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So M, Goldberg SA, Lu S, Garcia-Knight M, Davidson MC, Tassetto M, Murray VW, Anglin K, Pineda-Ramirez J, Chen JY, Rugart PR, Richardson ET, Briggs-Hagen M, Midgley CM, Andino R, Seitzman GD, Gonzales J, Peluso MJ, Martin JN, Kelly JD. Prevalence, Patterns, and Predictors of SARS-CoV-2 RNA and Culturable Virus in Tears of a Case-Ascertained Household Cohort. Am J Ophthalmol 2024; 265:48-53. [PMID: 38663502 DOI: 10.1016/j.ajo.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 03/30/2024] [Accepted: 04/14/2024] [Indexed: 05/20/2024]
Abstract
PURPOSE To investigate the prevalence, patterns, and predictors of SARS-CoV-2 RNA and culturable virus in tears of a case-ascertained household cohort. DESIGN Prospective, longitudinal case-ascertained household cohort identified through convenience sampling. METHODS This analysis was restricted to individuals who were non-hospitalized, symptomatic, and tested positive for SARS-CoV-2 by nasal RT-PCR. Tears and anterior nasal biospecimens were serially collected throughout the acute period. Tears specimens were collected by the study staff using Schirmer test strips, and nasal specimens were self-collected. For both, SARS-CoV-2 RNA was quantified using qRT-PCR, and culturable virus was detected using presence of cytopathic effect (CPE) in tissue culture; positive CPE was confirmed by a qRT-PCR step. A series of cross-sectional unadjusted analyses were performed investigating the relationship between different sociodemographic determinants and biological factors associated with tears RNA positivity. RESULTS Among the 83 SARS-CoV-2 infected participants, 10 (12%) had at least one RNA-positive tears specimen. Amongst these 10, 5 (50%) had concurrent presence of culturable virus, at a median of 7 days postsymptom onset (IQR: 4-7 days) (absolute range: 4-8 days). CONCLUSIONS In this longitudinal cohort, we found evidence of culturable virus in the tears of a small proportion of nonhospitalized SARS-CoV-2 infected individuals. Current public health infection precautions do not account for transmission via tears, so these findings may improve our understanding of potential sources of SARS-CoV-2 transmission and contribute to developing future guidelines.
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Affiliation(s)
- Matthew So
- Institute for Global Health Sciences (M.S, S.A.G, S.L, K.A, J.P.-R, J.Y.C, J.D.K), University of California, San Francisco, California, USA
| | - Sarah A Goldberg
- Institute for Global Health Sciences (M.S, S.A.G, S.L, K.A, J.P.-R, J.Y.C, J.D.K), University of California, San Francisco, California, USA; Department of Epidemiology and Biostatistics (S.A.G, S.L, P.R.R, J.N.M, J.D.K), University of California, San Francisco, San Francisco, California, USA
| | - Scott Lu
- Institute for Global Health Sciences (M.S, S.A.G, S.L, K.A, J.P.-R, J.Y.C, J.D.K), University of California, San Francisco, California, USA; Department of Epidemiology and Biostatistics (S.A.G, S.L, P.R.R, J.N.M, J.D.K), University of California, San Francisco, San Francisco, California, USA
| | - Miguel Garcia-Knight
- Department of Microbiology and Immunology (M.G.-K, M.T), University of California, San Francisco, San Francisco, California, USA
| | - Michelle C Davidson
- School of Medicine (M.C.D), University of California, San Francisco, San Francisco, California, USA
| | - Michel Tassetto
- Department of Microbiology and Immunology (M.G.-K, M.T), University of California, San Francisco, San Francisco, California, USA
| | - Victoria Wong Murray
- School of Medicine (V.W.M), Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Khamal Anglin
- Institute for Global Health Sciences (M.S, S.A.G, S.L, K.A, J.P.-R, J.Y.C, J.D.K), University of California, San Francisco, California, USA
| | - Jesus Pineda-Ramirez
- Institute for Global Health Sciences (M.S, S.A.G, S.L, K.A, J.P.-R, J.Y.C, J.D.K), University of California, San Francisco, California, USA
| | - Jessica Y Chen
- Institute for Global Health Sciences (M.S, S.A.G, S.L, K.A, J.P.-R, J.Y.C, J.D.K), University of California, San Francisco, California, USA
| | - Paulina R Rugart
- Department of Epidemiology and Biostatistics (S.A.G, S.L, P.R.R, J.N.M, J.D.K), University of California, San Francisco, San Francisco, California, USA
