Research on the Epidemiology of SARS-CoV-2 in Essential Response Personnel (RECOVER): Protocol for a Multisite Longitudinal Cohort Study

Abstract

Background Workers critical to emergency response and continuity of essential services during the COVID-19 pandemic are at a disproportionally high risk of SARS-CoV-2 infection. Prospective cohort studies are needed for enhancing the understanding of the incidence of symptomatic and asymptomatic SARS-CoV-2 infections, identifying risk factors, assessing clinical outcomes, and determining the effectiveness of vaccination. Objective The Research on the Epidemiology of SARS-CoV-2 in Essential Response Personnel (RECOVER) prospective cohort study was designed to estimate the incidence of symptomatic and asymptomatic SARS-CoV-2 infections, examine the risk factors for infection and clinical spectrum of illness, and assess the effectiveness of vaccination among essential workers. Methods The RECOVER multisite network was initiated in August 2020 and aims to enroll 3000 health care personnel (HCP), first responders, and other essential and frontline workers (EFWs) at 6 US locations. Data on participant demographics, medical history, and vaccination history are collected at baseline and throughout the study. Active surveillance for the symptoms of COVID-19–like illness (CLI), access of medical care, and symptom duration is performed by text messages, emails, and direct participant or medical record reports. Participants self-collect a mid-turbinate nasal swab weekly, regardless of symptoms, and 2 additional respiratory specimens at the onset of CLI. Blood is collected upon enrollment, every 3 months, approximately 28 days after a reverse transcription polymerase chain reaction (RT-PCR)–confirmed SARS-CoV-2 infection, and 14 to 28 days after a dose of any COVID-19 vaccine. From February 2021, household members of RT-PCR–confirmed participants are self-collecting mid-turbinate nasal swabs daily for 10 days. Results The study observation period began in August 2020 and is expected to continue through spring 2022. There are 2623 actively enrolled RECOVER participants, including 280 participants who have been found to be positive for SARS-CoV-2 by RT-PCR. Enrollment is ongoing at 3 of the 6 study sites. Conclusions Data collected through the cohort are expected to provide important public health information for essential workers at high risk for occupational exposure to SARS-CoV-2 and allow early evaluation of COVID-19 vaccine effectiveness. International Registered Report Identifier (IRRID) DERR1-10.2196/31574

Incidence of SARS‐CoV‐2 infection among COVID‐19 vaccinated and unvaccinated healthcare personnel, first responders, and other essential and frontline workers: Eight US locations, January–September 2021

“…The HEROES‐RECOVER Network includes Arizona Healthcare, Emergency Response, and Other Essential Workers Surveillance Study (HEROES) conducted in Phoenix, Tucson, and other noncentrally located areas in Arizona and Research on the Epidemiology of SARS‐CoV‐2 in Essential Response Personnel (RECOVER) conducted in Miami, Florida, Duluth, Minnesota, Portland, Oregon, Temple, Texas, and Salt Lake City, Utah. Active surveillance is conducted with weekly participant or medical record reports for COVID‐19‐like illness (CLI) defined as ≥1 symptom of fever, chills, cough, shortness of breath, sore throat, diarrhea, muscle aches, or change in smell or taste 6,7 . As rotating questions in weekly surveys, participants reported hours in the past 7 days of direct contact (within 3 ft.) and associated percentage facemask use with people at work, in the community, or in any setting who may have COVID‐19.…”

“…Active surveillance is conducted with weekly participant or medical record reports for COVID‐19‐like illness (CLI) defined as ≥1 symptom of fever, chills, cough, shortness of breath, sore throat, diarrhea, muscle aches, or change in smell or taste. 6 , 7 As rotating questions in weekly surveys, participants reported hours in the past 7 days of direct contact (within 3 ft.) and associated percentage facemask use with people at work, in the community, or in any setting who may have COVID‐19. Hours of direct contact and percent facemask use were summarized as monthly averages, and then each week was categorized as above or below the corresponding monthly average.…”

Detection and Stability of SARS-CoV-2 in Three Self-Collected Specimen Types: Flocked Midturbinate Swab (MTS) in Viral Transport Media, Foam MTS, and Saliva

“…This analysis includes data from participants in three prospective cohorts: the Coronavirus Household Evaluation and Respiratory Testing (C-HEaRT) study ( 32 ), the Arizona Healthcare, Emergency Response, and Other Essential Workers Study (AZ HEROES) ( 33 ), and the Research on the Epidemiology of SARS-CoV-2 in Essential Response Personnel (RECOVER) study ( 34 ). The C-HEaRT study included 1,361 participants from 357 households with at least 1 child aged <18 years in New York City and selected counties in Utah.…”

High Burden of COVID-19 among Unvaccinated Law Enforcement Officers and Firefighters

“…Detailed methods of the prospective HEROES-RECOVER cohorts in 6 States are published previously. [4][5][6] From January to September 2021, first responders contributed to weekly active surveillance for COVID-19-like illness (CLI). Self-collected respiratory specimens collected weekly, irrespective of symptoms, and at the onset CLI were tested by Reverse Transcription Polymerase Chain Reaction (RT-PCR) assay for SARS-CoV-2.…”

“…On average, first responders were sick with COVID-19 for over 2 weeks and missed close to 40 hours of work due to their illness. Although this is among the largest prospective studies of its kind, [4][5][6] the relatively small number of COVID-19 illnesses among fully vaccinated participants limited the precision of estimates and precluded models of incidence that could adjust for potential confounders. Nonetheless, these findings suggest that state and local governments with large numbers of unvaccinated first responders may face major disruptions in their workforce due to COVID-19 illness.…”