Mid-America Regional Coordinating Center (MARCC)

Abstract Subacute neurological changes due to COVID-19 (six months - one year post infection) remain poorly characterized. This may be increasingly important as previous pandemics, e.g. 1918 influenza, have demonstrated that neurological conditions (e.g. delirium, encephalitis, and neurodegenerative conditions) are more prevalent during the subacute and chronic (> one year) phases. Anecdotal accounts of COVID-19 positive patients have suggested that "brain fog" and fatigue develop during the subacute period, especially in more severely affected individuals. This proposal leverages two existing cohorts of patients enrolled at Barnes-Jewish Hospital and the Infectious Disease Clinical Research Unit at Washington University in Saint Louis. An acute cohort consists of participants who present to the emergency room with symptoms consistent with COVID-19 and who are followed throughout their hospital stay, if admitted, and post infection in the outpatient setting. A second cohort, a convalescent cohort, is enrolling confirmed COVID-19 positive participants who were primarily asymptomatic or mildly symptomatic and who are followed post infection in the outpatient setting. This proposal has three aims. Aim 1 will evaluate subacute cognitive changes observed six months post infection in COVID- 19 positive patients. Aim 2 will evaluate subacute neuroimaging changes observed six months post infection in COVID-19 positive patients. Aim 3 will evaluate subacute multi-omic blood changes observed six months post infection in COVID-19 positive patients. Overall, we hypothesize that COVID-19 positive patients with more severe symptoms (intensive care unit (ICU) admission) will have more cognitive deficits, neuroimaging changes, and blood transcriptomic, proteomic, metabolomic, and lipidomic abnormalities at six months post infection compared to COVID-19 positive patients who were hospitalized or who were asymptomatic. This proposal is therefore a time sensitive opportunity to characterize the neurological changes seen at six months post infection within 100 patients from these diverse cohorts of COVID-19 positive individuals.