ABSTRACT The goal of this proposal will be to study the frequency, chronicity and etiology of post-acute sequelae of SARS CoV-2 with protocols designed to characterize genetic and immuno-inflammatory factors that influence post- COVID complications. We will establish a cohort of 1200 or more deeply phenotyped SARS CoV-2 patients in order to determine the long-term effects of COVID-19 infection in distinct PASC cohorts. Patients will be categorized by the presence or absence of pulmonary symptoms. We will focus on changes in pulmonary lung function (DLCO and FVC, TLC) and 6-minute walk test (6MWT) distance at 3, 6, and 12 months and bi- annually thereafter for 5 years. To assess for progressive pulmonary fibrosis we will include x-rays and computerized tomography (CT) of the lung. To explore pathogenic mechanisms we will: 1) determine whether specific cytokine levels associate with the severity or progression of PASC-associated disease; and, 2) determine whether there is a characteristic autoantibody profile, including anti-cytokine antibodies, in PASC patients; 3) perform Global Diversity Array (GDA) chip analysis on 1200 patients to develop an unbiased genetic risk score for PASC; 4) determine whether specific genotypes: a) influence the severity or chronicity of PASC, including the development of Idiopathic Pulmonary Fibrosis or b) contribute to the sustained immunological responses in PASC patients. Finally, we will determine whether there is a genetic association with PASC syndromes that varies across self-identified race/ethnicity (SIRE). Taken together, these novel studies are intended to better understand pathogenetic mechanisms of disease, which can lead to the identification of therapeutic targets and strategies for patients with post-acute sequelae.

NARRATIVE Following acute infection with SARS-Cov2 persistent symptoms of fatigue and shortness of breath are common, with physiologic, functional and quality of life impairments lasting up to 6 months or more. Little is known about the causes and long-term effects of these post-COVID, or “long COVID” syndromes. Our longitudinal studies will evaluate progressive pulmonary and neurocognitive dysfunction following acute COVID-19 infection, assessing host genetic and etiologic causes that will enable the development of future treatments.