| | - Eugene T Richardson
- Department of Global Health and Social Medicine (E.T.R), Harvard Medical School, Boston, Massachusetts, USA; Division of Infectious Diseases (E.T.R), Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Melissa Briggs-Hagen
- Coronavirus and Other Respiratory Viruses Division (M.B.H, C.M.M), National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Claire M Midgley
- Coronavirus and Other Respiratory Viruses Division (M.B.H, C.M.M), National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Raul Andino
- Department of Microbiology and Immunology (M.G.-K, M.T), University of California, San Francisco, San Francisco, California, USA
| | - Gerami D Seitzman
- F.I. Proctor Foundation (G.D.S, J.G, J.D.K), University of California, San Francisco, San Francisco, California, USA; Department of Ophthalmology (G.D.S, J.G), University of California, San Francisco, California, USA
| | - John Gonzales
- F.I. Proctor Foundation (G.D.S, J.G, J.D.K), University of California, San Francisco, San Francisco, California, USA; Department of Ophthalmology (G.D.S, J.G), University of California, San Francisco, California, USA
| | - Michael J Peluso
- Division of HIV, Infectious Diseases and Global Medicine (M.J.P), Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Jeffrey N Martin
- Department of Epidemiology and Biostatistics (S.A.G, S.L, P.R.R, J.N.M, J.D.K), University of California, San Francisco, San Francisco, California, USA
| | - John Daniel Kelly
- Institute for Global Health Sciences (M.S, S.A.G, S.L, K.A, J.P.-R, J.Y.C, J.D.K), University of California, San Francisco, California, USA; Department of Epidemiology and Biostatistics (S.A.G, S.L, P.R.R, J.N.M, J.D.K), University of California, San Francisco, San Francisco, California, USA; F.I. Proctor Foundation (G.D.S, J.G, J.D.K), University of California, San Francisco, San Francisco, California, USA; Division of Hospital Medicine (J.D.K), San Francisco Veterans Affairs Medical Center, San Francisco, California, USA.
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Goldberg SA, Lu S, Garcia-Knight M, Davidson MC, Tassetto M, Anglin K, Pineda-Ramirez J, Chen JY, Rugart PR, Mathur S, Forman CA, Donohue KC, Abedi GR, Saydah S, Briggs-Hagen M, Midgley CM, Andino R, Peluso MJ, Glidden DV, Martin JN, Kelly JD. Viral Determinants of Acute COVID-19 Symptoms in a Nonhospitalized Adult Population in the Pre-Omicron Era. Open Forum Infect Dis 2023; 10:ofad396. [PMID: 37636517 PMCID: PMC10456204 DOI: 10.1093/ofid/ofad396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 07/20/2023] [Indexed: 08/29/2023] Open
Abstract
Background The influence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA level and presence of infectious virus on symptom occurrence is poorly understood, particularly among nonhospitalized individuals. Methods The study included 85 nonhospitalized, symptomatic adults, who were enrolled from September 2020 to November 2021. Data from a longitudinal cohort studied over 28 days was used to analyze the association of individual symptoms with SARS-CoV-2 viral RNA load, or the presence or level of infectious (culturable) virus. Presence of infectious virus and viral RNA load were assessed daily, depending on specimen availability, and amount of infectious virus was assessed on the day of maximum RNA load. Participants were surveyed for the start and end dates of 31 symptoms at enrollment and at days 9, 14, 21, and 28; daily symptom presence was determined analytically. We describe symptoms and investigate their possible association with viral determinants through a series of single or pooled (multiple days across acute period) cross-sectional analyses. Results There was an association between viral RNA load and the same-day presence of many individual symptoms. Additionally, individuals with infectious virus were more than three times as likely to have a concurrent fever than individuals without infectious virus, and more than two times as likely to have concurrent myalgia, chills, headache, or sore throat. Conclusions We found evidence to support the association of viral RNA load and infectious virus on some, but not all symptoms. Fever was most strongly associated with the presence of infectious virus; this may support the potential for symptom-based isolation guidance for COVID-19.
