Health professional students at the University of Illinois Chicago (HOLISTIC) Cohort study: Prevalence of mental health and lifestyle behaviors effects among health professional students during the COVID-19 pandemic (preprint)

Background The COVID-19 pandemic adversely affected the mental health of healthcare workers. The World Health Organization estimates a 25% increase in anxiety prevalence during the pandemic. The mental health of students across the health professions during the pandemic is less well understood. Objectives To better understand the impact of the COVID-19 pandemic on health professional students, a cross-sectional analysis of data collected on enrollment in a cohort study was utilized to examine the prevalence of poor mental health days in association with lifestyle behaviors in seven health sciences colleges at a large public Midwestern university during the first two years of the COVID-19 pandemic. The study recruited 890 students enrolled full- or part-time across seven health sciences colleges in 2020 and/or 2021 using convenience sampling. Methods Participants completed questionnaires which included socio-demographic questions and items from the U.S. Centers for Disease Control and Prevention’s (CDC) Behavioral Risk Factor and Surveillance System (BRFSS) 2019 survey. Results The participants reported a median of 7 days with poor mental health (IQR: 3-15 days) in the past 30 days. Female sex (OR 1.70, 95% CI [1.21, 2.38]), Asian race (OR 1.47, 95% CI [1.06, 2.06]), adverse childhood events (OR 2.01, 95 % CI [1.45-2.78]), and frequent cannabis use (OR = 2.03, 95 % CI [1.14-3.61]) were each associated with an increased risk of poor mental health during the COVID-19 pandemic. Exercise (OR 0.64, 95 % CI [0.42-0.97]) was found to be a protective factor, during COVID-19. Conclusions and Implications Results indicate the need to design, implement, and evaluate services to support mental health in health sciences students, particularly among certain subgroups. Students who are frequent cannabis users or have significant childhood trauma are more likely to have poor mental health and as such may benefit from additional mental health support. Health promotions around home-based exercise and intramural sports to health professional students along with longer open hours for the gym may be beneficial.

Researching COVID to enhance recovery (RECOVER) adult study protocol: Rationale, objectives and design (preprint)

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.

Genetic and non-genetic factors affecting the expression of COVID-19 relevant genes in the large airway epithelium (preprint)

Particular host and environmental factors influence susceptibility to severe COVID-19. We analyzed RNA-sequencing data from bronchial epithelial brushings - a relevant tissue for SARS-CoV-2 infection - obtained from three cohorts of uninfected individuals, and investigated how non-genetic and genetic factors affect the regulation of host genes implicated in COVID-19. We found that ACE2 expression was higher in relation to active smoking, obesity, and hypertension that are known risk factors of COVID-19 severity, while an association with interferon-related inflammation was driven by the truncated, non-binding ACE2 isoform. We discovered that expression patterns of a suppressed airway immune response to early SARS-CoV-2 infection, compared to other viruses, are similar to patterns associated with obesity, hypertension, and cardiovascular disease, which may thus contribute to a COVID-19-susceptible airway environment. eQTL mapping identified regulatory variants for genes implicated in COVID-19, some of which had pheWAS evidence for their potential role in respiratory infections. These data provide evidence that clinically relevant variation in the expression of COVID-19-related genes is associated with host factors, environmental exposures, and likely host genetic variation.