Tracking the burden, distribution, and impact of Post COVID-19 conditions among a diverse group of children, adolescents, and adults in Philadelphia, PA. - As of February 25, 2022, there were 78,595,529 confirmed COVID-19 cases and 939,654 COVID-19-related deaths in the United States. Although most COVID-19 patients recover within a few weeks, some have symptoms that persist for months after recovering from an acute infection with SARS-CoV-2 (i.e., referred to as post COVID-19 conditions [PCC]). Because the clinical presentation varies from person to person, there is currently no consensus on the definition of this syndrome. There is some evidence to suggest that those with more severe acute infections (i.e., those hospitalized, treated in the intensive care unit, or with encephalopathy) may be more likely to experience at least one PCC and multiple PCCs. The NIH previously estimated that 10-30% of those infected with SARS-CoV-2 may experience PCCs; however, depending on the population studied, PCC definition, and length of follow-up, some studies have reported that as many as 87% of COVID-19 survivors may experience PCCs. Collectively, emerging findings from COVID-19 and other viral infections suggest that a sizable fraction of patients will experience persisting neurologic, respiratory, cardiovascular, muscular, and mental health problems. Further, the racial and ethnic disparities observed with respect to COVID-19 hospitalizations and deaths are likely to also manifest among those experiencing chronic health sequelae following an acute SARS-CoV-2 infection. There is a need to better estimate the burden and distribution of PCC, identify factors that increase or reduce the risk of their occurrence and persistence, and monitor trends over time. This surveillance project will leverage collaborations between the Temple University Health System (TUHS), Temple University Lewis Katz School of Medicine, Temple University College of Public Health, and the Philadelphia Department of Public Health (PDPH) to (1) estimate the cumulative incidence and period prevalence of various PCCs in the 3, 6, 12, and 18 months after an acute infection with SARS-CoV-2, (2) investigate secular trends, (3) calculate the incidence rate for PCCs (individually, by category, and for symptom clusters) and (4) identify factors that increase or reduce the risk for each (i.e., age group, sex, race, ethnicity, neighborhood, severity of SARS-CoV-2 infection, vaccination history, treatments received during the acute phase, laboratory measures, and other comorbidities). Our cohort will include over 16,000 TUHS patients living in Philadelphia who were diagnosed with RNA-confirmed SARS-CoV-2 infection between 1/1/20 and 5/31/25 and will use TUHS electronic health records, medical chart review, PDPH vaccine and COVID-19 case data, and vital records data. Temple is an ideal setting to conduct PCC surveillance, given that TUHS was at the center of Philadelphia's medical response to COVID-19, the TUHS catchment area was one of the areas most impacted by COVID-19 in the region, and TUHS serves a racially and ethnically diverse population of socio-economically disadvantaged patients with higher rates of comorbidities that increase the risk for severe COVID-19 outcomes and may also increase the risk for PCC. Through this project, we will also disseminate complete, timely, and quality PCC surveillance findings to the public via an interactive dashboard and provide hands-on training opportunities in epidemiology, information technology, and health disparities. Overall, this project aims to better characterize the overall burden of morbidity following SARS-CoV-2 infection, identify geographic areas and groups of individuals that are disproportionately impacted, and monitor PCC trends over time. Our findings will guide the development of PCC prevention programs, public health actions to reduce health disparities, and clinical guidelines and care efforts; and be used to plan for future rehabilitation and treatment needs.
