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.

In CHF, B-lymphocytes exhibit remodeled leaky RyR1 channels and decreased endoplasmic reticulum Ca stores consistent with chronic intracellular Ca leak. RyR1-mediated Ca leak in B-lymphocytes assessed using flow cytometry provides a surrogate measure of intracellular Ca handling and systemic sympathetic burden, presenting a novel biomarker for monitoring response to pharmacological and mechanical CHF therapy.

Background As public health becomes increasingly central to the practice of medicine, educational efforts are necessary to prepare medical students to apply public health concepts in their care of patients. There are few accessible and informative tools to prepare students to engage with population health challenges. Methods We distributed an online questionnaire to clinical students, querying gaps in their education on public health topics. Based upon the responses, we developed a web-based curriculum for medical students rotating at a public safety-net hospital on pediatrics, medicine, primary care, psychiatry, and surgery services from April–December 2017 (available at www.publichealthcommute.com ). Students received guiding questions and media-based resources (e.g. podcasts, TedTalks, YouTube videos) in weekly modules addressing topics in public health. Each module incorporated 30 min of mobile-optimized content, including specific data relating the topic to the Central Harlem community. Familiarity with public health was assessed with pre- and post-program quizzes, including 10 multiple-choice and 2 open-ended questions. Results Among the 70 participating students, 59 (84%) completed both the pre- and post-assessments. The five-week curriculum covered health systems, social determinants, race, substance use, violence, and alternative care models. After completing the five-week curriculum, the mean correct score on a multiple-choice quiz rose from 57 to 66% ( p = 0.001). In the qualitative section of the test, students were asked what public health topics should be taught in medical school. Frequently suggested topics included social determinants of health (25%), epidemiology (25%), health systems (25%), insurance (21%), policy (17%), economics (17%), racism (15%), and health disparities (8%). When asked how public health will impact their medical career, students frequently responded that it would greatly impact their clinical practice (49%), choice of residency program (17%), and decision to pursue advocacy or additional degrees (15%). Conclusions Learners participating in this five-week online public health curriculum demonstrated a significant increase in public health knowledge. The online format allowed for high participation across five different specialty rotations, and community-specific data allowed students to recognize the importance of public health in medical practice.

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Background: During the height of the coronavirus disease 2019 (COVID-19) pandemic in New York City, COVID-19 hospitalization was associated with high mortality. It is unknown how palliative care was utilized in this context. Objectives: To describe the frequency of palliative care consultation and its association with end-of-life care for deceased patients with COVID-19. Methods: Adults who were admitted to our institution between February 23, 2020, and April 21, 2020, and died from COVID-19 were included. The primary outcome was the frequency of palliative care consultation. Secondary analyses included the association of palliative care consultation with code status at the time of death, life-sustaining treatments, mechanical ventilation, invasive procedures, intensive care unit (ICU) admissions, and length of hospital stay. Results: The 203 patients were 61% male with median age 76 (interquartile range [IQR] 67-84) years. Palliative care was consulted for 113 patients (56%). At baseline, they were less independent in instrumental activities of daily living (28 patients, 26.1%, vs. 47 patients, 49.0%, p < 0.01) and had more do-not-resuscitate orders (35 patients, 32.7%, vs. 11 patients, 11.5%, p < 0.01). Palliative care consultation was associated with fewer invasive procedures (0, IQR 0-2, vs. 2, IQR 0-3, p < 0.01), less mechanical ventilation (32 patients, 29.9% vs. 65 patients, 67.7%, p < 0.01), and fewer ICU admissions (33 patients, 30.8% vs. 69 patients, 71.9%, p < 0.01). Palliative care was associated with shorter ICU stays (0 days, IQR 0-4, vs. 4 days, IQR 0-12, p < 0.01), whereas hospital stays did not differ significantly (8 days, IQR 5-12.5, vs. 10 days, IQR 5-16.3, p = 0.15). Conclusion: Palliative care was consulted for roughly half of deceased patients with COVID-19 and those patients were less likely to undergo invasive procedures or life-sustaining treatments and spent less time in the ICU at the end of life.