of these documents as described in the preceding paragraph.

Scilex and its directors and executive officers may also be deemed to be participants in the solicitation of proxies from the shareholders of Vickers in connection with the proposed transaction. Information about Scilex’s directors and executive officers and information regarding their interests in the proposed transaction will be included in the proxy statement/prospectus for the proposed transaction.

Non-Solicitation

This press release is not a proxy statement or solicitation of a proxy, consent or authorization with respect to any securities or in respect of the potential transaction and shall not constitute an offer to sell or a solicitation of an offer to buy the securities of Vickers, the Combined Company or Scilex, nor shall there be any sale of any such securities in any state or jurisdiction in which such offer, solicitation or sale would be unlawful prior to registration or qualification under the securities laws of such state or jurisdiction. No offer of securities shall be made except by means of a prospectus meeting the requirements of the Securities Act of 1933, as amended.

Forward-Looking Statements

This press release and any statements made for and during any presentation or meeting concerning the matters discussed in this press release contain forward-looking statements related to Vickers, Sorrento and its subsidiaries, including but not limited to Scilex, under the safe harbor provisions of Section 21E of the Private Securities Litigation Reform Act of 1995 and are subject to risks and uncertainties that could cause actual results to differ materially from those projected. Forward-looking statements include statements regarding the impact of CH Group’s expertise in helping expand the commercialization of ZTlido® in key Middle East and North Africa markets, the proposed business combination between Scilex and Vickers, including the timing of such business combination, the potential listing of the Combined Company’s common stock and warrants to purchase common stock on Nasdaq or other major securities exchange and the anticipated stock ticker symbol for such shares and warrants to purchase common stock, the expectation that Vickers will file subsequent amendments to the Registration Statement on Form S-4, the estimated or anticipated future results and benefits of the Combined Company following the proposed business combination, including the likelihood and ability of the parties to successfully consummate the proposed business combination, future opportunities for the Combined Company, the timing of the completion of the proposed business combination, Scilex’s and the Combined Company’s proposed business strategies, the expected cash resources of the Combined Company and the expected uses thereof; Scilex’s and the Combined Company’s current and prospective product candidates, planned clinical trials and preclinical activities and potential product approvals, as well as the potential for market acceptance of any approved products and the related market opportunity; statements regarding SP-102 (SEMDEXA), SP-103 or SP-104, if approved by the FDA; Scilex’s development and commercialization plans; and Sorrento’s products, technologies and prospects and Scilex’s products, technologies and prospects. Risks and uncertainties that could cause Sorrento’s and Scilex’s actual results to differ materially and adversely from those expressed in our forward-looking statements, include, but are not limited to: the inability of the parties to consummate the proposed business combination transaction for any reason or the occurrence of any event, change or other circumstances that could give rise to the termination of the BCA, including any failure to meet applicable closing conditions; changes in the structure, timing and completion of the proposed transaction between Vickers and Scilex; Vickers’s ability to continue its listing on the Nasdaq Capital Market until closing of the proposed transaction; the Combined Company’s ability to list its securities on Nasdaq or other major securities exchange after closing of the proposed transaction; the ability of the parties to achieve the benefits of the proposed transaction, including future financial and operating results of the Combined Company; the ability of the parties to realize the expected synergies from the proposed transaction; risks related to the outcome of any legal proceedings that may be instituted against the parties following the announcement of the proposed business combination; general economic, political and business conditions; risks related to the ongoing COVID-19 pandemic; the risk that the potential product candidates that Scilex develops may not progress through clinical development or receive required regulatory approvals within expected timelines or at all; risks relating to uncertainty regarding the regulatory pathway for Scilex’s product candidates; the risk that Scilex will be unable to successfully market or gain market acceptance of its product candidates; the risk that Scilex’s product candidates may not be beneficial to patients or successfully commercialized; the risk that Scilex has overestimated the size of the target patient population, their willingness to try new therapies and the willingness of physicians to prescribe these therapies; risks that the results of the Phase 2 trial for SP-103 or Phase 1 trials for SP-104 may not be successful; risks that the prior results of the clinical trials of SP-102 (SEMDEXA), SP-103 or SP-104 may not be replicated; regulatory and intellectual property risks; the risk that any requisite regulatory approvals to complete the transaction are not obtained, are delayed or are subject to unanticipated conditions that could adversely affect the Combined Company or the expected benefits of the proposed transaction or that the approval of Vickers’s shareholders is not obtained; the risk of failure to realize the anticipated benefits of the proposed transaction; the amount of redemption requests made by Vickers’s shareholders and other risks and uncertainties indicated from time to time and other risks set forth in Sorrento’s and Vickers’s filings with the SEC, including in the Registration Statement. Investors are cautioned not to place undue reliance on these forward-looking statements, which speak only as of the date of this release, and we undertake no obligation to update any forward-looking statement in this press release except as may be required by law.

