Development of a Definition of Postacute Sequelae of SARS-CoV-2 Infection.

Importance: SARS-CoV-2 infection is associated with persistent, relapsing, or new symptoms or other health effects occurring after acute infection, termed postacute sequelae of SARS-CoV-2 infection (PASC), also known as long COVID. Characterizing PASC requires analysis of prospectively and uniformly collected data from diverse uninfected and infected individuals. Objective: To develop a definition of PASC using self-reported symptoms and describe PASC frequencies across cohorts, vaccination status, and number of infections. Design, Setting, and Participants: Prospective observational cohort study of adults with and without SARS-CoV-2 infection at 85 enrolling sites (hospitals, health centers, community organizations) located in 33 states plus Washington, DC, and Puerto Rico. Participants who were enrolled in the RECOVER adult cohort before April 10, 2023, completed a symptom survey 6 months or more after acute symptom onset or test date. Selection included population-based, volunteer, and convenience sampling. Exposure: SARS-CoV-2 infection. Main Outcomes and Measures: PASC and 44 participant-reported symptoms (with severity thresholds). Results: A total of 9764 participants (89% SARS-CoV-2 infected; 71% female; 16% Hispanic/Latino; 15% non-Hispanic Black; median age, 47 years [IQR, 35-60]) met selection criteria. Adjusted odds ratios were 1.5 or greater (infected vs uninfected participants) for 37 symptoms. Symptoms contributing to PASC score included postexertional malaise, fatigue, brain fog, dizziness, gastrointestinal symptoms, palpitations, changes in sexual desire or capacity, loss of or change in smell or taste, thirst, chronic cough, chest pain, and abnormal movements. Among 2231 participants first infected on or after December 1, 2021, and enrolled within 30 days of infection, 224 (10% [95% CI, 8.8%-11%]) were PASC positive at 6 months. Conclusions and Relevance: A definition of PASC was developed based on symptoms in a prospective cohort study. As a first step to providing a framework for other investigations, iterative refinement that further incorporates other clinical features is needed to support actionable definitions of PASC.

Covid 19: A community based nursing disaster response.

Nursing has been criticized for inconsistent and episodic attention to disaster response training in academic settings. The work described herein demonstrates that nursing was not only prepared for the COVID-19 pandemic but was able to mobilize and lead a large-scale response that benefited a university community and the larger surrounding communities and neighborhoods paying particular attention to marginalized populations. For healthcare providers outside of hospitals, it was clear that disaster response methods would need to be implemented. The authors demonstrate that nursing established an on-the-ground response in collaboration with other University officials and departments. Initially established for the University community, the response was moved into surrounding neighborhoods vaccinating the city's most vulnerable. The nurse led effort answered more than 25,000 Hotline telephone calls, collected more than 30,000 COVID-19 molecular tests, and administered more than 150,000 COVID-19 vaccines in an operation that served up to 2500 people a day for 5 months. Nurses saved thousands of lives at the height of the COVID-19 pandemic in hospitals and in community-based settings. The University of Texas Health Science Center San Antonio School of Nursing demonstrated the nimble nature of academic nursing and outlines a large-scale community response to an international pandemic in the seventh-largest United States city. The authors establish guidelines for nurses and others to follow for future events.