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National

The mystery of how SARS-CoV-2 may cause brain fog or other neurological symptoms in some people is driving new global research.

Why it matters: Roughly 79 million Americans contracted COVID-19 in the first two years of the pandemic. While most survived, many are grappling with long-term symptoms, or long COVID, that affect the brain and other body systems.

"Neuro-long COVID is a very important problem in the U.S. It affects millions of people and leads to people not being able to work the way they used to, or to lose time from work," Igor Koralnik, chief of neuro-infectious diseases and global neurology at Northwestern Memorial Hospital, tells Axios.

There's an "urgent need" to research the disorders and develop therapies, NIH's Avindra Nath and Yale's Serena Spudich wrote in a January Science perspective. 

"It's the third-most frequent neurological condition in the U.S. today," says Koralnik, who started a long COVID clinic in May 2020 that's treated about 1,200 patients.

Some of the big questions researchers are trying to answer: if and how the virus is breaching the protective blood-brain barrier, how it is damaging the brain, and if the effect is permanent. 

Most of the accumulated data so far is based on adults, so there's less known about how the virus affects the brains of older teens or children and infants.

Accessing the brain: The blood-brain barrier often prevents many germs from reaching the brain, but certain pathogens are able to breach it.

Whether SARS-CoV-2 has the ability to directly cross that barrier remains in question, although recent studies indicate it can.

Autopsies have also found SARS-CoV-2 infections in cells near the brain can inflame the brain-barrier cells and that this inflammation can be relayed into the brain's neurons and glial cells.

Koralnik's team published a study this week that found biomarkers in blood plasma that suggest the brain's supportive glial cells are activated — indicating there is inflammation — and neurons were found to be damaged in both long COVID patients who'd had mild disease and those who had been hospitalized with severe symptoms.

Tracking damage: Some MRI studies link brain lesions to the virus, although those were not found in all patients. 

A study of 785 people aged 51 to 81 published this week in Nature indicates COVID can shrink the size of the brain, so that months after infection some people show as much as a decade of normal aging.

People infected with even mild cases showed cognitive decline, degeneration in parts of the brain, and brain shrinkage, says co-author Anderson M. Winkler, senior associate scientist at the National Institute of Mental Health.

Comparing MRI scans before and after the pandemic started, infected participants "may have lost 2.9% gray matter in a given brain region, whereas non-infected participants will have lost only 0.9% over the same three-year period," Winkler tells Axios.

"The data available for the study doesn't allow us to indicate a specific mechanism for the effects observed; these can be because the virus invades the brain, or because of the inflammation it causes," Winkler adds.

Long-term implications: Whether this damage is permanent is unknown as the brain has a remarkable ability to recover or compensate for certain damage. 

But, there is some concern it might accelerate or trigger early Alzheimer's or Parkinson's diseases.

A JAMA Neurology study out this week followed 1,438 COVID survivors and 438 uninfected people from Wuhan, China, all 60 or older, for more than a year. They found a "markedly higher" risk of dementia in those who had experienced severe COVID. The risk appears to increase for those with mild symptoms as well.

But Winkler says there's still much unknown. "Small previous studies using functional imaging seem to indicate improvement over time" of brain function, he says.

What's next: NIH and others are working to determine if the changes are reversible, if they affect younger individuals the same as older ones, if changes in the brain are directly related to the brain fog people experience, and what the best therapeutic options will be.

COVID linked to brain damage in scent areas

Axios-Ipsos poll indicates long COVID prevalence

Long COVID leaves patients and researchers in a maze of questions

Editor's note: This story originally published on March 10.

How COVID can damage the brain

"It's the third-most frequent neurological condition in the U.S. today."

A pixelated illustration of a brain vibrates in place and is blurry

COVID-19

Coronavirus

News and analysis of the scientific advances fueling AI and quantum computing, revolutionizing biology and medicine, and tackling climate change. Science is changing the world and colliding with the global politics that shape it.

Science

The U.S. health system faces critical questions about cost, access and equity. Technological advances and new discoveries about diseases like cancer and Alzheimer’s are transforming patient care and reshaping public health.

Health

Pharmacies that say they've been a linchpin in the U.S. pandemic response are pressing for key regulatory changes and higher payment rates to cement their enhanced role in patient care.

Why it matters: Pharmacies have become fixtures of pandemic life through testing, vaccinations and, increasingly, dispensing antivirals. But pharmacists say they're being shortchanged, because they can't prescribe COVID pills and receive prohibitively low fees to dispense them.

Driving the news: The Biden administration's test-to-treat initiative, which began this week, has ignited a fierce debate over what pharmacists can and cannot do.

