A longitudinal SARS-CoV-2 biorepository for COVID-19 survivors with and without post-acute sequelae

Abstract

Background: SARS-CoV-2 has swept across the globe, causing millions of deaths worldwide. Though most survive, many experience symptoms of COVID-19 for months after acute infection. Successful prevention and treatment of acute COVID-19 infection and its associated sequelae is dependent on in-depth knowledge of viral pathology across the spectrum of patient phenotypes and physiologic responses. Longitudinal biobanking provides a valuable resource of clinically integrated, easily accessed, and quality-controlled samples for researchers to study differential multi-organ system responses to SARS-CoV-2 infection, post-acute sequelae of COVID-19 (PASC), and vaccination.

Methods: Adults with a history of a positive SARS-CoV-2 nasopharyngeal PCR are actively recruited from the community or hospital settings to enroll in the Northern Colorado SARS-CoV-2 Biorepository (NoCo-COBIO). Blood, saliva, stool, nasopharyngeal specimens, and extensive clinical and demographic data are collected at 4 time points over 6 months. Patients are assessed for PASC during longitudinal follow-up by physician led symptom questionnaires and physical exams. This clinical trial registration is NCT04603677 .

Results: We have enrolled and collected samples from 119 adults since July 2020, with 66% follow-up rate. Forty-nine percent of participants assessed with a symptom surveillance questionnaire (N = 37 of 75) had PASC at any time during follow-up (up to 8 months post infection). Ninety-three percent of hospitalized participants developed PASC, while 23% of those not requiring hospitalization developed PASC. At 90-174 days post SARS-CoV-2 diagnosis, 67% of all participants had persistent symptoms (N = 37 of 55), and 85% percent of participants who required hospitalization during initial infection (N = 20) still had symptoms. The most common symptoms reported after 15 days of infection were fatigue, loss of smell, loss of taste, exercise intolerance, and cognitive dysfunction.

Conclusions: Patients who were hospitalized for COVID-19 were significantly more likely to have PASC than those not requiring hospitalization, however 23% of patients who were not hospitalized also developed PASC. This patient-matched, multi-matrix, longitudinal biorepository from COVID-19 survivors with and without PASC will allow for current and future research to better understand the pathophysiology of disease and to identify targeted interventions to reduce risk for PASC. Registered 27 October 2020 - Retrospectively registered, https://ichgcp.net/clinical-trials-registry/NCT04603677 .

Keywords: Biobank; Biorepository; COVID-19; Coronavirus; Long-hauler; Post-acute sequelae of COVID-19 (PASC); SARS-CoV-2.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2021. The Author(s).

Figures

Fig. 1

Schematic of multi-matrix biorepository, sample processing, analysis and storage from adults across the clinical spectrum of disease severity. Image was created using BioRender.com (Toronto, ON, Canada). PBMCs denotes peripheral blood mononuclear cells, CBC complete blood count, CMP comprehensive metabolic panel, Coag coagulation

Fig. 2

Percentage of participants reporting symptoms between 25 and > 175 days post infection. a 25–89 days (N = 56), b 90–174 days (N = 55), and c greater than 175 days (N = 42). The number of participants in the surveys vary for each time point. d Percentage of participants who suffered mild (N = 43), moderate (N = 13), or severe (N = 16) COVID-19, reporting symptoms at any follow-up visit (from days 20–243 post infection)

Fig. 3

Rand SF-36 item health survey scores in participants with and without Post-Acute Sequelae of COVID-19 (N = 69). The survey was administered an average of 125 days post SARS-CoV-2 positive PCR diagnostic test result