The role of chronic diseases, environmental and genetic influences on the infection with SARS-CoV-2: boosters, effect modifiers or mediators?

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The recently discovered virus “Severe Acute Respiratory Syndrome CoronaVirus 2” (SARS-CoV-2) is the pathogenic agent of COVID-19. The disease course of COVID-19 is often mild, but leads in a substantial number of cases to hospitalization and even death, which is likely depending on pre-existing conditions and genetic predisposition. Ambient air pollution is a major environmental risk factor for cardio-metabolic, respiratory and neurological diseases, and also has been implicated to significantly contribute to COVID-19 disease spread and severity. It is the objective of COVGENAIR to assess the role of chronic diseases, environmental factors and genetic predisposition and their interplay on the severity of SARS-CoV-2 infections. In particular, we will investigate: (a) the prevalence of SARS-CoV-2 infections and symptoms within different age and risk groups, (b) disentangle the association between environmental exposures and SARS-CoV-2 infections, (c) identify susceptible subgroups in the population who might be particularly vulnerable for an infection with the SARS-CoV-2 virus, and (d) investigate the long-term health effects of an infection with SARS-CoV-2. This proposal is based on data obtained from three comprehensively phenotyped longitudinal cohort studies, all reaching back more than 20 years with participants now being 20 to 95 years old, comprising an extensive assessment of previous subclinical disease manifestations, exposure history, lifestyle factors and genotyping before the COVID-19 pandemic. Within the proposal, we will collect data on SARS-CoV-2 infections by questionnaire and antibody tests and invite subjects for re-examination to assess the most common consequences of COVID-19, such as loss of smell and persistent respiratory problems. Elucidating the environmental and molecular pathways which could increase the risk of a SARS-CoV-2 infection to identify susceptible subjects and determining the long-term post-COVID-19 health outcomes on the respiratory, cardiometabolic and neurological system are important steps in managing the public health challenges of the COVID-19 pandemic. Specifically, understanding the influence of our genetic make-up and the interplay with air pollution and pre-existing conditions on the response to an infection in different age groups would help to better understand the underlying molecular pathways as well as the variability and pathogenesis in at-risk individuals.