Rutgers Robert Wood Johnson Medical School (RWJMS) is projected to receive approximately $30 million, establishing a critical partnership with the larger National Institutes of Health–funded RECOVER Initiative to study long-term and delayed impacts of COVID-19 on children and lead a national collaboration with the potential to recruit from any state to investigate these outcomes.
Impacts of infection with the virus SARS-CoV-2 that present or persist more than 30 days are collectively referred to as post-acute sequelae of COVID-19 (PASC).
Among the first PASC recognized in children is Multisystem Inflammatory Syndrome in Children (MIS-C), a severe acute inflammatory illness, which typically begins unexpectedly about a month after the initial infection. Children with MIS-C have fever and other symptoms that may include inflammation of the gastrointestinal tract, circulatory system and skin that sometimes mimic another rare illness, Kawasaki’s Disease. Beyond MIS-C, children are also susceptible to what is commonly referred to as “long COVID.” A team of researchers at Rutgers have studied COVID-19 and MIS-C from shortly after it was first described in the United States.
“Children and adolescents are susceptible to long-term symptoms. Some have brain fog. Others lose their stamina and with it their ability to participate in athletic activities. We are still learning what long COVID may look like in children – as well as in adults. Pain, headaches, fatigue, anxiety, depression, fever, cough and sleep problems have all been reported,” said Lawrence Kleinman, a professor and vice chair of the Department of Pediatrics at RWJMS and a professor of global public health at the Rutgers School of Public Health and lead investigator for the Collaborative Long-term study of Outcomes of COVID-19 in Kids (CLOCK) consortium at Rutgers. The CLOCK team will recruit children, adolescents and young adults from across the United States into the NIH’s RECOVER cohort study.
“CLOCK will make essential contributions to the RECOVER Cohort’s ability to identify the nature of PASC, what makes children susceptible to PASC and ultimately what we can do to prevent and treat this frightening and potentially debilitating condition in children as well as in adults,” Kleinman said.
CLOCK was developed collaboratively with a variety of prominent organizations, most of which are expected to participate in the four-year research study. CLOCK partners include the American Academy of Pediatrics and its PROS Research Network, the American Academy of Family Physicians and its National Research Network, along with its partner the DARTNet Institute, Family Voices – a national grassroots organization that advances partnerships with parents, and distinguished pediatric institutions such as Baylor College of Medicine/Texas Children’s Hospital, Bristol Myers Squibb Children’s Hospital, Central Michigan University, Children’s Hospital of Philadelphia, Children’s Mercy Hospital of Kansas City, Connecticut Children’s, Johns Hopkins University School of Medicine, Hackensack Meridian Children’s Health, MetroHealth System (Cleveland), New York Medical College/Maria Ferari Children’s Hospital, RWJ Barnabas Health, University of California, San Francisco and the Yale University School of Medicine.
Several of the CLOCK partners also join Rutgers as colleagues in the Eunice Kennedy Shriver National Institute of Child Health and Development’s Predicting Viral-Associated Inflammatory Disease Severity in Children with Laboratory Diagnostics and Artificial Intelligence (PreVAIL kIds) initiative. PreVAIL kIds is part of the Rapid Acceleration of Diagnostics (RADx) Radical (RADx-rad) program and seeks to develop and validate translational tools to predict which children with SARS-CoV-2, the virus that causes COVID-19, are most likely to experience severe illness such as pneumonia or MIS-C.
“This scientifically rigorous and collaborative approach allows us to research a diverse group of children and their parents or caregivers as participants, which is critical to informing the treatment and prevention of the long-term effects of COVID-19,” Kleinman said.
Data from the RECOVER Cohort will include clinical information, laboratory tests and analyses of participants in various stages of recovery following SARS-CoV-2 infection. The full RECOVER Cohort will include adults, pregnant individuals and children; enroll patients during the acute as well as post-acute phases of the SARS-CoV-2 infection; evaluate tissue pathology; analyze data from millions of electronic health records; and use mobile health technologies, such as smartphone apps and wearable devices, which will gather real-world data in real time. In addition to hubs like Rutgers/CLOCK, the RECOVER study is supported by cores such as those for clinical sciences (NYU Grossman School of Medicine), data resources (Massachusetts General Hospital) and a biorepository (Mayo Medical School).
Those interested in the work of the CLOCK consortium can email email@example.com.
For more information about the NIH RECOVER Initiative go to https://recovercovid.org/.
What is PASC?
- The long-term effects of the virus are called post-acute sequelae of SARS-CoV-2 infection (PASC).
- Long COVID is a form of PASC and refers to symptoms that persist for weeks or months after the acute infection.
- MIS-C is a form of PASC that impacts children, typically 4 -5 weeks after their initial infection
- Persistent symptoms originate in multiple organs and systems. The most common symptoms include pain, headaches, fatigue, “brain fog,” shortness of breath, anxiety, depression, fever, chronic cough, and sleep problems.
- PASC includes multisystem inflammatory syndrome in children and adults (MIS-C and MIS-A), which is rare, but results in severe immune responses to SARS-CoV-2.
- Some people, especially those who were severely ill, may have lingering lung problems.
Why the RECOVER Initiative?
- The Researching COVID to Enhance Recovery (RECOVER) Initiative is a centralized effort that will enable a nationally representative cohort of participants. More than 30 research teams across the country will study and share data in real time which will provide the scale we need to get real answers to help alleviate suffering as fast as possible.
- The Researching COVID to Enhance Recovery (RECOVER) Initiative was established to find answers to critical PASC-related issues including why some people recover while others do not, PASC risk factors, and strategies for preventing and treating PASC. Research will help us better understand the post-acute sequelae of the SARS-CoV-2 infection. Current data suggest that about 10-30% of those who have had an acute infection will experience persistent symptoms lasting at least one month.
- The goals of RECOVER are to understand, treat, and prevent PASC.