PHOSP-COVID Post-hospitalisation COVID-19 study: a national consortium to understand and improve long-term health outcomes

The COVID-19 pandemic has tragically led to severe acute illness, hospitalisation and death. Beyond the health of those affected, it has had widespread economic, psychological and societal effects. The clinical spectrum is broad, ranging from those with no or minimal symptoms to severe pneumonia in 15-20% with evidence of widespread disease beyond the lung. As we emerge from the first wave of the pandemic we have new insights into the acute phase of this disease but very little information concerning longterm effects of COVID-19 and the ongoing medical, psychological and rehabilitation needs of these patients. We shall establish a national consortium and a research platform embedded within clinical care to understand and improve long-term outcomes for survivors following hospitalisation with COVID-19. We have built the consortium from existing expert groups across the UK and shall use standardised assessments of patients, including advanced imaging, recording of information and collection of samples. This study will provide us with a comprehensive understanding of the impact on the health of those that have been hospitalised with COVID-19. This will enable trials of new strategies of clinical care including personalised treatments to improve the long-term outcome of current and future COVID-19 survivors.

The SARS-CoV-2 (COVID-19) pandemic, has caused significant mortality and morbidity, alongside economic, psychological and societal effects. Over 100,000 people have been hospitalised in the UK with an in-hospital mortality of 26%. In addition to severe pneumonia, there is evidence of widespread pathology beyond the lung. To understand and improve long-term outcomes for survivors following hospitalisation with COVID-19, we shall establish a national platform embedding research into a standardised clinical pathway and biosampling integrated with ISARIC-4C and utilising the NIHR Bioresource. This will enable detailed clinical phenotyping of individuals. We propose to analyse routine
clinical data with linkage to retrospective and prospective health and social care records (Tier 1), enhanced clinical data and research-specific biosampling (Tier 2) and re-call of participants by genotype and phenotype for more detailed studies (Tier 3). We shall recruit 10000 individuals with a minimum of 5000 in Tier 2. We aim to i) determine the short to long-term chronic health (and health economic) sequelae of COVID-19 infection in post-hospitalisation survivors; to define demographic, clinical and molecular biomarkers of the susceptibility, development, progression and resolution of these health sequelae, ii) to understand the impact of interventions during the acute illness on these long-term sequelae and iii) to build the foundation for multiple indepth studies e.g. lung fibrosis, pulmonary and systemic vasculature, cardiometabolic, renal, sarcopaenia, rehabilitation, mental health and neurological disease. Our findings will
inform precision medicine in at risk groups by directing new clinical trials and care for current and future post-COVID-19 patients.