Contacts:

For Scilex Holding Company

Jaisim Shah

Chief Executive Officer

Scilex Holding Company

960 San Antonio Road

Palo Alto, CA 94303

Office: (650) 516-4310

Email: jshah@scilexpharma.com

Website: www.sorrentotherapeutics.com and www.scilexholding.com

Investors and Media Contact:

Contact:

Brian Cooley

Email: mediarelations@sorrentotherapeutics.com

Website: www.sorrentotherapeutics.com

For Vickers Vantage Corp. I

Jeffrey Chi

Chief Executive Officer

85 Broad Street, 16th Floor

New York, NY 10004

Phone: (646) 974-8301

Email: jeff.chi@vickersventure.com

Website: www.vickersvantage.com

Investors and Media Contact: Nicolette Ten, Senior Account Executive, SPRG

Email: nicolette.ten@sprg.com.sg

Sorrento® and the Sorrento logo are registered trademarks of Sorrento Therapeutics, Inc.

G-MAB, DAR-T, Seprehvec, SOFUSA, COVISHIELD, COVI-MSC, and COVIMARK are trademarks of Sorrento Therapeutics, Inc.

SEMDEXA (SP-102) is a trademark owned by Semnur Pharmaceuticals, Inc., a wholly owned subsidiary of Scilex Holding Company. A proprietary name review by the FDA is planned.

ZTlido® is a registered trademark owned by Scilex Pharmaceuticals Inc., a wholly owned subsidiary of Scilex Holding Company.

Gloperba® is an exclusive, transferable license to use the trademark by Scilex Holding Company.

All other trademarks are the property of their respective owners.

© 2022 Sorrento Therapeutics, Inc. All Rights Reserved.

I blame it all on Robert Preston — my dislike of exercise and fitness, that is. Now that I’m 65 and unretired and someone with Type 2 diabetes, I’m trying to change my attitude and habits about exercising (with mixed success). If you’re in your 60s or so, I’m here to tell you how and why you might want to become more active, too.

Back to Robert Preston. I loved him in “The Music Man,” but if you’re around my age, odds are that when you were a kid in gym class, you, too, were subjected to Preston’s 1962 recording of the song “Chicken Fat.”

Composed for President Kennedy’s Council on Physical Fitness by “The Music Man” creator Meredith Willson, it played relentlessly while elementary, junior high and high school kids touched their toes, and did jumping jacks, push-ups and pull-ups to lines like this:

“Push up every morning. Ten times! Push up starting low.

Once more on the rise, nuts to the flabby guys, go you chicken fat, go.”

Turns out, I’m not the only one whose fear and loathing of exercise has a link back to childhood.

Bad memories from gym class

A 2018 Iowa State University study of phys ed memories found that embarrassment from being made to feel incompetent by the PE instructor or other classmates or lacking perceived competence in the activity or sport “may have powerful, long-lasting effects on attitudes and behavior.”

Loretta DiPietro, 65, who chairs our current president’s Physical Activity Guidelines Advisory Committee’s Aging Subcommittee, understands.

“You’re not the only one,” she told me. “When we ask older people, ‘Why aren’t you physically active?’ they say, ‘I’m not good at it.’”

It’s one reason DiPietro, a professor in George Washington University’s department of exercise and nutrition sciences, suggests we try to get more “physical activity,” not “fitness” or “exercise.”

Fitness and exercise, she says, “are scary words.”

Think ‘physical activity,’ not ‘exercise’

But physical activity, notes DiPietro, is “basically everything you do that uses your muscles and results in some ambulatory activity.” (That, I can do.)  

“So, walking across the room, lifting, carrying, raking leaves, doing laundry, it’s all good,” says DiPietro. And, she adds, “one of the best pieces of evidence that came from doing the recent [federal physical activity] guidelines is that it doesn’t have to be vigorous, physical activity to count.”

