Functional Recovery of Hospitalised Patients With COVID-19: The COREG Extension Study

The coronavirus disease of 2019 (COVID-19) is an international public health challenge with
far-reaching social, economic and health impacts. Older adults and those with chronic
underlying health conditions are the most susceptible to COVID-19 and its complications. Of
the 15,381 reported cases of COVID-19 in Ontario to date, approximately 22.2% (n=3,420) are
aged 60-79 and 22.4% (n=3,443) are 80 and over. Although there has been a rapid and
coordinated response to studying the effects of COVID-19 in the acute stages, little is known
about recovery over the longer-term. Anecdotally, the investigators are seeing severe
declines in function, persistent symptoms, and new and worsening chronic conditions among
older survivors of COVID-19. It is known that older adults who survive acute respiratory
distress syndrome and associated diseases are at risk of developing persistent mobility
limitations due to extensive bed rest and/or long stays in the intensive care unit (ICU)
during hospitalization. Recent studies have shown that many older patients spend only 4% of
their hospital stay out of bed, and each day in bed is associated with a 1-5% loss in muscle
strength. For older patients and those with underlying frailty recovering from COVID-19, this
could rapidly lead to significant physical deconditioning and rapid declines in mobility;
with further losses in physiological reserve and resilience. Understanding the trajectory of
functional recovery of older hospitalised patients with COVID-19 in the short- and long-term
is critical to improving patient outcomes and informing health and rehabilitative
interventions for survivors.

This study is an extension of the Coronavirus (COVID-19) Registry (COREG) platform (PI Andrew
Costa)- a unique Kitchener-Waterloo-Hamilton registry of suspected and confirmed COVID-19
hospital admissions based on (and in collaboration with) the WHO International Severe Acute
Respiratory and Emerging Infection Consortium (ISARIC). The addition of a prospective cohort
study extension to COREG will allow the investigators to follow-older hospitalised COVID-19
patients over the longer-term in order to gain an understanding of the trajectory of
functional recovery of the disease. Combining the primary data collection with COREG will
also allow the investigators to identify determinants of long-term outcomes for at-risk older
adults. These data are necessary to guide the clinical care and optimal management of older
patients who survive serious COVID-19 illness.