Rutkowski notes physicians at Mount Sinai Health System in New York, who have treated hundreds of patients, reporting how dialysis catheters are getting plugged with clots and how clots have even formed on the tip of a catheter during an interventional procedure to remove a clot from the brain.

Confusion is a common problem the neurologists also are seeing in patients with COVID-19, but it's hard to know in some patients whether that results from the fact that they are so sick and their oxygen levels are low or it's a direct result of brain infection, Rutkowski says. In others there are clear cases of a brain infection and of virus present in the spinal fluid. As part of their study, which is just getting started, the neurologists will be looking at what happens to cognition and the sense of smell in survivors over time, Rutkowski says, noting that in some pandemics, a viral or bacterial infection actually sets off a neurodegenerative condition that worsens with time. In the wake of the Spanish Flu Pandemic of 1918, for example, physicians were seeing immediate problems like delirium and encephalitis lethargica, which causes troubles like excessive sleepiness and movement problems, and -- sometimes years later -- a form of Parkinson's. "We could have the same thing happening here," Hess says of the current pandemic.

Their new study now underway at MCG and AU Health System likely will be expanded in coming months to MCG campuses statewide, starting with Albany which has one of the highest per capita COVID-19 death rates in the country.

With ongoing concern about COVID-19, those interested in the study can participate remotely or in person. Those enrolled in person will be examined by an MCG neurologist at AU Health System and those enrolled remotely will undergo a telehealth neurological evaluation. Both remote and onsite evaluations will include cognitive testing and a scent identification test where study participants will be asked to identify different smells like chocolate, bubble gum and root beer, queries that will provide more objective measure of changes in the smell sense, Rutkowski says.

They also are taking a more comprehensive look on what type of neurological effects the virus has, and if there are risk factors like preexisting medical problems or gender-- males seem preferentially impacted by COVID-19 -- that make people more susceptible to those effects, Rutkowski says.

Participants will provide details like medications they are taking, demographics and any COVID-19 related symptoms. Those opting for remote participation will receive similar remote examinations annually for five years. Those who opt for onsite participation will be asked to provide blood samples within a month of diagnosis or soon after a follow-up test shows they are disease free, then again at three and 12 months, then yearly. Blood will be examined for markers of inflammation like cytokines and chemokines and genetic factors like changes in the ACE2 gene that may predispose to neurological problems. Blood also will be examined for the presence and levels off antibodies against the virus and antibodies against sugars coating the virus, both signs of an attack by the immune system.

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