Richard Ashworth, president and CEO of Tivity Health, which owns the nationwide SilverSneakers community fitness program for people 65+ with Medicare Advantage plans, says: “The number one most impactful way you can live a higher quality life is to be physically active. If you want to live the longest, the best thing you can do is have more friends. But if you want to live the highest quality life, what you want to do is be physically active.”

The current federal guidelines say that, for substantial health benefits, adults should do at least 2 ½ hours to 5 hours a week of moderate-intensity physical activity (it doesn’t have to be all at once) or 1 hour and 15 minutes to 2 ½ hours a week of vigorous intensity aerobic physical activity or — and here’s the important part — an equivalent combination of moderate-and vigorous-intensity aerobic activity.

Plus, the guidelines advise, adults should also do muscle-strengthening activities of moderate or greater intensity on two or more days a week.

New thinking about the right physical activities

In fact, the U.S. government guidelines suggest what’s known as “multicomponent physical activity” to help reduce the risk of injury from falls or injury from falls. This means including more than one type of physical activity, such as aerobic, muscle strengthening and balance training.”

DiPietro says that in the past, experts “thought the only thing that mattered for health was vigorous physical activity.” But now, she notes, analysts have discovered that moderate-intensity activity, light-intensity activity and vigorous physical activity “all counts.”

Think of daily physical activity as a glass of water, DiPietro says.

“What you want to do is fill that glass of water. You could turn on the tap and get a real vigorous flow of water, which would fill it up quickly. Or you could do a little vigorous and then some moderate and then a weak stream that will fill it up over the course of the day. It doesn’t matter how you fill your glass,’ she notes. “You should just try and fill it every day.”

Any physical activity, DiPietro says, is better than sitting.

The biggest gain in benefits, the government says, happen when you go from no physical activity to being active for just 60 minutes a week or roughly eight minutes a day.

Troubling numbers for older Americans

Problem is, many of us — especially those of us around 65 — aren’t doing anywhere close to what the government recommends.

In fact, according to the U.S. Department of Health and Human Services’ Healthypeople.gov site, 31% of Americans 65 to 74 engage in no leisure-time physical activity. Overall, just 28% of men and 21% of women in the U.S. meet the government’s aerobic and muscle-strengthening guidelines.

You know, of course, all the bad things that can happen to you and your health if you’re an older adult and don’t exercise…er, get physical activity: an increased risk of falls, injuries, stroke, heart- and other chronic conditions and depression.

But the Centers for Disease Control and Prevention (CDC) also says people who do little or no physical activity are more likely to be hospitalized or die from COVID-19 than those who are more physically active.

But what exactly does the government mean by moderate intensity, vigorous intensity aerobic and muscle-strengthening activities and how can you do them?

A guide to types of physical activities

Let me take them one at a time:

Moderate intensity aerobic activities: These are ones that produce a noticeable increase in your breathing rate and heart rate. You can talk, but not sing, while you do them. Examples: walking briskly, riding a bike on level ground, pushing a lawn mower or playing doubles tennis or pickleball.

Vigorous intensity aerobic activities: These are ones that produce large increases in your breathing and heart rate. When you do them, you can’t say more than a few words without pausing for a breath. Examples: running, jogging, swimming laps, riding a bike on hills and playing singles tennis or basketball.

Muscle-strengthening activities: These involve all the major muscle groups and include things like using exercise bands, weight machines, hand-held weights; doing push-ups, pull-ups, planks, squats and lunges (Robert Preston!); gardening chores such as digging, lifting and carrying things as well as some yoga postures and some forms of tai chi. According to the Physical Activity Guidelines for Americans, 2nd Edition, these exercises “should be performed to the point at which it would be difficult to do another repetition.”

If you’ve been largely sedentary like me, the key is to increase the amount of physical activity gradually.

According to the government’s physical activity guidelines report, “it can take months for those with low fitness to gradually meet their activity goals.” It’s best to start muscle-strengthening activities one day a week at a light or moderate intensity, for example, and then raise the level to two or more days a week, increasing the intensity slightly along the way.

What I’m doing — or trying

I’ve started to take DiPietro’s advice and am trying to get more physical activity into my life and build my stamina.

Aside from walking my dog, I’m now also trying to walk stairs rather than take escalators or elevators and park my car further away from my destination to force myself to get in more steps.

