Severity and long-term health effects of COVID-19 among World Trade Center responders

项目摘要/摘要 自2019年末以来，SARS-CoV-2病毒以及由此产生的一种名为新冠肺炎的潜在致命疾病已经造成了 全球大流行。SARS-CoV-2主要引起肺部疾病，但也可引起胃肠道和 神经系统疾病。大多数SARS-CoV-2感染是轻微的，但老年人和 患有某些先前存在的疾病的人患重病和死亡的风险增加。新出现的证据表明 遗传因素也可能是新冠肺炎严重程度的原因之一。虽然大多数感染完全在 几周后，一些人会在几周甚至几个月后继续出现新冠肺炎症状 从急病中恢复。最令人担忧的是，新出现的证据表明，即使是那些从 有症状的新冠肺炎，甚至是那些有轻微疾病的人，可能会经历严重的长期并发症 影响到不同的身体器官。其中一些并发症包括呼吸系统、心血管、肾脏、 神经和精神疾病。重要的是，新冠肺炎的许多潜在的长期影响，以及 长期并发症的风险因素仍不清楚。 在2001年9月11日世界贸易中心(WTC)悲剧性事件中担任急救人员的男性和女性 构成了老龄化的人口。世贸中心场址暴露的有毒物质导致不成比例的高发病率 这一人群中的某些健康状况(被指定为与WTC相关的状况)，其中许多人有 被确定或被假设为严重新冠肺炎病的危险因素，并可能增加 出现长期并发症的可能性。纽约市(NYC)地区，包括长岛，遭受了一场重大的 SARS-CoV-2早期暴发，纽约市估计有19%-23%的总人口受到感染。引航员 来自长岛WTC健康项目的数据表明，这一地区约10%的WTC响应人员可能已经 被感染了。本研究项目旨在：1)评估SARS-CoV-2感染、新冠肺炎疾病、 和强制性社会疏远措施对短期和长期身心健康结果的影响 WTC响应者；2)调查人口、健康和职业风险因素，以及有毒物质的影响 世贸中心对新冠肺炎严重程度和感染SARS-CoV-2后的负面健康后果的暴露， 3)调查新冠肺炎病情严重程度和冠状病毒感染后阴性结局的遗传危险因素。我们 假设在这个人群中，SARS-CoV-2感染将加剧 呼吸、心血管和精神健康状况，以及类似的人口、健康、遗传、 职业性和毒性暴露因素会增加严重疾病和长期患病的风险。 并发症。本次研究的结果将有助于更好地了解新冠肺炎对世贸中心的影响 应答者，确定负结果风险增加的亚人群，并提供有针对性的干预措施 来管理这些风险。一些研究发现，特别是职业和遗传危险因素的负面影响 新冠肺炎的成果，将对世贸中心应答者群体产生更广泛的影响。

PROJECT SUMMARY / ABSTRACT Since late 2019, SARS-CoV-2 virus, and a resulting, potentially deadly disease called COVID-19, have caused a global pandemic. SARS-CoV-2 primarily causes disease in lungs but can also cause gastrointestinal and neurological disease. The majority of SARS-CoV-2 infections are mild, however people of older age and people with certain pre-existing conditions are at increased risk of severe illness and death. Emerging evidence suggests that genetic factors may also contribute to COVID-19 severity. While most infections completely resolve within several weeks, some people continue experiencing COVID-19 symptoms for weeks or even months after recovering from acute illness. Of major concern is an emerging evidence that even those who recover from symptomatic COVID-19 and even those who had a mild disease, may experience serious long-term complications affecting different body organs. Some of these complications include respiratory, cardiovascular, renal, neurological, and psychiatric conditions. Importantly, many potential long-term effects of COVID-19, as well as risk factors for long-term complications, remain unknown. Men and women who worked as first responders during the tragic 9/11/2001 World Trade Center (WTC) events constitute an aging population. Toxic exposures at the WTC sites caused a disproportionally high prevalence of certain health conditions (designated as WTC-related conditions) in this population, many of which have either been identified or are hypothesized to be risk factors for severe COVID-19 disease and may increase the likelihood of developing long-term complications. New York City (NYC) area, including Long Island, suffered from a major early SARS-CoV-2 outbreak, with an estimated 19-23% of the general population being infected in NYC. Pilot data from Long Island WTC Health Program suggest that about 10% of WTC responders in this area may have been infected. This research project aims to: 1) Assess the impact of SARS-CoV-2 infection, COVID-19 disease, and mandatory social distancing measures on short- and long-term physical and mental health outcomes among WTC responders; 2) Investigate demographic, health, and occupational risk factors, as well as the impact of toxic WTC exposures on COVID-19 disease severity and negative health outcomes following SARS-CoV-2 infection, and 3) Investigate genetic risk factors for COVID-19 disease severity and negative post-COVID outcomes. We hypothesize that in this population SARS-CoV-2 infection will exacerbate incidence and progression of respiratory, cardiovascular, and mental health conditions, and that similar demographic, health, genetic, occupational, and toxic exposure factors will be associated with increased risk of severe disease and long-term complications. The results of this study will help to better understand the impact of COVID-19 on WTC responders, identify sub-populations at increased risk of negative outcomes, and inform targeted interventions to manage these risks. Some of the study findings, in particular occupational and genetic risk factors of negative COVID-19 outcomes, will have broader implications beyond WTC responder population.