The initiative allows patients to get tested for COVID in a pharmacy and be prescribed antivirals at the same location if they're found to be positive. But only pharmacies with qualified providers — like those with on-site clinics — can participate, under the FDA authorization for both Merck and Pfizer's COVID antivirals.

Pharmacists are pushing for the FDA exclusion to be lifted so that they can take part in the effort, which they say will ultimately expand access to the antivirals.

Under current policy, "Americans who test positive at a pharmacy will only be able to access time-sensitive oral antivirals, on the spot, from a limited number of pharmacies with in-house access to non-pharmacist prescribers, primarily in metropolitan areas," a group of pharmacy associations wrote yesterday in a letter to the administration. 

The big picture: The push isn't the first time during the pandemic that  pharmacists have argued they are well-qualified for a more active role in patient care. 

They say that certain emergency powers the government granted on a temporary basis has provided the opportunity to shine.

"We've proven our worth during the pandemic, and we need a federal law that allows us to do what we've already been doing — to test and treat patients," said Scott Knoer, CEO of the American Pharmacists Association.

Between the lines: Broadening pharmacists' formal role in patient care could open the door to them getting paid more. 

For example, pharmacists are currently only paid a dispensing fee for the antivirals by pharmacy benefit managers, which many have argued is prohibitively low. Other providers — like physician assistants and nurse practitioners — can bill for professional fees.

But even if pharmacists are allowed to order the pills for patients, there's no clear mechanism under current law for them to get paid the way other providers are, pharmacists say.

"We need to have a professional fee," Knoer said. "Folks that would want to do antivirals on a large scale, if there wasn't reimbursement for it, that wouldn't be long-term viable."

The other side: The American Medical Association has argued that expanding prescribing authority is dangerous.  

"Leaving prescribing decisions this complex in the hands of people without knowledge of a patient's medical history is dangerous in practice and precedent," the organization recently said in a statement.

What we're watching: The pharmacists are set to lose their enhanced role when the public health emergency expires, setting up a test of how policymakers will approach a post-pandemic future.

Without any changes, pharmacies worry that they won't have federal authority to administer tests and vaccines, though state policy varies.

Nor will there be a clear payment mechanism for them to be reimbursed for these services.

"If we don't have payment reform, pharmacy isn't going to be around like we were for the next pandemic," Knoer said.

Pharmacists push for enhanced role in post-pandemic life

They say they need more federal authorities — and higher payments.

Illustration of a turn over pill bottle the pills forming an upward trending arrow

Pharmacies

Finish Line

Axios Finish Line

From Axios Finish Line, here's a stat to savor: America was the world's most generous country this past decade, according to the Charities Aid Foundation's World Giving Index, which surveyed 1.3 million people in 125 countries. 

Not only do we give money, but 72% of Americans help strangers and 42% of us volunteer.

We grew more generous during the pandemic: 2020 and 2021 donations each topped 2019.

Why it matters: This cuts across religion, region and age, with nearly 60% of Americans giving money last year. Average donation: $574.

Trend to watch: There's a big surge in people setting up Facebook and TikTok fundraisers in lieu of birthday presents. You might roll your eyes at the exhibitionist dimension of public giving ... but it beats the alternative. 

Facebook says birthday fundraisers bring in hundreds of millions of dollars a year. Top beneficiaries include St. Jude Children's Research Hospital, the Alzheimer's Association, the American Cancer Society and No Kid Hungry.

An even newer, real-time wave to surf: Booking an Airbnb stay in Ukraine — not to visit but as a way to send money to a family in need.

Last week, 61,000 nights were booked at Airbnbs in Kyiv and other cities — 34,000 of them by Americans. 

Tip to go: Be careful when giving. These four sites, all recommended by the Federal Trade Commission, let you verify whether a charity is reputable: 

And remember, if you want a deduction, you can make sure the charity qualifies by hitting the IRS Tax Exempt Organization Search.

Editor's note: This story originally published on March 8.

America the generous: U.S. leads globe in giving

Not only do we give money, but 72% of Americans help strangers. 42% of us volunteer.

Illustration of Uncle Sam holding a dollar bill

Charities

2024 will be an election year like no other, as President Biden seeks re-election amid economic uncertainty, two wars and questions about his age. His likely foe, former President Trump, faces felony charges and vows revenge on his political enemies. Meanwhile, Americans generally are dissatisfied with those choices and are divided over immigration, race, education and more.

Politics & Policy

The first installment of the next phase of our Hard Truths series explores what's being tried to solve the problems of race and elections.

Race and voting: The path forward

The next phase of our Hard Truths series explores the efforts to find solutions.

Photo illustration of a young Black man with the word "VOTE" painted on his forehead. 