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Affiliation(s)
- Sarah A Goldberg
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Scott Lu
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Miguel Garcia-Knight
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, California, USA
| | - Michelle C Davidson
- School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Michel Tassetto
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, California, USA
| | - Khamal Anglin
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Jesus Pineda-Ramirez
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Jessica Y Chen
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Paulina R Rugart
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Sujata Mathur
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Carrie A Forman
- College of Medicine, Drexel University, Philadelphia, Pennsylvania, USA
| | - Kevin C Donohue
- School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Glen R Abedi
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sharon Saydah
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Melissa Briggs-Hagen
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Claire M Midgley
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Raul Andino
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, California, USA
| | - Michael J Peluso
- Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - David V Glidden
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Jeffrey N Martin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - J Daniel Kelly
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California, USA
- F.I. Proctor Foundation, University of California, San Francisco, San Francisco, California, USA
- Division of Hospital Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
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3
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Peluso MJ, Kelly JD, Lu S, Goldberg SA, Davidson MC, Mathur S, Durstenfeld MS, Spinelli MA, Hoh R, Tai V, Fehrman EA, Torres L, Hernandez Y, Williams MC, Arreguin MI, Ngo LH, Deswal M, Munter SE, Martinez EO, Anglin KA, Romero MD, Tavs J, Rugart PR, Chen JY, Sans HM, Murray VW, Ellis PK, Donohue KC, Massachi JA, Weiss JO, Mehdi I, Pineda-Ramirez J, Tang AF, Wenger MA, Assenzio MT, Yuan Y, Krone MR, Rutishauser RL, Rodriguez-Barraquer I, Greenhouse B, Sauceda JA, Gandhi M, Scheffler AW, Hsue PY, Henrich TJ, Deeks SG, Martin JN. Persistence, Magnitude, and Patterns of Postacute Symptoms and Quality of Life Following Onset of SARS-CoV-2 Infection: Cohort Description and Approaches for Measurement. Open Forum Infect Dis 2022; 9:ofab640. [PMID: 35106317 PMCID: PMC8755302 DOI: 10.1093/ofid/ofab640] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 12/20/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND There is mounting evidence for the presence of postacute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (PASC), but there is limited information on the spectrum, magnitude, duration, and patterns of these sequelae as well as their influence on quality of life. METHODS We assembled a cohort of adults with a documented history of SARS-CoV-2 RNA positivity at ≥2 weeks past onset of coronavirus disease 2019 (COVID-19) symptoms or, if asymptomatic, first positive test. At 4-month intervals, we queried physical and mental health symptoms and quality of life. RESULTS Of the first 179 participants enrolled, 10 were asymptomatic during the acute phase of SARS-CoV-2 infection, 125 were symptomatic but not hospitalized, and 44 were symptomatic and hospitalized. During the postacute phase, fatigue, shortness of breath, concentration problems, headaches, trouble sleeping, and anosmia/dysgeusia were most common through 8 months of observation. Symptoms were typically at least somewhat bothersome and sometimes exhibited a waxing-and-waning course. Some participants experienced symptoms of depression, anxiety, and post-traumatic stress, as well as difficulties with performance of usual activities. The median visual analogue scale rating of general health was lower at 4 and 8 months compared with pre-COVID-19. Two clusters of symptom domains were identified. CONCLUSIONS Many participants report bothersome symptoms following onset of COVID-19 with variable patterns of persistence and impact on quality of life. The substantial variability suggests the existence of multiple subphenotypes of PASC. A rigorous approach to the prospective measurement of symptoms and functional manifestations sets the stage for the next phase of research focusing on the pathophysiologic causes of the various subgroups of PASC.
