RESUMEN
Importance: SARS-CoV-2 infection can result in ongoing, relapsing, or new symptoms or other health effects after the acute phase of infection; termed post-acute sequelae of SARS-CoV-2 infection (PASC), or long COVID. The characteristics, prevalence, trajectory and mechanisms of PASC are ill-defined. The objectives of the Researching COVID to Enhance Recovery (RECOVER) Multi-site Observational Study of PASC in Adults (RECOVER-Adult) are to: (1) characterize PASC prevalence; (2) characterize the symptoms, organ dysfunction, natural history, and distinct phenotypes of PASC; (3) identify demographic, social and clinical risk factors for PASC onset and recovery; and (4) define the biological mechanisms underlying PASC pathogenesis. Methods: RECOVER-Adult is a combined prospective/retrospective cohort currently planned to enroll 14,880 adults aged [≥]18 years. Eligible participants either must meet WHO criteria for suspected, probable, or confirmed infection; or must have evidence of no prior infection. Recruitment occurs at 86 sites in 33 U.S. states, Washington, DC and Puerto Rico, via facility- and community-based outreach. Participants complete quarterly questionnaires about symptoms, social determinants, vaccination status, and interim SARS-CoV-2 infections. In addition, participants contribute biospecimens and undergo physical and laboratory examinations at approximately 0, 90 and 180 days from infection or negative test date, and yearly thereafter. Some participants undergo additional testing based on specific criteria or random sampling. Patient representatives provide input on all study processes. The primary study outcome is onset of PASC, measured by signs and symptoms. A paradigm for identifying PASC cases will be defined and updated using supervised and unsupervised learning approaches with cross-validation. Logistic regression and proportional hazards regression will be conducted to investigate associations between risk factors, onset, and resolution of PASC symptoms. Discussion: RECOVER-Adult is the first national, prospective, longitudinal cohort of PASC among US adults. Results of this study are intended to inform public health, spur clinical trials, and expand treatment options.
Asunto(s)
COVID-19 , Síndrome Respiratorio Agudo GraveRESUMEN
ABSTRACT Little is known about the pattern and course of recovery following acute COVID-19. Increasing numbers of reports describe persistent illness following infection with SARS-COV-2, also known as Post-Acute Sequelae of SARS-CoV-2 (PASC). This report describes the methods and results of a multi-pronged strategy to rapidly identify and enroll, over a one week period in April 2021, a racially and ethnically diverse sample of individuals and to characterize PASC among a this diverse sample. Participants were recruited through community outreach, clinical registries, and research registries across four cities in Illinois to complete an online survey. We examined presence of symptoms among 246 individuals who were at least three months past testing positive for SARS-CoV-2. Respondents were 70% female; 48% Hispanic/Latinx; 18% Black, and 28% White. Most had mild illness (78% were not hospitalized), and 26% reported they had not yet returned to their usual health within 3 months of their diagnosis. The most prevalent symptoms persisting 3-months following COVID-19 diagnosis included fatigue (20%), difficulty thinking (19%), problems with taste or smell (15%), and muscle or body aches (15%). In a multivariable logistic regression model, older age (40-59 vs. 18-39 years: adjusted odds ratio [aOR] = 0.46 [95% confidence interval, 0.24 to 0.90]) and having been hospitalized with COVID-19 (vs. not hospitalized: aOR = 0.28 [0.12 to 0.64]) were independently associated with a lower likelihood of recovery within 3 months. Compromised health continued well beyond the acute phase of COVID-19 in our ethnically diverse sample, especially among older individuals and those who were hospitalized. The partnerships with community- and faith-based organizations developed for the current study offer the potential to broadly disseminate study findings and to further understand and mitigate underlying determinants of risk, severity, and duration of PASC.