Photo illustration: Aïda Amer/Axios. Photo: Stephen F. Somerstein/Getty Images

Deep Dive: Hard Truths - Voting

Latino

Axios Latino

Nick Fuentes, identified as a "white supremacist" in Justice Department filings, made headlines last week for hosting a white nationalist conference in Florida. His father is also half Mexican American. 

The big picture: Fuentes is part of a small but increasingly visible number of far-right provocateurs with Hispanic backgrounds who spread racist, antisemitic messages.

Driving the news: Cuban American Enrique Tarrio, the former leader of the Proud Boys, a group the Anti-Defamation League calls an extremist group with a violent agenda, was arrested Tuesday and charged with conspiracy in connection to the Jan. 6 Capitol riot.

What they're saying: Experts tell Axios far-right extremism within the Latino community stems from three sources: Hispanic Americans who identify as white; the spread of online misinformation; and lingering anti-Black, antisemitic views among U.S. Latinos that are rarely openly discussed.

Brian Levin, director of the Center for the Study of Hate and Extremism at Cal State University, said in an interview that the trend is "part of the mutation that takes place as the racist fringe tries to become more mainstream." 

Racism is deeply rooted in Latin American and Caribbean nations, where slavery was common, Tanya K. Hernández, a Fordham University law professor and author of the upcoming book, "Racial Innocence: Unmasking Latino Anti-Black Bias," told Axios. "In Latin America, white supremacy is alive and well.” 

Even families who have been in the U.S. for generations can often bring those biases with them. 

Between the lines: The U.S. trend, fueled over the course of Donald Trump's presidency and the pandemic, extends beyond movement leaders to a broader network of participants, some of whom have faced hate crimes charges. 

Last month, Jose Gomez III, 21, of Midland, Texas, pleaded guilty in federal court to three counts of committing a hate crime for attacking an Asian American family, including two children, he believed to be responsible for the pandemic.

In 2018, Alex Michael Ramos, a Puerto Rican resident of Georgia, was sentenced by a Virginia District Court to six years in prison for his role in a beating of a Black man in Charlottesville, Virginia, following the "Unite the Right" rally.

Christopher Rey Monzon, a Cuban American man and member of the neo-Confederate group League of the South, was arrested in 2017 for attempting to assault anti-racist protesters in Hollywood, Fla. He later resigned from the group and said he regretted using slurs for Black and Jewish people.

Context: At the conference in Orlando, which made headlines because U.S. Rep. Marjorie Taylor Greene (R-Ga.) accepted an invitation to speak, Fuentes drew attention for comments of his own:

"And now they’re going on about Russia and Vladimir Putin is Hitler — they say that’s not a good thing..." He then laughed and said, "I shouldn't have said that."

Fuentes has questioned the Holocaust, criticized interracial marriage and defended Jim Crow-era segregation. The ADL describes him as "a white supremacist leader and podcaster who seeks to forge a white nationalist alternative to the mainstream GOP."

Proud Boys leader Enrique Tarrio, wearing a shirt supporting Derek Chauvin, watches protest on the one-year anniversary of his death at the hands of a police officer, in Miami.

Proud Boys leader Enrique Tarrio wears a shirt supporting Derek Chauvin, the police officer convicted of killing George Floyd. Photo: Chandan Khanna/AFP via Getty Images

Tarrio, 38, has previously faced charges: He was sentenced to five months in jail for setting fire to a Black Lives Matter banner stolen from a historic Black church in Washington, D.C. 

"I'm pretty brown, I'm Cuban. There's nothing white supremacist about me," Tarrio told Insider in 2020.

But Tarrio was suspended from Twitter in 2019 for posting anti-immigrant threats, has denigrated transgender people and has used racist language to describe a Black actor.

But, but, but: There are limits to how accepted some far-right Latino activists can become in white supremacist and neo-Nazi circles, Mark Pitcavage, a senior research fellow at the ADL's Center on Extremism, told Axios.

Some extremists on 4chan and 8chan say Fuentes' Latino heritage disqualifies him from speaking on white supremacy, Pitcavage said. Meanwhile, some white supremacist elements of the Proud Boys dismiss Tarrio as a leader but so far he has withstood the criticism, said Pitcavage, who monitors the chats.

Tarrio's lawyer, Lucas Dansie, did not respond to emails seeking comment. Fuentes' American First Foundation also did not respond to requests for comment. 

What we're watching: U.S. Latinos identifying as multiracial soared during the last decade, while those identifying as solely white dropped significantly, according to the latest census.”

 Subscribe to Axios Latino and get more news that matters about Latinos and Latin America, delivered right to your inbox on Tuesdays and Thursdays.

Editor's note: This story first published on March 10.

The rise of white nationalist Hispanics

Experts say the far-right extremism among some Latino residents stems from those identifying as white  and anti-Black sentiment.

Axios

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