manifest; what is the mechanism behind the Covid symptom of anosmia (loss of smell), and does that mean the virus can enter the brain via the olfactory bulb; and what are the neural consequences of the “cytokine storm,” the disordered immune response associated with Covid-19. Silver Linings? Amid the chaos and confusion of science interruptus are a few silver linings that portend long-term benefits of pandemic-forced changes. One example cited by many is the rapid advancement of telemedicine in clinical care and its potential applications to research. In the clinical realm, the switchover to video-based medical visits had been slogging along for years, mostly limited to special populations who were unable to get to a doctor, but it had never really caught on as general practice. With Covid, it became an urgent necessity overnight, as doctor’s offices and hospitals shut their physical doors. Medical groups scrambled to get their systems in place, and barriers to insurance coverage of telehealth fell away. MacArthur, the Johns Hopkins University neurologist,
Nita Farahany / Duke
says the institution’s Covid experience “has been a springboard for incredible advancement in telemedicine visits, from just a handful to thousands and thousands.” While the adoption of telemedicine has catapulted far ahead of where it would be without a pandemic, “teleresearch” has been a little slower to follow, even as the possible applications span all phases of clinical research, from recruitment to e-consent to follow-up. Spurred by the need to sustain research progress during social distancing, researchers are making inroads into each of these areas. In an American Nurses Association webinar on Continuing Clinical Care During Shelter-in-Place, Lesli Skolaris, a stroke neurologist at University of Michigan, says her team has taken clinical trial recruitment “wholly virtual” and says they “may never go back to in-person recruitment.” Jeffrey Cohen, a multiple sclerosis researcher at the Cleveland Clinic, says their research team switched to virtual visits within a week of the Covid shutdown and has shifted some clinical trial assessments to
virtual as well, such as patient reporting or self-administered performance tests. “The old model of research, in which participants have to come to the study site, needs to be reassessed,” Cohen says. One area of need is for scientifically validated assessment protocols tailored for virtual platforms. The pandemic is also shifting the ground for scientific conferences of all sizes, as scores of meetings have been cancelled and others moved online. The 2020 annual meeting of the Federation of European Neuroscience Societies will be a completely virtual affair for the first time ever. So will the meeting of the American Neurological Association (ANA)—a move MacArthur, the current ANA president, predicts “is going to change academic life substantially.” Others say it signals the impending (and overdue) extinction of large in-person meetings that are carbon- intensive. “In every crisis is an opportunity,” Koroshetz says with an eye to the future. “For clinical neuroscience, it’s how to use these newer tools and put them into play over the long-term.” l
Shannon Agner / Washington University
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