Researching COVID to enhance recovery (RECOVER) tissue pathology study protocol: Rationale, objectives, and design

Andrea B. Troxel; Marie Abele C. Bind; Thomas J. Flotte; Carlos Cordon-Cardo; Lauren A. Decker; Aloke V. Finn; Robert F. Padera; R. Ross Reichard; James R. Stone; Natalie L. Adolphi; Faye Victoria C. Casimero; John F. Crary; Jamie Elifritz; Arline Faustin; Saikat Kumar B. Ghosh; Amanda Krausert; Maria Martinez-Lage; Jonathan Melamed; Roger A. Mitchell; Barbara A. Sampson; Alan C. Seifert; Aylin Simsir; Cheryle Adams; Stephanie Haasnoot; Stephanie Hafner; Michelle A. Siciliano; Brittany B. Vallejos; Phoebe Del Boccio; Michelle F. Lamendola-Essel; Chloe E. Young; Deepshikha Kewlani; Precious A. Akinbo; Brendan Parent; Alicia Chung; Teresa C. Cato; Praveen C. Mudumbi; Shari Esquenazi-Karonika; Marion J. Wood; James Chan; Jonathan Monteiro; Daniel J. Shinnick; Tanayott Thaweethai; Amber N. Nguyen; Megan L. Fitzgerald; Alice A. Perlowski; Lauren E. Stiles; Moira L. Paskett; Stuart D. Katz; Andrea S. Foulkes; Preciosa Akinbo; Phoebe Del Boccio; Michelle Lamendola-Essel; Chloe Young; Faye Victoria C. Casimero; Maria Martinez Lage Alvarez; Robert F. Padera; Michelle Siciliano; Aloke Virmani Finn; Katie Burack; Ashley DeGrange; Youraline Joseph; Rika Kawakami; Robert Kutys; Tina Richards; Maria Romero; Torie Samuda; Renu Virmani; Cheryle Adams; Hassan Brim; La Tenzar Everrett; Devon Jackson; Mary Bruno; Ezeddin Fadel; Camila Fang; Arline Faustin; Estefania Gallego; Eduardo Iturrate; Deepshikha Kewlani; Jan Osea; Timothy Shepherd; Michael Harris; Melissa Klein; Matthew LoMastro; Moira Paskett; Stephanie Hafner; Lisa Hines; Kejal Kantarci; Claudia Lucinetti; Joseph Maleszewski; Teresa Moran; Kristina Peters; Katelyn Reed; Emily Scharrer; Nicole Steinle; Suzanne Taylor; Luke Wilson; Thor Wirth; Thomas Flotte; Mary Beth Beasley; Kristin Beaumont; Michael Beaumont; Rachel Brody; Alessandra Cervera; Alexander Charney; John Crary; Kristen Dams-O’Connor; Siraj El Jamal; Rebecca Folkerth; Andrea Gonzalez; Ronald Gordon; Sabina Guliyeva; Stephanie Haasnoot; Kenneth Haines; Nathalie Jette; Amanda Krausert; Bea Martin; Russell McBride; Alberto Mondolfi; Susan Morgello; Elisabet Pujadas; Barbara Sampson; Robert Sebra; Alan Seifert; Aryeh Stock; Aleeka Wade; Emma Woodoff Leith; Paula Yarbrough; Natalie Adolphi; Stacy Catanach; Lauren Decker; Jamie Elifritz; Hadya Khawaja; Jacob Ormsby; Kyla Sorensen; Brittany Vallejos; Claire Wells

doi:10.1371/journal.pone.0285645

Researching COVID to enhance recovery (RECOVER) tissue pathology study protocol: Rationale, objectives, and design

