Swallowing Impairment After COVID-19 Infection

The recent spread of COVID-19 has led to an international pandemic, with >3 million confirmed
cases to date worldwide, of which 1 million confirmed cases and >50,000 deaths have been
reported in the USA. Infected individuals commonly experience severe respiratory difficulties
and pneumonia, leading to hospital admission and the need for intensive care and mechanical
ventilation. Emerging evidence suggests that impaired taste and smell may be early markers of
the disease, and that in severe cases, there may be neurological damage in in the medulla, an
important brainstem control site for both respiration and swallowing. Given the overlapping
neuroanatomical regulation of breathing and swallowing, the investigators hypothesize that
dysphagia (swallowing impairment) will be common in People recovering from COVID-19 (PrC-19)
and associated with poorer outcomes.

The investigators will offer comprehensive swallowing assessments to PrC-19 after initial
recovery and a confirmed negative test for continuing COVID-19 infection. Study sites will be
located in the Toronto area (PI Steele); the Hamilton-Niagara region to the west of Toronto
(Co-I Namasivayam-MacDonald) and in Gainesville, Florida (Co-I Plowman). The assessments will
include the collection of case history information, videofluoroscopy (i.e., a dynamic
swallowing x-ray), use of a digital stethoscope to measure respiratory-swallow coordination,
measures of other risk factors for dysphagia (e.g. bulbar muscle strength) and
patient-reported outcomes. Detailed analyses of the videofluoroscopy swallowing studies (i.e.
dynamic x-rays) will identify specific measures of swallowing that fall outside the range of
normal variation based on comparison to healthy reference values established through the PI's
NIH-funded research program exploring swallowing physiology on liquids of different
consistencies.