The weekend volunteering I’ve begun for the Furniture Assist nonprofit entails lifting and carrying pieces of furniture and heavy bags of clothes from owners’ cars into the warehouse or from the warehouse to recipients’ trucks.

And I’ve just become a member of my local YMCA so I can start taking twice-a-week, 50-minute “Lite Total Body Fitness” classes.

My wife, Liz, and I recently rode bicycles on the Atlantic City boardwalk from, and to, the town of Ventnor — roughly 5 miles each way. (Biking against the wind was harder for me.)

We’ve also just started taking up pickleball, which is a cross between tennis and Ping-Pong. I enjoyed getting my heart pumping, but confess I had to sit down a few times due to heat exhaustion (a problem that’s not uncommon for people with diabetes).

DiPietro’s advice: hydrate, hydrate, hydrate. 

Passionate for Pickleball

“Pickleball is great for so many reasons,” DiPietro says. “It’s aerobic, it’s impact because you’re running on a court and it’s strategic, so it helps keep those marbles upstairs rolling around perfectly.”

A friend who’s roughly my age, public relations manager Rebecca Theim of College Park, Md., began playing pickleball a year ago. Now, she’s rabid about it.

“My goal is always to do at least a minimum of four to five days a week,” she told me.

Theim, who had a tennis scholarship while attending Northwestern University, now regularly enters pickleball tournaments. In fact, she and her partner were the second-best team from Maryland in the 2021 Maryland Senior Olympics.

Pickleball, she says, “is much more manageable than tennis — the court’s 40% of the size and the net’s about 6 inches lower.” Plus, she adds, it’s a lot less strenuous.

But playing pickleball is one reason Theim will be having surgery to replace both her knees in coming months. “I think it certainly accelerated it,” she says.

She also has Achilles tendinitis, which according to the Therapeutics Associates Physical Therapy website, “is often caused by a sudden increase in the amount or type of repetitive activity, such as going from never playing pickleball to playing it 4 times a week.”

How to get started becoming more active

I asked SilverSneakers’ Ashworth what retirees can do to become more physically active. His response: “If their doctor clears them to get started [with physical activity], walking is amazing,” Ashworth said. “Walking is a full-body activity — your arms, your core is engaged.”

DiPietro’s walking advice for older adults with diabetes: “Do that walking after each meal.”

Ashworth has three other suggestions to begin getting physical activity into your life in retirement: hiking, cycling and gardening. But, Ashworth says, “We all have different limits and capacities; knowing your own limitations is an important concept.”

DiPietro also recommends launching a walking plan, building up to a half-hour a day every day, especially if you don’t want a performance-based activity.

“Then, go to something fun like pickleball or a dance class or complementary exercises like tai chi,” she suggests.

Fitness and your finances

Ashworth mentioned a hidden benefit to getting regular physical activity: you can save money. By becoming healthier, you may be able to eliminate or reduce some of your prescriptions for ailments.

DiPietro says that for some people, physical activity means “I don’t have Type 2 diabetes anymore or I can go off my medication for hypertension.”

One CDC study found that people who attended a SilverSneakers gym or fitness class at least twice a week spent $1,250 less on healthcare in their second year of the program than those attending just once a week. The American Diabetes Association research showed that people with diabetes in SilverSneakers activities saved more than $1,600 in medical expenses their first year compared with others; they also had fewer hospitalizations.

Junking the old definition of retirement

DiPietro says trashing the traditional definition of retirement could help people in their 60s and older get more physical activity in their lives.

“I grew up in an era where older people were told, especially upon retirement, to relax and take it easy. And that is probably the worst advice we could have given,” she says. “The advice I have to give is: Use it or lose it. And that becomes especially so in older age.”

The National Institute on Aging has three free, helpful online tools to help you get started and keep going. There’s the Find Your Starting Point Activity Log; its guide to the four types of exercise (endurance, balance, flexibility and strength) and the Monthly Progress Test.

Remember, as the Chinese proverb says: a journey of 1,000 miles begins with a single step.

While working at a domestic violence nonprofit in Arizona during the height of the Covid-19 summer wave in 2020, Timmer wrote pandemic policies for her workplace, encouraging her colleagues to wear masks and, if they had been exposed to the coronavirus or had symptoms, get tested.

Timmer herself was not aware of being exposed or having any Covid-19 symptoms, such as cough or fever, but she started experiencing some unusual moments when she felt fatigued or forgetful, along with several episodes of confusion.

