UH Med Now

Select states and universities, including the University of Hawaiʻi Mānoa John A. Burns School of Medicine (UH JABSOM) are participating in the REsearching COVID to Enhance Recovery (RECOVER) Initiative, recently launched by the National Institutes of Health (NIH) to solve the puzzle of post-acute sequelae of SARS-CoV-2 Infection (PASC), also known as Long COVID. 

The most common prolonged symptoms (lasting six months or more) of Long COVID include pain, headaches, fatigue, brain fog, shortness of breath, anxiety, depression, fever, chronic cough and sleep problems. Many of the reported symptoms are vague and subtle, resulting in the under-diagnosis of disease conditions by general physicians. But when extensive workup is performed, objective evidence of pulmonary, neurologic, cardiac and other organ damage and dysfunction is usually found. 

Cecilia Shikuma, MD.

“We need to find out what is going on,” said Cecilia Shikuma, MD, a JABSOM professor of medicine and principal investigator of the study here in Hawai’i. “We do not know what causes Long COVID or why Long COVID develops in some individuals and not in others.” She adds, “When discussing the syndrome with our patients, it is very frustrating that we can explain very little about why it develops and even less about what can be done about it.” 

 RECOVER plans to recruit 17,680 individuals across the nation from over 30 different enrolling sites into its study. Hawaiʻi is participating as one of 11 IDeA (Institutional Development Award) Clinical and Translational Research sites including Kansas, Kentucky, Louisiana, Maine, Mississippi, Nebraska, North Dakota, Oklahoma, Puerto Rico and West Virginia.

 Shikuma states that “It is important that Hawai’i local populations, including those traditionally underrepresented in clinical studies, are included in studying and finding solutions to prevent and treat Long COVID.”

 COVID disease disproportionately affects minority populations like Blacks and American Indians in the U.S. Locally, we see COVID disproportionately affecting Native Hawaiians, other Pacific Islanders and Filipinos. There is evidence that these populations may not only be at higher risk of catching the virus, but once infected, may be more likely to become severely ill.

 “We need to find out if these minority populations are also at higher risk for Long COVID disease.” Shikuma says. “Are there socio-economic or behavioral factors at work here? We know diabetes, cardiovascular disease and other chronic illnesses are seen more often in these populations and that these are also risk factors that predispose individuals to become more severely ill with COVID. Will we find that these chronic diseases also increase the risk of Long COVID and are related to higher risk in certain ethnic groups? Could there be immunologic differences that are making a difference?”

 Locally, the JABSOM team will work in collaboration with the Queen’s Medical Center (QMC), led by Dr. Todd Seto, the QMC director of Academic Affairs and Research. Dr. Dominic Chow, internist and JABSOM professor of medicine, who is in charge of the QMC post-COVID clinic, will also be helping with the study. 

 JABSOM’s participation in RECOVER was made possible by the recent NIH funding that created a Clinical and Translational Research (CTR) Program for Hawaiʻi. This was awarded to UH together with Hawaii Pacific University and Chaminade and a large statewide network of 18 practice-based organizations (PBO) and other community-based organizations (CBO). The program is named PIKO (Center for Pacific Innovations, Knowledge, and Opportunities) and is led by Dr. Keawe Kaholokula, associate professor and chair of Native Hawaiian Health, and Dr. Neal Palafox, professor of family medicine, both at JABSOM. 

 Locally, the four-year study plans to recruit participants within a one-year. The RECOVER study is particularly interested in recruiting participants who recently had COVID disease in order to see how many develop Long COVID disease. It is currently roughly estimated that between 30% to 50% of individuals who get COVID disease will become Long COVID sufferers although data is still incomplete. The study is also interested in recruiting individuals already suffering with Long COVID, and individuals who have no history of a COVID infection.

 The study will follow participants for up to four years, collecting medical history and symptoms. The data, without personal information, will be forwarded to a central database to help the researchers answer questions such as: 

• What percentage of individuals get Long COVID?
• Are there ethnic differences?
• Are there risk factors that predispose you to Long COVID?

For more information about RECOVER or to participate in this study in Hawai’i, please call the local RECOVER team at 808 692-1335, or visit https://recovercovid.org/

By Paula Bender, UH Med News

(top left) Drive-thru testing by Malia Agustin at the Waianae Coast Comprehensive Health Center. (top right) The JABSOM Tropical Medicine Clinical Laboratory (TMCL) photo by Lauren Ching. Composite by Paula Bender