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Affiliation(s)
- Michael J Peluso
- Division of HIV, Infectious Diseases, and Global Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California, USA
| | - J Daniel Kelly
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
- Institute of Global Health Sciences, University of California, San Francisco, San Francisco, California, USA
- F.I. Proctor Foundation, University of California, San Francisco, San Francisco, California, USA
| | - Scott Lu
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Sarah A Goldberg
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Michelle C Davidson
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Sujata Mathur
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Matthew S Durstenfeld
- Division of Cardiology, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California, USA
| | - Matthew A Spinelli
- Division of HIV, Infectious Diseases, and Global Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California, USA
| | - Rebecca Hoh
- Division of HIV, Infectious Diseases, and Global Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California, USA
| | - Viva Tai
- Division of HIV, Infectious Diseases, and Global Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California, USA
| | - Emily A Fehrman
- Division of HIV, Infectious Diseases, and Global Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California, USA
| | - Leonel Torres
- Division of HIV, Infectious Diseases, and Global Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California, USA
- Division of Experimental Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Yanel Hernandez
- Division of HIV, Infectious Diseases, and Global Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California, USA
| | - Meghann C Williams
- Division of HIV, Infectious Diseases, and Global Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California, USA
| | - Mireya I Arreguin
- Division of HIV, Infectious Diseases, and Global Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California, USA
| | - Lynn H Ngo
- Division of HIV, Infectious Diseases, and Global Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California, USA
| | - Monika Deswal
- Division of HIV, Infectious Diseases, and Global Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California, USA
| | - Sadie E Munter
- Division of HIV, Infectious Diseases, and Global Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California, USA
- Division of Experimental Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Enrique O Martinez
- Division of HIV, Infectious Diseases, and Global Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Khamal A Anglin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Mariela D Romero
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Jacqueline Tavs
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Paulina R Rugart
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Jessica Y Chen
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
- Division of Experimental Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Hannah M Sans
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Victoria W Murray
- Division of HIV, Infectious Diseases, and Global Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California, USA
| | - Payton K Ellis
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Kevin C Donohue
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Jonathan A Massachi
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Jacob O Weiss
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Irum Mehdi
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Jesus Pineda-Ramirez
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Alex F Tang
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Megan A Wenger
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Melissa T Assenzio
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Yan Yuan
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Melissa R Krone
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Rachel L Rutishauser
- Division of Experimental Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Isabel Rodriguez-Barraquer
- Division of HIV, Infectious Diseases, and Global Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California, USA
| | - Bryan Greenhouse
- Division of HIV, Infectious Diseases, and Global Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California, USA
| | - John A Sauceda
- Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California, USA
| | - Monica Gandhi
- Division of HIV, Infectious Diseases, and Global Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California, USA
| | - Aaron Wolfe Scheffler
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Priscilla Y Hsue
- Division of Cardiology, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California, USA
| | - Timothy J Henrich
- Division of Experimental Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Steven G Deeks
- Division of HIV, Infectious Diseases, and Global Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California, USA
| | - Jeffrey N Martin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
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4
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Peluso MJ, Kelly JD, Lu S, Goldberg SA, Davidson MC, Mathur S, Durstenfeld MS, Spinelli MA, Hoh R, Tai V, Fehrman EA, Torres L, Hernandez Y, Williams MC, Arreguin MI, Bautista JA, Ngo LH, Deswal M, Munter SE, Martinez EO, Anglin KA, Romero MD, Tavs J, Rugart PR, Chen JY, Sans HM, Murray VW, Ellis PK, Donohue KC, Massachi JA, Weiss JO, Mehdi I, Pineda-Ramirez J, Tang AF, Wenger M, Assenzio M, Yuan Y, Krone M, Rutishauser RL, Rodriguez-Barraquer I, Greenhouse B, Sauceda JA, Gandhi M, Hsue PY, Henrich TJ, Deeks SG, Martin JN. Rapid implementation of a cohort for the study of post-acute sequelae of SARS-CoV-2 infection/COVID-19. medRxiv 2021:2021.03.11.21252311. [PMID: 33758895 PMCID: PMC7987054 DOI: 10.1101/2021.03.11.21252311] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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.
