Rapid implementation of cross-sectional study: Post-acute sequelae of SARS-CoV-2 (PASC) in a racially and ethnically diverse sample in Illinois

  1. Robin J. Mermelstein
  2. Meenakshy Aiyer
  3. Christine Canfield
  4. David Chestek
  5. Judith A. Cook
  6. Marina Del Rios
  7. Kathleen R. Diviak
  8. Angela M. Ellison
  9. Howard S. Gordon
  10. Sai Dheeraj Illendula
  11. Manasa Kandula
  12. Jonathan D. Klein
  13. Karen Larimer
  14. James Lash
  15. Janet Lin
  16. Jeffrey A. Loeb
  17. Teresa J. Lynch
  18. Hugh Musick
  19. Richard M. Novak
  20. Heather M. Prendergast
  21. Jerry A. Krishnan

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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.

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  1. ScreenIT

    SciScore for 10.1101/2021.04.29.21256304: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsIRB: To ensure rapid launch of the study protocol, we leveraged existing institutional review board (IRB)-approved research studies for which investigators had ongoing approval to contact participants for potential study recruitment; partnerships with the Chicago Department of Public Health and Peoria City & County Health Department
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    We employed a cross-sectional study design to collect self-reported information using an on-line questionnaire programmed with REDCap from April 7 to 12, 2021.(16) Our goal was to simultaneously employ a set of rapid recruitment approaches to maximize enrollment within a 7-day window for data collection that would yield a diverse sample of individuals living in Illinois who had tested positive for SARS-CoV-2 and who were willing to share their recovery experiences.
    REDCap
    suggested: (REDCap, RRID:SCR_003445)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Our study also has limitations. We relied on self-reported data, rather than laboratory-confirmed test results for SARS-CoV-2. Our study did not employ a population-based sampling strategy, so the prevalence and duration of different symptoms may not offer generalizable estimates across the state of Illinois. Moreover, our data were collected over a one week period in April 2021 and results may change with secular trends in the number of mild, moderate, and severe cases of COVID-19 cases. Also, the size of our one-week participant sample was insufficient to adequately examine gender, race and ethnicity as predictors of PASC at 3 months. A longer duration of survey collection or additional sources of participant populations will be needed to overcome limitations due to inadequate statistical power for some analyses. In summary, we have demonstrated that the combination of community-engaged enrollment, COVID-19 research registries, and COVID-19 clinical registries can be used to rapidly recruit a predominantly minority participant population across the spectrum of COVID-19 severity. About 1 in 4 individuals had not recovered to their usual state of health after 3 months (even fewer among older individuals and those who had been hospitalized with COVID-19). Until there are proven-effective interventions to treat PASC, public health messaging should include the importance of preventing PASC through vaccination and other strategies to prevent infection with SARS-CoV-2. The partner...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

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  2. Version published to 10.1101/2021.04.29.21256304 on medRxiv