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

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.