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Affiliation(s)
- Michael J. Peluso
- Division of HIV, Infectious Diseases, and Global Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, USA
| | - J. Daniel Kelly
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
- Department of Ophthalmology, University of California, San Francisco, USA
| | - Scott Lu
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Sarah A. Goldberg
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Michelle C. Davidson
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Sujata Mathur
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Matthew S. Durstenfeld
- Division of Cardiology, Zuckerberg San Francisco General Hospital, University of California, San Francisco, USA
| | - Matthew A. Spinelli
- Division of HIV, Infectious Diseases, and Global Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, USA
| | - Rebecca Hoh
- Division of HIV, Infectious Diseases, and Global Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, USA
| | - Viva Tai
- Division of HIV, Infectious Diseases, and Global Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, USA
| | - Emily A. Fehrman
- Division of HIV, Infectious Diseases, and Global Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, USA
| | - Leonel Torres
- Division of HIV, Infectious Diseases, and Global Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, USA
- Division of Experimental Medicine, University of California, San Francisco, USA
| | - Yanel Hernandez
- Division of HIV, Infectious Diseases, and Global Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, USA
| | - Meghann C. Williams
- Division of HIV, Infectious Diseases, and Global Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, USA
| | - Mireya I. Arreguin
- Division of HIV, Infectious Diseases, and Global Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, USA
| | - Jennifer A. Bautista
- Division of HIV, Infectious Diseases, and Global Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, USA
| | - Lynn H. Ngo
- Division of HIV, Infectious Diseases, and Global Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, USA
| | - Monika Deswal
- Division of HIV, Infectious Diseases, and Global Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, USA
| | - Sadie E. Munter
- Division of HIV, Infectious Diseases, and Global Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, USA
- Division of Experimental Medicine, University of California, San Francisco, USA
| | - Enrique O. Martinez
- Division of HIV, Infectious Diseases, and Global Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Khamal A. Anglin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Mariela D. Romero
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Jacqueline Tavs
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Paulina R. Rugart
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Jessica Y. Chen
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
- Division of Experimental Medicine, University of California, San Francisco, USA
| | - Hannah M. Sans
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Victoria W. Murray
- Division of HIV, Infectious Diseases, and Global Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, USA
| | - Payton K. Ellis
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Kevin C. Donohue
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Jonathan A. Massachi
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Jacob O. Weiss
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Irum Mehdi
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Jesus Pineda-Ramirez
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Alex F. Tang
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Megan Wenger
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Melissa Assenzio
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Yan Yuan
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Melissa Krone
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | | | - Isabel Rodriguez-Barraquer
- Division of HIV, Infectious Diseases, and Global Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, USA
| | - Bryan Greenhouse
- Division of HIV, Infectious Diseases, and Global Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, USA
| | - John A. Sauceda
- Center for AIDS Prevention Studies, University of California, San Francisco, USA
| | - Monica Gandhi
- Division of HIV, Infectious Diseases, and Global Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, USA
| | - Priscilla Y. Hsue
- Division of Cardiology, Zuckerberg San Francisco General Hospital, University of California, San Francisco, USA
| | - Timothy J. Henrich
- Division of Experimental Medicine, University of California, San Francisco, USA
| | - Steven G. Deeks
- Division of HIV, Infectious Diseases, and Global Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, USA
| | - Jeffrey N. Martin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| |
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