Andrea B. Troxel, Marie Abele C. Bind, Thomas J. Flotte, Carlos Cordon-Cardo, Lauren A. Decker, Aloke V. Finn, Robert F. Padera, R. Ross Reichard, James R. Stone, Natalie L. Adolphi, Faye Victoria C. Casimero, John F. Crary, Jamie Elifritz, Arline Faustin, Saikat Kumar B. Ghosh, Amanda Krausert, Maria Martinez-Lage, Jonathan Melamed, Roger A. Mitchell, Barbara A. SampsonAlan C. Seifert, Aylin Simsir, Cheryle Adams, Stephanie Haasnoot, Stephanie Hafner, Michelle A. Siciliano, Brittany B. Vallejos, Phoebe Del Boccio, Michelle F. Lamendola-Essel, Chloe E. Young, Deepshikha Kewlani, Precious A. Akinbo, Brendan Parent, Alicia Chung, Teresa C. Cato, Praveen C. Mudumbi, Shari Esquenazi-Karonika, Marion J. Wood, James Chan, Jonathan Monteiro, Daniel J. Shinnick, Tanayott Thaweethai, Amber N. Nguyen, Megan L. Fitzgerald, Alice A. Perlowski, Lauren E. Stiles, Moira L. Paskett, Stuart D. Katz, Andrea S. Foulkes, Preciosa Akinbo, Phoebe Del Boccio, Michelle Lamendola-Essel, Chloe Young, Faye Victoria C. Casimero, Maria Martinez Lage Alvarez, Robert F. Padera, Michelle Siciliano, Aloke Virmani Finn, Katie Burack, Ashley DeGrange, Youraline Joseph, Rika Kawakami, Robert Kutys, Tina Richards, Maria Romero, Torie Samuda, Renu Virmani, Cheryle Adams, Hassan Brim, La Tenzar Everrett, Devon Jackson, Mary Bruno, Ezeddin Fadel, Camila Fang, Arline Faustin, Estefania Gallego, Eduardo Iturrate, Deepshikha Kewlani, Jan Osea, Timothy Shepherd, Michael Harris, Melissa Klein, Matthew LoMastro, Moira Paskett, Stephanie Hafner, Lisa Hines, Kejal Kantarci, Claudia Lucinetti, Joseph Maleszewski, Teresa Moran, Kristina Peters, Katelyn Reed, Emily Scharrer, Nicole Steinle, Suzanne Taylor, Luke Wilson, Thor Wirth, Thomas Flotte, Mary Beth Beasley, Kristin Beaumont, Michael Beaumont, Rachel Brody, Alessandra Cervera, Alexander Charney, John Crary, Kristen Dams-O’Connor, Siraj El Jamal, Rebecca Folkerth, Andrea Gonzalez, Ronald Gordon, Sabina Guliyeva, Stephanie Haasnoot, Kenneth Haines, Nathalie Jette, Amanda Krausert, Bea Martin, Russell McBride, Alberto Mondolfi, Susan Morgello, Elisabet Pujadas, Barbara Sampson, Robert Sebra, Alan Seifert, Aryeh Stock, Aleeka Wade, Emma Woodoff Leith, Paula Yarbrough, Natalie Adolphi, Stacy Catanach, Lauren Decker, Jamie Elifritz, Hadya Khawaja, Jacob Ormsby, Kyla Sorensen, Brittany Vallejos, Claire Wells

Laboratory Medicine and Pathology

Research output: Contribution to journal › Article › peer-review

Abstract

Importance SARS-CoV-2 infection can result in ongoing, relapsing, or new symptoms or organ dysfunction after the acute phase of infection, termed Post-Acute Sequelae of SARS-CoV-2 (PASC), or long COVID. The characteristics, prevalence, trajectory and mechanisms of PASC are poorly understood. The objectives of the Researching COVID to Enhance Recovery (RECOVER) tissue pathology study (RECOVER-Pathology) are to: (1) characterize prevalence and types of organ injury/disease and pathology occurring with PASC; (2) characterize the association of pathologic findings with clinical and other characteristics; (3) define the pathophysiology and mechanisms of PASC, and possible mediation via viral persistence; and (4) establish a post-mortem tissue biobank and post-mortem brain imaging biorepository. Methods RECOVER-Pathology is a cross-sectional study of decedents dying at least 15 days following initial SARS-CoV-2 infection. Eligible decedents must meet WHO criteria for suspected, probable, or confirmed infection and must be aged 18 years or more at the time of death. Enrollment occurs at 7 sites in four U.S. states and Washington, DC. Comprehensive autopsies are conducted according to a standardized protocol within 24 hours of death; tissue samples are sent to the PASC Biorepository for later analyses. Data on clinical history are collected from the medical records and/or next of kin. The primary study outcomes include an array of pathologic features organized by organ system. Causal inference methods will be employed to investigate associations between risk factors and pathologic outcomes. Discussion RECOVER-Pathology is the largest autopsy study addressing PASC among US adults. Results of this study are intended to elucidate mechanisms of organ injury and disease and enhance our understanding of the pathophysiology of PASC.

