Some coronavirus patients still have symptoms months after they are first infected, challenging the narrative that most people will survive the disease and move on.

Why it matters: As cases soar in the U.S., thousands more people will not only be hospitalized or die, but also will keep feeling the effects of the infection months from now.

Long-term symptoms range from neurological issues like “brain fogs” to an elevated heart rate.

• One study of Italian patients, published in JAMA, evaluated patients' symptoms several weeks after they'd been discharged from the hospital and tested negative for the virus. It found that only 12.6% of them were free of any coronavirus-related symptoms.
• Common symptoms among recovered patients include fatigue, difficulty breathing, joint and chest pain, cough and headache.
• Many of these patients are "younger and had previously been healthy, with Covid cases initially considered mild to moderate. But months later they are still sick, and some are getting worse," the Wall Street Journal reports.

What they're saying: David Putrino, director of rehabilitation innovation at Mount Sinai Health System in New York City, told WSJ that he thinks most patients with long-term symptoms are developing dysautonomia, a neurological condition that occurs when the autonomic nervous system is out of balance.

• It's not clear whether the condition is a result of an overactive immune system, the virus itself, or is a post-viral syndrome, Putrino said.
• Another explanation is chronic fatigue syndrome, which some scientists theorize can be caused by stressful events.

The bottom line: "I've been very concerned by friends and family who just aren't taking this seriously because they think you're either asymptomatic or dead," Hannah Davis, a patient who in June had been suffering from the virus for more than 70 days, told The Atlantic's Ed Yong. "This middle ground has been hellish."

The wide-ranging symptoms and many manifestations of COVID-19 are complicating efforts to treat the disease and stop its spread, Axios' Alison Snyder reports.

The big picture: There are very few diseases that everyone experiences the same. But the patterns of disease with COVID-19 are unusual compared to other recent pandemics, and it could usher in a new framework for thinking about disease.

The range of experiences in people infected with SARS-CoV-2, the virus that causes COVID-19, spans from no symptoms to hospitalization to death.

• "In SARS-Cov-2 , there is an extreme divergence in host responses. We don’t yet know what is leading to that," says immunologist José Ordovas-Montañes of Boston Children's Hospital.

Details: Many people have mild symptoms of the disease — or none at all — meaning they can unknowingly carry and spread the virus, complicating efforts to control its spread.

• On the other end of the spectrum are the roughly 1 in 5 people who are infected and need to be hospitalized.
• Beyond pneumonia and acute respiratory distress syndrome, the long and varied list of common manifestations of COVID-19 in hospitalized patients includes cardiac, neurological, renal, hepatic, gastrointestinal, endocrine, thrombotic, and dermatological complications, according to a recent review by Aakriti Gupta of the Columbia University Irving Medical Center.

Other viruses, like influenza, SARS-CoV-1 and Ebola, can affect the body in multiple ways.

• But with COVID-19, "the proportion of people in which this multiple organ injury is occurring is higher than anything we’ve seen before," says Gupta.

Go deeper.

The number of U.S. coronavirus cases exceeded 4 million on Thursday, Johns Hopkins data illustrates.

President Trump says he's canceled the Republican National Convention in Jacksonville, Florida, citing public health concerns over the coronavirus and a need to protect the public.

Senate Republicans' upcoming coronavirus relief proposal will not include a payroll tax cut, Treasury Secretary Steven Mnuchin told reporters Thursday.

New York Gov. Andrew Cuomo said Thursday the state prison system tested more than 3,922 prison inmates 55 years and older for COVID-19. 77 positive cases were found, or 1.9%.

No matter what's going on at home, schools have always been something of an equalizer — with all the neighborhood kids, richer and poorer, sitting behind the same desks in the same classrooms. Pandemic-induced remote learning is doing away with that, Axios' Erica Pandey reports.

Coronavirus infections in France have increased by 66% over the past three weeks, the country's health ministry said on Thursday.

A committee of Parliament members released a report Thursday saying they were "astonished by the government's failure to consider in advance how it might deal with the economic impacts of a pandemic," BBC reports.

President Trump spoke with Russian President Vladimir Putin about the coronavirus pandemic and arms control on Thursday, the Kremlin announced and the White House later confirmed.

South Korea went into recession Thursday after the pandemic caused exports to plunge, per Bloomberg. The economy contracted 2.9% in the April-June period following a fall of 1.3% in the first quarter — the worst economic performance in two decades.

Australia reported on Thursday its budget has hit an A$86 billion ($60.9 billion) deficit. It's the country's biggest deficit since World War II, and the government warned that number would grow to A$184 billion in the next financial year.

The governors in four of the states hit hardest by the coronavirus have taken a massive hit in public approval over their handling of the pandemic, according to SurveyMonkey poll data shared exclusively with Axios.

Why it matters: Florida Gov. Ron DeSantis, Texas Gov. Greg Abbott, Arizona Gov. Doug Ducey, and Georgia Gov. Brian Kemp — all Republicans — saw their ratings take a nosedive this month as coronavirus cases skyrocketed in their states, Axios' David Nather reports.

Between the lines: In all four states, there were sharp increases between May and July in how many people knew someone with the coronavirus.

• In Florida, for example, just 33% knew someone with the virus in the May 11–17 survey. By the July 13–19, that share had jumped to 55%.
• In Texas, the numbers for those weeks jumped from 32% to 62%.

The key to the sharp declines for the four GOP governors was a softening in their support among Republicans, according to SurveyMonkey chief research officer Jon Cohen.

• By contrast, California Gov. Gavin Newsom — a Democrat — still has 60% support for his handling of the virus even though cases have exploded there too (setting a record of more than 12,800 new cases on Wednesday).

The bottom line: The political damage from the coronavirus won't just be a factor in the presidential election. It's going to affect the political standing — and the legacies — of the governors in the hardest-hit states, too.

Quest Diagnostics, one of the largest lab testing companies, expects demand for coronavirus tests will grow even more over the next two months as faculty and students return to college campuses, more workers return to offices, more patients visit their doctor, and more people use retail testing locations.

Why it matters: These variables could further strain testing capacity, which has already been stretched to the limit due to the rising number of coronavirus infections, Axios' Bob Herman writes.

Driving the news: Universities, in particular, will require "a lot of testing required in the month of August," Quest Diagnostics CEO Steve Rusckowski said on an investor call Thursday.

• However, he said the company expects turnaround times for test results will get back to "acceptable levels that we've had in the past."

Between the lines: Private labs are going to be under a lot of pressure to do more tests a lot quicker to help identify and stem the spread of the virus, and the past four months has shown there are weaknesses in the system.

Go deeper: Why speedy test results matter