ImportanceSARS-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.ObjectiveTo develop a definition of PASC using self-reported symptoms and describe PASC frequencies across cohorts, vaccination status, and number of infections.Design, Setting, and ParticipantsProspective 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.ExposureSARS-CoV-2 infection.Main Outcomes and MeasuresPASC and 44 participant-reported symptoms (with severity thresholds).ResultsA 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 RelevanceA 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.

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Southeast Texas is home to some of the largest refineries in the United States. During Hurricane Harvey, emergency shutdowns took place. In this exploratory investigation, we examine how government air monitors performed in measuring air quality in Beaumont, Texas during and in the months following Hurricane Harvey. Texas Commission on Environmental Quality (TCEQ) data from two active air monitors in Beaumont, Texas were analyzed during the year 2017–2018. Concentrations of sulfur dioxide (SO2), nitric oxide (NO), oxides of nitrogen (NOx), ozone, benzene, and hydrogen sulfide (H2S) were investigated. The number of hours and days no data were reported by air monitors were also investigated. Yearly maximum values (MAX, all in parts per billion (ppb)) in 2017 for SO2, NO, and NOx (53.7, 113.4, 134, respectively) and their respective standard deviations (SD: 1.3, 3.4, and 14) were higher as compared to 2018 (MAX, all in ppb and (SD) = 40.9, (1.4); 103.9, (3.3); 123.8, (14), respectively). The data capture rate for these chemicals were between 88 and 97% in both years. During the months following Hurricane Harvey (August–December 2017) there was an increase in most maximum values. The yearly averages for H2S were 0.68 ppb (SD 1.02) in 2017 and 0.53 ppb (SD 1.07) in 2018. Missing days were observed for both the H2S and NOx air monitors, with the highest number observed in 2017 (213 missing days) for the air monitor measuring H2S. We identified that residents of Beaumont, Texas are exposed daily to low-level concentrations of air pollutants. H2S is released each day at a level high enough to be smelled. Data capture rates for air monitors are not always above 90%. Improved air quality data and disaster preparations are needed in Beaumont, Texas.

The inclusion of self-reported health into cross-country population surveys has contributed to substantial progress in the social science, public health and epidemiology fields. Measuring self-reported health in cross-country population surveys is a cost-effective method to gain information on individual-health status. The self-reported health measurement however is not without flaws. In this glossary we provide a basic definition of self-reported health. Cross-country population surveys that contain self-reported health data are discussed. We highlight the limitations and advantages of using self-reported health measure. Other aspects related to self-reported health are discussed, including the importance of the self-reported health measurement for future long COVID-19 investigations.

Importance: The prevalence, pathophysiology, and long-term outcomes of COVID-19 (post-acute sequelae of SARS-CoV-2 [PASC] or “Long COVID”) in children and young adults remain unknown. Studies must address the urgent need to define PASC, its mechanisms, and potential treatment targets in children and young adults. Observations: We describe the protocol for the Pediatric Observational Cohort Study of the NIH’s REsearching COVID to Enhance Recovery (RECOVER) Initiative. RECOVER-Pediatrics is an observational meta-cohort study of caregiver-child pairs (birth through 17 years) and young adults (18 through 25 years), recruited from more than 100 sites across the US. This report focuses on two of five cohorts that comprise RECOVER-Pediatrics: 1) a de novo RECOVER prospective cohort of children and young adults with and without previous or current infection; and 2) an extant cohort derived from the Adolescent Brain Cognitive Development (ABCD) study (n=10,000). The de novo cohort incorporates three tiers of data collection: 1) remote baseline assessments (Tier 1, n=6000); 2) longitudinal follow-up for up to 4 years (Tier 2, n=6000); and 3) a subset of participants, primarily the most severely affected by PASC, who will undergo deep phenotyping to explore PASC pathophysiology (Tier 3, n=600). Youth enrolled in the ABCD study participate in Tier 1. The pediatric protocol was developed as a collaborative partnership of investigators, patients, researchers, clinicians, community partners, and federal partners, intentionally promoting inclusivity and diversity. The protocol is adaptive to facilitate responses to emerging science. Conclusions and Relevance: RECOVER-Pediatrics seeks to characterize the clinical course, underlying mechanisms, and long-term effects of PASC from birth through 25 years old. RECOVER-Pediatrics is designed to elucidate the epidemiology, four-year clinical course, and sociodemographic correlates of pediatric PASC. The data and biosamples will allow examination of mechanistic hypotheses and biomarkers, thus providing insights into potential therapeutic interventions.