“They weren’t really putting that in the list of symptoms to go get tested for,” said Timmer, now 64.

That August, “the brain confusion was so unusual for me that I just thought, ‘I’m telling everyone to wear masks and follow these policies; I better go get tested, too,’ ” Timmer said. She decided to get tested for Covid-19 at a drive-up site.

“I never expected to be positive,” she said, adding that she was “devastated,” because she did not want to miss work.

Not only did she test positive, that was just the beginning of a long battle.

Emerging research suggests that a small portion of people who now live with long Covid may have showed no Covid-19 symptoms at all when they were initially infected — or their symptoms were mild or unusual, similar to what Timmer had.

‘This was my most terrifying time in my life’

Within about two weeks, Timmer had recovered from acute Covid-19 infection. But as she returned to work, she still felt unusual, with problems like overheating, confusion, loss of taste, sound hallucinations and breathlessness.

“I realized the more I tried to walk or return to normal, my symptoms worsened severely, and I would end up in bed with pain and fatigue for weeks,” Timmer said.

“This was my most terrifying time in my life,” she said.

Timmer retired early — before her illness, she had not made plans to retire — and moved to New Mexico in November 2020 to live with her sister while she sought treatment for her ongoing symptoms. In February 2021, she moved to Michigan to live with her son.

Some people with long Covid have said that they noticed their symptoms ease after they got vaccinated against Covid-19. Research also shows that vaccines not only reduce the risk of severe disease and hospitalization, they can lower the odds of long-term Covid-19 symptoms.

Timmer was originally diagnosed with Covid-19 before vaccines became available in the United States. Once they were authorized for her age group, she got vaccinated — and boosted. She felt good after the first vaccine dose, but her long Covid symptoms persisted.

Timmer still has “debilitating” symptoms from long Covid, and she is not alone.

One preprint paper, posted last year to the server MedRxiv, featured an analysis of more than 1,400 medical records in California for people who tested positive for Covid-19. It found that roughly 32% of those reporting long-haul symptoms more than 60 days following a Covid-19 diagnosis had no symptoms at the time of their initial Covid-19 test.

“I’ve seen similar stuff in clinic, as well. Patients coming in with either no symptoms or some very mild symptoms like sore throat, cough, maybe some sneezing, and a few weeks later, debilitating headaches, inability to get up in the morning or just unrelenting fatigue and weakness. And before we knew that long Covid was really a phenomenon, we didn’t know what to do,” said Dr. Ali Khan, who specializes in internal medicine at Oak Street Health in Chicago.

In some people, “we are seeing the coronavirus itself interact with almost every single part of the human body, which is just so atypical for most diseases, particularly most viruses. So we see that in some people — even in people whose initial infections were silent — it can work in the bloodstream to cause you to be more likely to get a blood clot,” he said. “For other people, that coronavirus is attacking the nerves, and it’s causing nerve pain; it’s causing headaches; it’s causing longstanding sciatica that many of my patients are dealing with.”

‘Even people who did not have COVID-19 symptoms … can have post-COVID conditions’

The US Centers for Disease Control and Prevention describes long Covid, or “post-Covid” conditions, as a wide range of new, returning or ongoing health problems four or more weeks after acute Covid-19 infection.

“Even people who did not have COVID-19 symptoms in the days or weeks after they were infected can have post-COVID conditions,” according to the CDC. “These conditions can present as different types and combinations of health problems for different lengths of time.”

The consensus in the medical field is that Covid-19 is an “acute illness” and long Covid is a “subacute chronic illness,” said Dr. Adupa Rao, a pulmonologist with the University of Southern California’s Keck Medicine who sees long Covid patients through Keck Medicine’s COVID Recovery Clinic.

“In the medical world, acute illnesses usually mean a week to two weeks of illness. Subacute means anywhere from two to four weeks and chronic means anything from four to six weeks on that is persistent,” Rao said. “So, the chronic long Covid symptoms are usually people that don’t return to their baseline or close to their baseline after the initial infection — and being able to diagnose long Covid is quite difficult.”

Estimates of long Covid’s incidence range from about 30% to more than half of people who have recovered from acute Covid-19 infection. Women and older adults appear to be more likely to have it than men and younger adults.Even though the risk of long Covid-19 appears to increase with the severity of acute Covid-19 infection, almost a third of people who had mild symptoms when they were originally diagnosed may still have symptoms months later, according to some estimates. “We do know that even a mild or relatively asymptomatic acute infection with Covid can eventually cause long Covid,” said Dr. Gerald Harmon, a family medicine specialist and president of the American Medical Association.