Original language	English (US)
Article number	e0285645
Journal	PloS one
Volume	19
Issue number	1 January
DOIs	https://doi.org/10.1371/journal.pone.0285645
State	Published - Jan 2024

ASJC Scopus subject areas

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10.1371/journal.pone.0285645

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Troxel, A. B., Bind, M. A. C., Flotte, T. J., Cordon-Cardo, C., Decker, L. A., Finn, A. V., Padera, R. F., Ross Reichard, R., Stone, J. R., Adolphi, N. L., Casimero, F. V. C., Crary, J. F., Elifritz, J., Faustin, A., Ghosh, S. K. B., Krausert, A., Martinez-Lage, M., Melamed, J., Mitchell, R. A., ... Wells, C. (2024). Researching COVID to enhance recovery (RECOVER) tissue pathology study protocol: Rationale, objectives, and design. PloS one, 19(1 January), Article e0285645. https://doi.org/10.1371/journal.pone.0285645

Troxel, AB, Bind, MAC, Flotte, TJ, Cordon-Cardo, C, Decker, LA, Finn, AV, Padera, RF, Ross Reichard, R, Stone, JR, Adolphi, NL, Casimero, FVC, Crary, JF, Elifritz, J, Faustin, A, Ghosh, SKB, Krausert, A, Martinez-Lage, M, Melamed, J, Mitchell, RA, Sampson, BA, Seifert, AC, Simsir, A, Adams, C, Haasnoot, S, Hafner, S, Siciliano, MA, Vallejos, BB, Del Boccio, P, Lamendola-Essel, MF, Young, CE, Kewlani, D, Akinbo, PA, Parent, B, Chung, A, Cato, TC, Mudumbi, PC, Esquenazi-Karonika, S, Wood, MJ, Chan, J, Monteiro, J, Shinnick, DJ, Thaweethai, T, Nguyen, AN, Fitzgerald, ML, Perlowski, AA, Stiles, LE, Paskett, ML, Katz, SD, Foulkes, AS, Akinbo, P, Boccio, PD, Lamendola-Essel, M, Young, C, Casimero, FVC, Alvarez, MML, Padera, RF, Siciliano, M, Finn, AV, Burack, K, DeGrange, A, Joseph, Y, Kawakami, R, Kutys, R, Richards, T, Romero, M, Samuda, T, Virmani, R, Adams, C, Brim, H, Everrett, LT, Jackson, D, Bruno, M, Fadel, E, Fang, C, Faustin, A, Gallego, E, Iturrate, E, Kewlani, D, Osea, J, Shepherd, T, Harris, M, Klein, M, LoMastro, M, Paskett, M, Hafner, S, Hines, L, Kantarci, K, Lucinetti, C, Maleszewski, J, Moran, T, Peters, K, Reed, K, Scharrer, E, Steinle, N, Taylor, S, Wilson, L, Wirth, T, Flotte, T, Beasley, MB, Beaumont, K, Beaumont, M, Brody, R, Cervera, A, Charney, A, Crary, J, Dams-O’Connor, K, Jamal, SE, Folkerth, R, Gonzalez, A, Gordon, R, Guliyeva, S, Haasnoot, S, Haines, K, Jette, N, Krausert, A, Martin, B, McBride, R, Mondolfi, A, Morgello, S, Pujadas, E, Sampson, B, Sebra, R, Seifert, A, Stock, A, Wade, A, Leith, EW, Yarbrough, P, Adolphi, N, Catanach, S, Decker, L, Elifritz, J, Khawaja, H, Ormsby, J, Sorensen, K, Vallejos, B & Wells, C 2024, 'Researching COVID to enhance recovery (RECOVER) tissue pathology study protocol: Rationale, objectives, and design', PloS one, vol. 19, no. 1 January, e0285645. https://doi.org/10.1371/journal.pone.0285645

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title = "Researching COVID to enhance recovery (RECOVER) tissue pathology study protocol: Rationale, objectives, and design",

