Currently, the United States (US) has far more confirmed COVID-19 cases than any other country. The US epidemic is remarkably heterogeneous, with many cities and communities experiencing a disproportionately high disease burden and mortality. For example, at present, Miami, Minneapolis, Houston, Atlanta, and Durham NC, are projected to bear the brunt of the US epidemic and in the future, other communities may see an increase in the number of COVID-19 cases. The epidemic has also been marked by harsh disparities in COVID-19 rates and other health outcomes among African American and Latino communities who have substantially higher attack rates and higher mortality compared with any other racial or ethnic group across the US The communities surrounding several NIAID CRSs have suffered from not only longstanding racial inequalities, but also socioeconomic disparities in housing and employment, as well as varied access to health and other essential services. These populations also have a high prevalence of co-morbidities associated with higher incidence of COVID-19, more severe manifestations of COVID-19 disease , higher mortality from COVID-19, and have poorer health outcomes from a variety of illnesses overall. As with the observations among the elderly, these racial and ethnic factors all compel the need for the systematic collection of COVID-19-related data from populations at high risk for and highly impacted by COVID-19 and from the general population in their communities to enable the successful design and conduct of COVID-19 targeted prevention and treatment studies and provision of access to these populations of promising prevention and treatment interventions. The proposed research will provide comprehensive information on communities impacted by COVID-19 beyond surveillance studies currently in the field. It will directly contribute to preparedness for SARS-CoV-2 vaccine and other COVID-19 prevention and treatment studies by determining the prevalence of SARS-CoV-2 infection and seroprevalence among samples of individuals at elevated risk and of different ages who are recruited from communities where NIAID CRSs are situated. All prevalence estimates will be weighted for survey design, non-response and post-stratification population projections in order to generate estimates that are representative of the NIAID CRS communities. This research will determine the extent to which children and adults in these areas have SARS-CoV-2 infection or evidence of prior SARS-CoV-2 infection (based on results of antibody tests, self-report, and medical records). Additionally, data captured through questionnaires about participants' household members with COVID-like illness and deaths, combined with serologic data from participants, may also provide information about transmission dynamics within households. Questionnaire data will inform estimates of the percent of individuals of different age groups, including children, who may have had an asymptomatic COVID-19 infection. The frequency of infection among children and whether infected children play an important role in community transmission is poorly understood. The survey will also provide estimates of the association of SARS-CoV-2 seroprevalence with medical co-morbidities that have been associated with more severe disease outcomes and will also identify demographic and social risk factors associated with infection. Finally, this research will provide important information about SARS-CoV-2 transmission, COVID-19 disease, attitudes about and uptake of containment and mitigation measures, racial and ethnic health disparities, varied access to testing and public health resources by key demographic indicators, prospects for new prevention and treatment strategies, and be used to inform mathematical models of disease progression and projection of future COVID-19 risk.
The study will provide critically important information on the prevalence of current and prior SARS-CoV- 2 infections in communities in the US where NIAID research sites are situated. It will assess the impact of COVID-19 on the communities, model the potential impact of different prevention interventions, and set the foundation for COVID-19 prevention and treatment trials in these communities. It will also provide critical information to guide site section and the allocation of numbers of participants for future prevention and treatment studies and will provide valuable samples for key laboratory assessments related to SARS-CoV-2 infection and the COVID-19 epidemic
