DISCOVAR:Disparities in Immune Response to SARS-CoV-2 in ARkansas

PROJECT Summary: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel coronavirus, is the causative agent ofcoronavirus disease 2019 (COVID-19) and is responsible for the current pandemic, with 14.4 million totalconfirmed cases of coronavirus disease 2019 (COVID-19) in over 200 countries and territories and more than604,000 deaths as of July 19, 2020. Of these, 3.83 million cases and 143,000 deaths occurred in the UnitedStates (US). Most long-term public health and clinical approaches to pandemic containment are based on thepresumption that infection with SARS-CoV-2 confers immunity against reinfection for at least 1 year. However,understanding of immune responses to SARS-CoV-2 is extremely limited and evidence of conferred immunityagainst reinfection or its duration are lacking. Most concerning is that racial/ethnic minorities bear adisproportionate burden of the incidence, morbidity, and mortality from SARS-CoV-2 infection. To date,explanations for this disparity are postulated as structural racism and discrimination, higher rates of pre-existinghealth conditions, and delayed or limited access to healthcare. However, differences in immune response toSARS-CoV-2 may also play a part in this disparity. Racial/ethnic differences in the immune response are welldocumented for other viral diseases and vaccines, but little is known about immune response to SARS-CoV-2in racial/ethnic minorities. To address this critical gap in knowledge, we will assess and characterize the immuneresponse to SARS-CoV-2 infection in racial/ethnic minorities in Arkansas. To achieve this objective we proposea population-based, observational prospective cohort study comprised of men and women that is a racially,ethnically, and geographically diverse, representative sample of all noninstitutionalized adults residing inArkansas tested by real-time, reverse transcriptase polymerase chain reaction (RT-PCR) for COVID-19 betweenNovember 2020 and April 2021. The 450-person cohort will be sampled from the statewide COVID-19 testdatabase and followed up to 48 months posttesting. Our first aim is to determine the serological responses toSARS-CoV-2 infection over time by race/ethnicity among RT-PCR confirmed, positive adults in Arkansas. In thisaim we will assess serological response among NH black and Hispanic adults in comparison to NH white adults.Our second aim is to determine the durability of the serological response to SARS-CoV-2 infection over time byrace/ethnicity among RT-PCR confirmed positive adult Arkansans. In Aim 3 we will determine how psychosocialand behavioral factors such as, chronic stress, depression, anxiety, social support, tobacco use, alcohol intake,and sedentary lifestyle, influence the serological response over time to SARS-CoV-2 by race/ethnicity. Weexpect that our results will inform clinical management and prognosis of racial/ethnic minority patients withCOVID-19 and vaccine development. Our findings will also have a significant public health impact for long-termpublic health policies for pandemic containment.q