abstract = "Importance SARS-CoV-2 infection can result in ongoing, relapsing, or new symptoms or organ dysfunction after the acute phase of infection, termed Post-Acute Sequelae of SARS-CoV-2 (PASC), or long COVID. The characteristics, prevalence, trajectory and mechanisms of PASC are poorly understood. The objectives of the Researching COVID to Enhance Recovery (RECOVER) tissue pathology study (RECOVER-Pathology) are to: (1) characterize prevalence and types of organ injury/disease and pathology occurring with PASC; (2) characterize the association of pathologic findings with clinical and other characteristics; (3) define the pathophysiology and mechanisms of PASC, and possible mediation via viral persistence; and (4) establish a post-mortem tissue biobank and post-mortem brain imaging biorepository. Methods RECOVER-Pathology is a cross-sectional study of decedents dying at least 15 days following initial SARS-CoV-2 infection. Eligible decedents must meet WHO criteria for suspected, probable, or confirmed infection and must be aged 18 years or more at the time of death. Enrollment occurs at 7 sites in four U.S. states and Washington, DC. Comprehensive autopsies are conducted according to a standardized protocol within 24 hours of death; tissue samples are sent to the PASC Biorepository for later analyses. Data on clinical history are collected from the medical records and/or next of kin. The primary study outcomes include an array of pathologic features organized by organ system. Causal inference methods will be employed to investigate associations between risk factors and pathologic outcomes. Discussion RECOVER-Pathology is the largest autopsy study addressing PASC among US adults. Results of this study are intended to elucidate mechanisms of organ injury and disease and enhance our understanding of the pathophysiology of PASC.",

author = "Troxel, {Andrea B.} and Bind, {Marie Abele C.} and Flotte, {Thomas J.} and Carlos Cordon-Cardo and Decker, {Lauren A.} and Finn, {Aloke V.} and Padera, {Robert F.} and {Ross Reichard}, R. and Stone, {James R.} and Adolphi, {Natalie L.} and Casimero, {Faye Victoria C.} and Crary, {John F.} and Jamie Elifritz and Arline Faustin and Ghosh, {Saikat Kumar B.} and Amanda Krausert and Maria Martinez-Lage and Jonathan Melamed and Mitchell, {Roger A.} and Sampson, {Barbara A.} and Seifert, {Alan C.} and Aylin Simsir and Cheryle Adams and Stephanie Haasnoot and Stephanie Hafner and Siciliano, {Michelle A.} and Vallejos, {Brittany B.} and {Del Boccio}, Phoebe and Lamendola-Essel, {Michelle F.} and Young, {Chloe E.} and Deepshikha Kewlani and Akinbo, {Precious A.} and Brendan Parent and Alicia Chung and Cato, {Teresa C.} and Mudumbi, {Praveen C.} and Shari Esquenazi-Karonika and Wood, {Marion J.} and James Chan and Jonathan Monteiro and Shinnick, {Daniel J.} and Tanayott Thaweethai and Nguyen, {Amber N.} and Fitzgerald, {Megan L.} and Perlowski, {Alice A.} and Stiles, {Lauren E.} and Paskett, {Moira L.} and Katz, {Stuart D.} and Foulkes, {Andrea S.} and Preciosa Akinbo and Boccio, {Phoebe Del} and Michelle Lamendola-Essel and Chloe Young and Casimero, {Faye Victoria C.} and Alvarez, {Maria Martinez Lage} and Padera, {Robert F.} and Michelle Siciliano and Finn, {Aloke Virmani} and Katie Burack and Ashley DeGrange and Youraline Joseph and Rika Kawakami and Robert Kutys and Tina Richards and Maria Romero and Torie Samuda and Renu Virmani and Cheryle Adams and Hassan Brim and Everrett, {La Tenzar} and Devon Jackson and Mary Bruno and Ezeddin Fadel and Camila Fang and Arline Faustin and Estefania Gallego and Eduardo Iturrate and Deepshikha Kewlani and Jan Osea and Timothy Shepherd and Michael Harris and Melissa Klein and Matthew LoMastro and Moira Paskett and Stephanie Hafner and Lisa Hines and Kejal Kantarci and Claudia Lucinetti and Joseph Maleszewski and Teresa Moran and Kristina Peters and Katelyn Reed and Emily Scharrer and Nicole Steinle and Suzanne Taylor and Luke Wilson and Thor Wirth and Thomas Flotte and Beasley, {Mary Beth} and Kristin Beaumont and Michael Beaumont and Rachel Brody and Alessandra Cervera and Alexander Charney and John Crary and Kristen Dams-O{\textquoteright}Connor and Jamal, {Siraj El} and Rebecca Folkerth and Andrea Gonzalez and Ronald Gordon and Sabina Guliyeva and Stephanie Haasnoot and Kenneth Haines and Nathalie Jette and Amanda Krausert and Bea Martin and Russell McBride and Alberto Mondolfi and Susan Morgello and Elisabet Pujadas and Barbara Sampson and Robert Sebra and Alan Seifert and Aryeh Stock and Aleeka Wade and Leith, {Emma Woodoff} and Paula Yarbrough and Natalie Adolphi and Stacy Catanach and Lauren Decker and Jamie Elifritz and Hadya Khawaja and Jacob Ormsby and Kyla Sorensen and Brittany Vallejos and Claire Wells",

