Researching COVID to Enhance Recovery (RECOVER) adult study protocol: Rationale, objectives, and design
Leora I. Horwitz, Tanayott Thaweethai, Shari B. Brosnahan, Mine Cicek, Megan L. Fitzgerald, Jason D. Goldman, Rachel Hess, S L Hodder, Vanessa L. Jacoby, Michael R. Jordan, Jerry A. Krishnan, Adeyinka O. Laiyemo, Torri D. Metz, Lauren Nichols, Rachel E. Patzer, Anisha Sekar, Nora G. Singer, Lauren E. Stiles, Barbara S. Taylor, Shifa Ahmed, Heather A. Algren, Khamal Anglin, Lisa Aponte‐Soto, Hassan Ashktorab, Ingrid V. Bassett, Brahmchetna Bedi, Nahid Bhadelia, Christian Bime, Marie‐Abèle Bind, Lora Black, Andra L. Blomkalns, Hassan Brim, Mario Castro, James Chan, Alexander W. Charney, Benjamin K. Chen, Long‐Qing Chen, Peter Chen, David Chestek, Lori B. Chibnik, Dominic C. Chow, Helen Y. Chu, Rebecca G. Clifton, Shelby Collins, Maged M. Costantine, Sushma K. Cribbs, Steven G. Deeks, John D. Dickinson, Sarah E. Donohue, Matthew S. Durstenfeld, Ivette F. Emery, Kristine M. Erlandson, Julio C. Facelli, Rachael Farah-Abraham, Aloke V. Finn, Melinda S. Fischer, Valerie J. Flaherman, Judes Fleurimont, Vivian Fonseca, Emily J. Gallagher, Jennifer C. Gander, Maria Laura Gennaro, Kelly S. Gibson, Minjoung Go, Steven N. Goodman, Joey P. Granger, Frank L. Greenway, John W. Hafner, Jenny E. Han, Michelle Harkins, Kristine Hauser, James R. Heath, Carla R. Hernandez, On Ho, Matthew Hoffman, Susan E. Hoover, Carol R. Horowitz, Harvey Hsu, Priscilla Y. Hsue, Brenna L. Hughes, Prasanna Jagannathan, Judith A. James, Janice John, Sarah E. Jolley, Suzanne E. Judd, Joy J Juskowich, Diane G. Kanjilal, Elizabeth W. Karlson, Stuart D. Katz, J. Daniel Kelly, Sara Warfield Kelly, Arthur Y. Kim, John P. Kirwan, Kenneth S. Knox, Andre Kumar, Michelle F. Lamendola-Essel, Margaret Lanca, Joyce K. Lee-lannotti, R. Craig Lefebvre, Bruce D. Levy
Abstract
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. REGISTRATION: NCT05172024.