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The loss of revenue to institutions and philanthropies due to COVID-19 has taken a toll on the neurology research enterprise. The exceptionstudies related to the novel coronavirus.

Furloughed technical staff. Cancelled fundraising walks. Paused grant reviews. Busted budgets.

In myriad ways, the financial foundations of neurology research have been undermined in just the first few months of the COVID-19 pandemic and may well grow worse in the months to come, according to academic neurologists and officials at the charitable organizations that fund their studies.

For sure, new opportunities for research funds related to COVID-19 are making up some of the difference. But doubts remain that they could cover all the losses.

Every passing month, it gets harder and harder, said Brett Kissela, MD, MS, FAAN, the Albert Barnes Voorheis Professor and Chair of the department of neurology and rehabilitation medicine at the University of Cincinnati College of Medicine. Our business people are looking at the books and seeing we've lost a huge amount of research-related revenue.

As senior associate dean for clinical research, Dr. Kissela has had a bird's eye view on how COVID-19 has affected all categories of medical research.

Some critical research, like cancer trials, we kept open, but otherwise we really had to shut down the non-COVID research enterprise, he told Neurology Today. We're still accruing expenses but not able to generate revenues. It's a huge financial hit.

One major source of research funding, he said, comes from pharmaceutical companies, which typically pay medical schools per patient enrolled in a given trial.

Some of the companies have really been hoping we can get started again, Dr. Kissela said. The longer a study goes, the more it costs them. We'd all like to re-start. But we can only go slowly. We don't want to put patients or staff at risk, and definitely don't want to become a hot spot.

Another major source of study funding, from charitable organizations, has also been hit hard by the pandemic.

It's had a big impact, said Howard Fillitt, MD, founding director and chief science officer of the Alzheimer's Drug Discovery Foundation. Across the board, in talking with our colleagues at other non-profits, we've heard that fundraising is down this year. It's a very difficult situation.

On the bright side, a spate of new funding opportunities has opened for studies looking at the neurologic component of COVID-19. But with labs forced to practice social distancing and patients reluctant to enter hospitals, even those studies may prove difficult for neurologists to implement.

So far at the University of Cincinnati, there have been no furloughs or work reductions for research staff, Dr. Kissela said.

The problem is, if you're too aggressive with furloughs or pay cuts, you could lose valuable people for when you're finally ready to get back to full employment, he said. We're beginning a cautious return to research now, and hoping we'll be able to return to full speed sometime soon.

The biggest impact has been on technical staff who cannot do their work from home, said D. James Surmeier, PhD, the Nathan Smith Davis Professor and Chair of Physiology at the Feinberg School of Medicine at Northwestern University.

The postdoctoral fellows and grad students are more flexible, said Dr. Surmeier, who researches the mechanisms underlying Parkinson's disease, Huntington's disease and chronic pain. But there's really very little the technical staff can do from home. They're not in the position to analyze data or write manuscripts. Their primary job function is to maintain animal colonies, do genotyping, to be in the lab where the equipment is.

Some staffers have children, whose schools have been closed, and so the staffers cannot come into the office. Even for those who can come in, the continuing need for social distancing is forcing Dr. Surmeier to establish shifts to maintain safety. That means studies must proceed more slowly.

Some funding agencies, like NIH, are being very understanding about the need for extended deadlines, Dr. Surmeier said. But some of our private funders have more limited resources. I completely understand their position: They have a limited amount of money to accomplish their goals. The result is that we are having to furlough some people. The staff can't work, and the funder has refused to pay for idle time.

Even with the no-cost extensions offered by NIH, he added, There is a continuing cost that we simply can't turn on and off at will. I'm afraid that we will be forced to significantly down-size our scientific infrastructure if the situation does not change soon.

Deborah A. Hall, MD, PhD, FAAN, the Parkinson's Foundation professor of neurological sciences and head of the movement disorders section at Rush University Medical Center, said she has not had to lay off any of her 13 research staffers yet, even though most have been forced to work from home.

We've spent a lot of extra time writing requests for grant extensions and deadline postponements, she said. Although clinics at Rush re-opened on May 11, she said, non-essential research activities had not been scheduled to resume until June 1.

We will have to stagger the schedules of research staff to keep them socially distanced, Dr. Hall said. My group has 115 active studies underway. We will have to make decisions about which studies open initially and which ones stay on pause.

The Alzheimer's Drug Discovery Foundation made grants totaling approximately $30 million last year, said Dr. Fillit. This year, he said, I don't want to be too negative. Our fundraising is in good shape. There's a lot of optimism that facilities will be re-opening. The research will go on.

Officials at other charitable organizations were not quite so rosy.

We're talking with our grantees about adjusting the scope of their programs where feasible and re-budgeting the needs they might have, said Heather Snyder, PhD, vice president of medical and scientific operations for the Alzheimer's Association. We know dementia is not stopping. We are working closely with our senior leadership and advisors to look at potential ways we can support particular projects, including where some might have increased costs.

Mark Frasier, PhD, senior vice president of research programs at the Michael J. Fox for Parkinson's Research (MJFF), said that the organization has no endowment, and spends essentially everything it brings in via donations. Last year, that amounted to over $100 million in grants, a record for the foundation.

In terms of new grant-making, we are seeing some adjustments, he said. There have obviously been cancellations of fundraising events.

One of the biggest, the Parkinson's Unity Walk in New York City's Central Park, had been scheduled for April 25, raised over $1.5 million last year. (The event benefits a number of PD organizations, including MJFF.) Many other events, scheduled as part of Parkinson's Awareness Month in April, were likewise cancelled.

We have not paused grant-making entirely, Dr. Frasier said. We are continuing to make grants, although we are being more careful and scrutinizing them to be sure they are of the utmost priority. The good news is that our fundraising, like that of most non-profits, is year-end heavy. Charitable giving increases around the holidays. Most of our fundraising occurs from October to December. We feel like that is a good thing. We may get closer to a recovery toward the end of the year.

Jennifer Bain, MD, PhD, assistant professor of neurology at Columbia University Irving Medical Center, said she is seeing a shift in the kinds of research opportunities being offered by funding agencies.

Previously funded research is continuing, but new research seems to be shifting toward COVID-19, said Dr. Bain, who specializes in the study of rare neurodegenerative developmental disorders. The Autism Science Foundation, for instance, is offering new pivot grants to help scientists facing hardship due to the COVID-19 emergency. It's been interesting to see the shift toward funding for how to transition your research in the world of COVID.

In April, for example, the National Institute of Neurological Disorders and Stroke announced it was seeking research on the biological effects of COVID-19 on the central nervous system; grant applications not to exceed $200,000 in direct costs, must be submitted by April 15, 2021.

Also, in April, the National Institute on Aging announced grants for research on improving the prevention of disease transmission among older adults and mitigation of disease severity and mortality in older adults with the virus. Applications are open until May 1, 2021.

Dozens of other COVID-related funding opportunities from the National Science Foundation, the US Department of Defense, the Centers for Disease Control and Prevention, NIH, the US Department of Health and Human Services, and other sources have been listed on a webpage of the University of Michigan

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