year = "2024",

month = jan,

doi = "10.1371/journal.pone.0285645",

language = "English (US)",

volume = "19",

journal = "PloS one",

issn = "1932-6203",

publisher = "Public Library of Science",

number = "1 January",

}

TY - JOUR

T1 - Researching COVID to enhance recovery (RECOVER) tissue pathology study protocol

T2 - Rationale, objectives, and design

AU - Troxel, Andrea B.

AU - Bind, Marie Abele C.

AU - Flotte, Thomas J.

AU - Cordon-Cardo, Carlos

AU - Decker, Lauren A.

AU - Finn, Aloke V.

AU - Padera, Robert F.

AU - Ross Reichard, R.

AU - Stone, James R.

AU - Adolphi, Natalie L.

AU - Casimero, Faye Victoria C.

AU - Crary, John F.

AU - Elifritz, Jamie

AU - Faustin, Arline

AU - Ghosh, Saikat Kumar B.

AU - Krausert, Amanda

AU - Martinez-Lage, Maria

AU - Melamed, Jonathan

AU - Mitchell, Roger A.

AU - Sampson, Barbara A.

AU - Seifert, Alan C.

AU - Simsir, Aylin

AU - Adams, Cheryle

AU - Haasnoot, Stephanie

AU - Hafner, Stephanie

AU - Siciliano, Michelle A.

AU - Vallejos, Brittany B.

AU - Del Boccio, Phoebe

AU - Lamendola-Essel, Michelle F.

AU - Young, Chloe E.

AU - Kewlani, Deepshikha

AU - Akinbo, Precious A.

AU - Parent, Brendan

AU - Chung, Alicia

AU - Cato, Teresa C.

AU - Mudumbi, Praveen C.

AU - Esquenazi-Karonika, Shari

AU - Wood, Marion J.

AU - Chan, James

AU - Monteiro, Jonathan

AU - Shinnick, Daniel J.

AU - Thaweethai, Tanayott

AU - Nguyen, Amber N.

AU - Fitzgerald, Megan L.

AU - Perlowski, Alice A.

AU - Stiles, Lauren E.

AU - Paskett, Moira L.

AU - Katz, Stuart D.

AU - Foulkes, Andrea S.

AU - Akinbo, Preciosa

AU - Boccio, Phoebe Del

AU - Lamendola-Essel, Michelle

AU - Young, Chloe

AU - Casimero, Faye Victoria C.

AU - Alvarez, Maria Martinez Lage

AU - Padera, Robert F.

