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

项目总结/摘要 自2019年底以来，SARS-CoV-2病毒以及由此产生的潜在致命疾病COVID-19已经引起了一场 全球大流行SARS-CoV-2主要引起肺部疾病，但也可引起胃肠道疾病， 神经系统疾病大多数SARS-CoV-2感染是轻微的，但老年人和 患有某些预先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 遗传因素也可能导致COVID-19的严重程度。虽然大多数感染都能在 几周后，有些人继续经历COVID-19症状数周甚至数月， 从急性病中恢复过来。最令人担忧的是一个新的证据表明，即使那些从癌症中康复的人， 有症状的COVID-19，甚至那些患有轻微疾病的人，可能会出现严重的长期并发症 影响不同的身体器官。其中一些并发症包括呼吸道、心血管、肾脏， 神经和精神疾病重要的是，COVID-19的许多潜在长期影响，以及 长期并发症的风险因素仍然未知。 在2001年9月11日世界贸易中心（WTC）悲剧事件中担任第一反应者的男性和女性 构成人口老龄化。WTC场地的有毒物质暴露导致了 这一人群中的某些健康状况（指定为WTC相关状况），其中许多 已被确定或假设为严重COVID-19疾病的风险因素，并可能增加 长期并发症的风险包括长岛在内的纽约市地区， 早期SARS-CoV-2爆发，估计纽约市有19 - 23%的普通人群被感染。试点 长岛世贸中心健康计划的数据表明，该地区约有10%的世贸中心响应者可能患有 被感染了该研究项目旨在：1）评估SARS-CoV-2感染，COVID-19疾病， 和强制性社交距离措施对儿童短期和长期身心健康的影响 WTC响应者; 2）调查人口统计学，健康和职业风险因素，以及有毒物质的影响 WTC暴露对SARS-CoV-2感染后COVID-19疾病严重程度和负面健康结果的影响， 和3）调查COVID-19疾病严重程度和COVID后阴性结果的遗传风险因素。我们 假设在该人群中，SARS-CoV-2感染将加剧 呼吸道、心血管和精神健康状况，以及类似的人口统计学、健康、遗传， 职业和有毒暴露因素将与严重疾病和长期 并发症这项研究的结果将有助于更好地了解COVID-19对WTC的影响 响应者，识别负结果风险增加的亚人群，并告知有针对性的干预措施 来管理这些风险。一些研究结果，特别是职业和遗传风险因素的负面影响， COVID-19的结果将产生更广泛的影响，超出WTC响应人群。

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.