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DISCOVAR:Disparities in Immune Response to SARS-CoV-2 in ARkansas

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PROJECT SUMMARY Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel coronavirus, is the causative agent of coronavirus disease 2019 (COVID-19) and is responsible for the current pandemic, with 14.4 million total confirmed cases of coronavirus disease 2019 (COVID-19) in over 200 countries and territories and more than 604,000 deaths as of July 19, 2020. Of these, 3.83 million cases and 143,000 deaths occurred in the United States (US). Most long-term public health and clinical approaches to pandemic containment are based on the presumption that infection with SARS-CoV-2 confers immunity against reinfection for at least 1 year. However, understanding of immune responses to SARS-CoV-2 is extremely limited and evidence of conferred immunity against reinfection or its duration are lacking. Most concerning is that racial/ethnic minorities bear a disproportionate burden of the incidence, morbidity, and mortality from SARS-CoV-2 infection. To date, explanations for this disparity are postulated as structural racism and discrimination, higher rates of pre-existing health conditions, and delayed or limited access to healthcare. However, differences in immune response to SARS-CoV-2 may also play a part in this disparity. Racial/ethnic differences in the immune response are well documented for other viral diseases and vaccines, but little is known about immune response to SARS-CoV-2 in racial/ethnic minorities. To address this critical gap in knowledge, we will assess and characterize the immune response to SARS-CoV-2 infection in racial/ethnic minorities in Arkansas. To achieve this objective we propose a population-based, observational prospective cohort study comprised of men and women that is a racially, ethnically, and geographically diverse, representative sample of all noninstitutionalized adults residing in Arkansas tested by real-time, reverse transcriptase polymerase chain reaction (RT-PCR) for COVID-19 between November 2020 and April 2021. The 450-person cohort will be sampled from the statewide COVID-19 test database and followed up to 48 months posttesting. Our first aim is to determine the serological responses to SARS-CoV-2 infection over time by race/ethnicity among RT-PCR confirmed, positive adults in Arkansas. In this aim we will assess serological response among NH black and Hispanic adults in comparison to NH white adults. Our second aim is to determine the durability of the serological response to SARS-CoV-2 infection over time by race/ethnicity among RT-PCR confirmed positive adult Arkansans. In Aim 3 we will determine how psychosocial and behavioral factors such as, chronic stress, depression, anxiety, social support, tobacco use, alcohol intake, and sedentary lifestyle, influence the serological response over time to SARS-CoV-2 by race/ethnicity. We expect that our results will inform clinical management and prognosis of racial/ethnic minority patients with COVID-19 and vaccine development. Our findings will also have a significant public health impact for long-term public health policies for pandemic containment.

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