AU - Siciliano, Michelle

AU - Finn, Aloke Virmani

AU - Burack, Katie

AU - DeGrange, Ashley

AU - Joseph, Youraline

AU - Kawakami, Rika

AU - Kutys, Robert

AU - Richards, Tina

AU - Romero, Maria

AU - Samuda, Torie

AU - Virmani, Renu

AU - Adams, Cheryle

AU - Brim, Hassan

AU - Everrett, La Tenzar

AU - Jackson, Devon

AU - Bruno, Mary

AU - Fadel, Ezeddin

AU - Fang, Camila

AU - Faustin, Arline

AU - Gallego, Estefania

AU - Iturrate, Eduardo

AU - Kewlani, Deepshikha

AU - Osea, Jan

AU - Shepherd, Timothy

AU - Harris, Michael

AU - Klein, Melissa

AU - LoMastro, Matthew

AU - Paskett, Moira

AU - Hafner, Stephanie

AU - Hines, Lisa

AU - Kantarci, Kejal

AU - Lucinetti, Claudia

AU - Maleszewski, Joseph

AU - Moran, Teresa

AU - Peters, Kristina

AU - Reed, Katelyn

AU - Scharrer, Emily

AU - Steinle, Nicole

AU - Taylor, Suzanne

AU - Wilson, Luke

AU - Wirth, Thor

AU - Flotte, Thomas

AU - Beasley, Mary Beth

AU - Beaumont, Kristin

AU - Beaumont, Michael

AU - Brody, Rachel

AU - Cervera, Alessandra

AU - Charney, Alexander

AU - Crary, John

AU - Dams-O’Connor, Kristen

AU - Jamal, Siraj El

AU - Folkerth, Rebecca

AU - Gonzalez, Andrea

AU - Gordon, Ronald

AU - Guliyeva, Sabina

AU - Haasnoot, Stephanie

AU - Haines, Kenneth

AU - Jette, Nathalie

AU - Krausert, Amanda

AU - Martin, Bea

AU - McBride, Russell

AU - Mondolfi, Alberto

AU - Morgello, Susan

AU - Pujadas, Elisabet

AU - Sampson, Barbara

AU - Sebra, Robert

AU - Seifert, Alan

AU - Stock, Aryeh

AU - Wade, Aleeka

AU - Leith, Emma Woodoff

AU - Yarbrough, Paula

AU - Adolphi, Natalie

AU - Catanach, Stacy

AU - Decker, Lauren

AU - Elifritz, Jamie

AU - Khawaja, Hadya

AU - Ormsby, Jacob

AU - Sorensen, Kyla

AU - Vallejos, Brittany

AU - Wells, Claire

PY - 2024/1

Y1 - 2024/1

N2 - Importance SARS-CoV-2 infection can result in ongoing, relapsing, or new symptoms or organ dysfunction after the acute phase of infection, termed Post-Acute Sequelae of SARS-CoV-2 (PASC), or long COVID. The characteristics, prevalence, trajectory and mechanisms of PASC are poorly understood. The objectives of the Researching COVID to Enhance Recovery (RECOVER) tissue pathology study (RECOVER-Pathology) are to: (1) characterize prevalence and types of organ injury/disease and pathology occurring with PASC; (2) characterize the association of pathologic findings with clinical and other characteristics; (3) define the pathophysiology and mechanisms of PASC, and possible mediation via viral persistence; and (4) establish a post-mortem tissue biobank and post-mortem brain imaging biorepository. Methods RECOVER-Pathology is a cross-sectional study of decedents dying at least 15 days following initial SARS-CoV-2 infection. Eligible decedents must meet WHO criteria for suspected, probable, or confirmed infection and must be aged 18 years or more at the time of death. Enrollment occurs at 7 sites in four U.S. states and Washington, DC. Comprehensive autopsies are conducted according to a standardized protocol within 24 hours of death; tissue samples are sent to the PASC Biorepository for later analyses. Data on clinical history are collected from the medical records and/or next of kin. The primary study outcomes include an array of pathologic features organized by organ system. Causal inference methods will be employed to investigate associations between risk factors and pathologic outcomes. Discussion RECOVER-Pathology is the largest autopsy study addressing PASC among US adults. Results of this study are intended to elucidate mechanisms of organ injury and disease and enhance our understanding of the pathophysiology of PASC.

AB - Importance SARS-CoV-2 infection can result in ongoing, relapsing, or new symptoms or organ dysfunction after the acute phase of infection, termed Post-Acute Sequelae of SARS-CoV-2 (PASC), or long COVID. The characteristics, prevalence, trajectory and mechanisms of PASC are poorly understood. The objectives of the Researching COVID to Enhance Recovery (RECOVER) tissue pathology study (RECOVER-Pathology) are to: (1) characterize prevalence and types of organ injury/disease and pathology occurring with PASC; (2) characterize the association of pathologic findings with clinical and other characteristics; (3) define the pathophysiology and mechanisms of PASC, and possible mediation via viral persistence; and (4) establish a post-mortem tissue biobank and post-mortem brain imaging biorepository. Methods RECOVER-Pathology is a cross-sectional study of decedents dying at least 15 days following initial SARS-CoV-2 infection. Eligible decedents must meet WHO criteria for suspected, probable, or confirmed infection and must be aged 18 years or more at the time of death. Enrollment occurs at 7 sites in four U.S. states and Washington, DC. Comprehensive autopsies are conducted according to a standardized protocol within 24 hours of death; tissue samples are sent to the PASC Biorepository for later analyses. Data on clinical history are collected from the medical records and/or next of kin. The primary study outcomes include an array of pathologic features organized by organ system. Causal inference methods will be employed to investigate associations between risk factors and pathologic outcomes. Discussion RECOVER-Pathology is the largest autopsy study addressing PASC among US adults. Results of this study are intended to elucidate mechanisms of organ injury and disease and enhance our understanding of the pathophysiology of PASC.

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Researching COVID to enhance recovery (RECOVER) tissue pathology study protocol: Rationale, objectives, and design

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