“Anywhere from 10% to 30% of patients can experience symptoms of Covid after apparently recovering, even if they weren’t sick in the first place,” he said. “And it’s a wide range of new, returning or ongoing health problems that we typically have put into three different categories.”

The first category, Harmon said, includes people who have direct cell damage that was caused by the coronavirus during the initial infection and takes a long time to recover from. Examples include acute kidney damage, acute lung damage, a big infection of pneumonia in the lung or a blood clot in the brain.

The second category describes people hospitalized with Covid-19 who may have long-term complications from being bed-bound for weeks, such as neurological damage, lung damage or muscle weakness.

Experts are “probably more concerned with” the third category, Harmon said. It includes anyone who recovered from an initial Covid-19 infection that wasn’t severe but then had symptoms.

“And they’re thinking, ‘My goodness, is this a recurrence of the Covid infection? Is it delayed? Is it a new something that’s masquerading as Covid? Or is it Covid masquerading as something more common, such as pneumonia?’ ” Harmon said.

One review paper analyzed 11 studies published between December 2019 and September 2021 on people with asymptomatic or mild forms of Covid-19. The analysis suggests that long Covid develops on average in about 30% to 60% of patients, with fatigue, shortness of breath, cough, or loss of taste and smell as the most common symptoms.

Many studies on long Covid tend to lump together people who initially had asymptomatic or mild infections, Dr. Linda Geng, co-director of Stanford Health Care’s Post-Acute COVID-19 Syndrome Clinic, wrote in an email.

For instance, one of that review paper’s findings was that presence of anosmia, or loss of smell, during an asymptomatic or mild course of the disease can be “predictive factors” for the development of long Covid. If there is anosmia, then someone is not completely asymptomatic, Geng wrote.

In other studies, “some of the patients who were labeled ‘asymptomatic’ may have had some symptoms that were not brought to medical attention or captured” in their electronic health records, Geng wrote.

“Some patients didn’t think they had COVID until getting tested and thought instead that it was just some allergies or something else. All that to say it can be hard to make clear conclusions from studies due to certain limitations and complexities. We need further study in this area,” she said. “Regardless, it is clear that you do NOT need to have severe acute COVID to develop Long COVID.”

‘She didn’t want to live in a wheelchair’

Los Angeles-based filmmaker Nick Guthe says his wife, screenwriter Heidi Ferrer, was among those who did not initially have a severe Covid-19 infection but still developed debilitating long Covid symptoms.

In April 2020, Ferrer showed signs of Covid toes — which involves discoloration and swelling — “and that concerned her because she had been reading about Covid, and she had some very mild GI symptoms that were a slightly upset stomach for a day or two. That made her think that she should get tested,” Guthe said. “So she didn’t have the serious pulmonary issues that some people have, where their breathing is really messed up.”

Guthe and Ferrer visited a drive-through Covid-19 testing site at the University of California, Los Angeles. They both had their cheeks swabbed and tested negative.

But within six weeks, Ferrer’s Covid toes had worsened, making it excruciating to walk. The woman who used to walk for 90 minutes a day could barely go 100 feet without stabbing nerve pain in her feet — similar to diabetic neuropathy.

On May 28, 2020, “I remember her birthday at my mom’s house very distinctly because she had to sit with her feet on a pillow and she couldn’t wear sneakers anymore. They were too painful. She had to basically wear them just to walk on pavement and then take them off whenever she got in the house, and she put her feet on pillows,” Guthe said. “It was her 49th birthday.”

As Ferrer’s symptoms progressed, Guthe said, she had severe gastrointestinal issues, exhaustion, a racing heartbeat from just getting out of bed, brain fog, changes in vision, intense tremors and internal vibrations, which led to weeks of insomnia.

“She had tremors in her upper torso and shoulders and upper extremities, but they weren’t in the legs yet, but that’s where she thought she was going to end up,” Guthe said. “And she didn’t want to live in a wheelchair.”

Even though Ferrer did not initially test positive for Covid-19, she had a cytokine panel done at a long Covid clinic in the San Francisco Bay area early last year to look for clues behind her symptoms, searching for inflammation and signs of long Covid.

