Rapid implementation of a cohort for the study of post-acute sequelae of SARS-CoV-2 infection/COVID-19

Abstract

BACKGROUND: As the coronavirus disease 2019 (COVID-19) pandemic continues and millions remain vulnerable to infection with severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), attention has turned to characterizing post-acute sequelae of SARS-CoV-2 infection (PASC). METHODS: From April 21 to December 31, 2020, we assembled a cohort of consecutive volunteers who a) had documented history of SARS-CoV-2 RNA-positivity; b) were ≥ 2 weeks past onset of COVID-19 symptoms or, if asymptomatic, first test for SARS-CoV-2; and c) were able to travel to our site in San Francisco. Participants learned about the study by being identified on medical center-based registries and being notified or by responding to advertisements. At 4-month intervals, we asked participants about physical symptoms that were new or worse compared to the period prior to COVID-19, mental health symptoms and quality of life. We described 4 time periods: 1) acute illness (0-3 weeks), 2) early recovery (3-10 weeks), 3) late recovery 1 (12-20 weeks), and 4) late recovery 2 (28-36 weeks). Blood and oral specimens were collected at each visit. RESULTS: We have, to date, enrolled 179 adults. During acute SARS-CoV-2 infection, 10 had been asymptomatic, 125 symptomatic but not hospitalized, and 44 symptomatic and hospitalized. In the acute phase, the most common symptoms were fatigue, fever, myalgia, cough and anosmia/dysgeusia. During the post-acute phase, fatigue, shortness of breath, concentration problems, headaches, trouble sleeping and anosmia/dysgeusia were the most commonly reported symptoms, but a variety of others were endorsed by at least some participants. Some experienced symptoms of depression, anxiety, and post-traumatic stress, as well as difficulties with ambulation and performance of usual activities. The median visual analogue scale value rating of general health was lower at 4 and 8 months (80, interquartile range [IQR]: 70-90; and 80, IQR 75-90) compared to prior to COVID-19 (85; IQR 75-90). Biospecimens were collected at nearly 600 participant-visits. CONCLUSION: Among a cohort of participants enrolled in the post-acute phase of SARS-CoV-2 infection, we found many with persistent physical symptoms through 8 months following onset of COVID-19 with an impact on self-rated overall health. The presence of participants with and without symptoms and ample biological specimens will facilitate study of PASC pathogenesis. Similar evaluations in a population-representative sample will be needed to estimate the population-level prevalence of PASC.

Post-COVID-19 Syndrome: Nine Months after SARS-CoV-2 Infection in a Cohort of 354 Patients: Data from the First Wave of COVID-19 in Nord Franche-Comté Hospital, France

“…Among the 354 patients included in our cohort study, 36% of patients reported the presence of one or more symptoms after at least 9 months (in the mean) after COVID-19 onset. The most common symptoms were fatigue, dyspnea, and pain symptoms, which is consistent with the literature thus far [ 1 , 2 , 3 , 4 , 11 , 12 , 16 ]. These findings suggested systemic chronic inflammation with abnormal pro-inflammatory cytokine expression, which was observed in patients following COVID-19 [ 17 ].…”

“…Some authors referred to ‘long COVID-19 syndrome’ [ 2 , 4 , 5 , 6 ], ‘post-COVID-19 syndrome’ [ 7 , 8 ], or ‘post-acute COVID-19 syndrome’ [ 3 , 9 ], a syndrome that can possibly have an impact on the quality of life of patients [ 10 ]. The most common persistent symptoms in COVID-19 are fatigue and breathlessness [ 8 , 11 , 12 ]. Neurological symptoms, such as headaches [ 4 , 5 , 8 , 11 , 12 ]; otorhinolaryngological symptoms [ 11 , 13 ], such as olfactory and gustatory dysfunctions; psychiatric symptoms, such as concentration problems, sleep difficulties, and anxiety [ 11 , 14 ] are also common long-term consequences of COVID-19.…”

“…The most common persistent symptoms in COVID-19 are fatigue and breathlessness [ 8 , 11 , 12 ]. Neurological symptoms, such as headaches [ 4 , 5 , 8 , 11 , 12 ]; otorhinolaryngological symptoms [ 11 , 13 ], such as olfactory and gustatory dysfunctions; psychiatric symptoms, such as concentration problems, sleep difficulties, and anxiety [ 11 , 14 ] are also common long-term consequences of COVID-19. Although considerable progress has been made in treating COVID-19, very little is known about the long-term consequences of this infection.…”

SARS-CoV-2 variants, spike mutations and immune escape

“…Genomic analyses indicate a change in host environment and signatures of increased selective pressures acting upon immunologically important SARS-CoV-2 genes sampled from around November 2020 (ref. 23 ). This coincided with the emergence of variants with higher numbers of mutations relative to previous circulating variants.…”

Mass spectrometry-based proteomics in basic and translational research of SARS-CoV-2 coronavirus and its emerging mutants

“…Examples include HCoVs differentiation from influenza and respiratory viruses [ 124 , 125 ]. In addition, RT-PCR/MALDI-TOF assays reveal high agreement with the conventional real-time RT-PCR and equivalent diagnostic sensitivity (97%) and specificity (100%), albeit four times higher limit of detection in saliva (1,563 versus 391 copies/mL) [ 126 ].…”