When the results came back, Ferrer’s practitioner felt comfortable referring her to a long Covid clinic at Cedars-Sinai, Guthe said, but a mixup meant that referral letter arrived about 10 days later than intended.

It finally came on May 21, 2021 — a day before Ferrer took her life.

“I often wonder if it had arrived for her on the correct day — 10 days previous — would that have made a difference for her, because she would have felt some level of hope,” Guthe said. “But, I mean, hindsight is 20/20.”

Guthe hopes the medical community can learn from his wife’s story.

In the ER, on the day Ferrer died, Guthe said the doctor asked, ” ‘How long has your wife been depressed?’ And I said, ‘She wasn’t depressed. She was in excruciating pain from long Covid.’ And he said, ‘What’s long Covid?’ I said, ‘You’re kidding, right?’ And he said, ‘No, I don’t know what it is.’ ”

Guthe told the doctor to “just Google it.”

“May 22nd will be the anniversary of my wife’s suicide, and in some ways, it’s been extremely frustrating to see how little changed this year,” Guthe said. “The only thing that has changed is the public’s awareness of long Covid.”

Pulling back the curtain on long Covid

Although physicians know more about Covid-19 now than they did two years ago in the early days of the pandemic, the medical community still doesn’t “have all the answers” when it comes to the disease — and especially long Covid, said the American Medical Association’s Harmon.

The association held a special meeting of its House of Delegates in June at which delegates adopted a policy to show support for the development of specific medical codes for doctors to use when diagnosing and treating “post-acute sequelae of Covid-19,” or long Covid.In October, a diagnostic code was announced to specifically document post-acute sequelae of Covid-19 rather than active infection. Currently, there is no lab test that can definitively distinguish long Covid symptoms from other medical problems. But specific medical codes for long Covid can help health care providers when diagnosing and treating someone with a history of Covid-19 who has long Covid symptoms — or a completely different medical concern.

“It may have zero to do with your recent Covid infection or remote Covid infection,” Harmon said. “So if you’re having some symptom that you’re not sure about, talk to your doctor. You might simply have a different infection. You could have a pneumonia infection; you could be having had a tick bite and have a tickborne illness. You could have strep throat. You could have the flu.”

After all, “many things can masquerade as Covid, and unfortunately, post-Covid can masquerade as many things,” he said. “Right now, there’s no diagnostic tests per se — say, ‘let’s do a strep throat test; let’s do a flu test to see if you’ve got long Covid or not.’ There is no one test, so it becomes what we would call a diagnosis of exclusion.”

In other words, “you need to exclude other potential conditions that can cause those symptoms before attributing it directly to COVID,” Stanford Health Care’s Geng wrote in her email.

It is still “very difficult” for doctors to confirm when people who initially had asymptomatic or mild Covid-19 develop long Covid symptoms, Dr. Zijian Chen, medical director for Mount Sinai’s Center for Post-COVID Care, wrote in an email.

“We definitely have patients who have mild to no symptoms during a patient’s acute infection who then go on to develop long covid,” Chen said.

“The best we do is to evaluate the patient, and look for occult causes that are not covid. If we do not find another cause, and the covid infection happens relative to when the symptoms begin, we can say that it is likely the infection led to the patient developing symptoms,” Chen wrote, adding that “we do comprehensive evaluation to make sure there is not another cause.”

‘No one should be left behind’

Even though there is now a diagnostic code in the United States to help identify post-Covid symptoms, long Covid remains a mystery in medicine.

While spending time with her son in Michigan, Timmer often thinks about long Covid and how it manifests in her body. Sometimes, the exhaustion becomes overwhelming, her body aches, short-term memory loss makes conversations difficult, gastrointestinal issues are unrelenting, and there has been a constant, disruptive ringing in her ears.

There is still much to learn about Covid-19, and Timmer wants members of the medical community to know that they can and should listen to those with long Covid when seeking answers.

During her journey with Covid-19, she has “constantly” felt the need to defend her symptoms, and it’s “exhausting.”

“Long-haul asymptomatic people are unique in their awareness that these long haul symptoms are not normal and the fact medical procedures and tests do not reveal any issues for people,” Timmer said. “I hope the medical research continues and every long-haul survivor has the help needed to move forward, such as more clinics specializing in long-haul, medical insurance and transportation. No one should be left behind in the research of all things related to Covid-19.”