The PURE COVID-19, a sub-study of PURE, is a unique opportunity to document factors that predispose people to SARS-CoV-2 infection in different populations across high, middle and low-income countries.

The sub-study’s objectives are to:

  1. 1) Identify individual characteristics associated with higher risk of SARS-CoV-2 infection (both symptomatic and asymptomatic) as measured serologically;
  2. 2) Document the late sequelae after symptomatic and asymptomatic SARS-CoV-2 infection, and especially restrictive abnormalities in lung function.

PURE COVID-19 can be conducted with a high level of speed and efficiency by leveraging the PURE study, in which 200,000 people have been recruited in more than 1000 communities in 27 countries. Participants have already been characterized in detail prior to 2019. Data were collected on socio-economic factors, living circumstances, cooking fuels (solid versus gas or electricity), diet, social isolation, depression, alcohol and tobacco use, morbidities, physical activity, medications, anthropometrics, blood pressure and handgrip strength. Lung function was measured by spirometry. Also, blood specimens were stored in a central biobank.

In the PURE COVID-19 sub-study, we propose to draw a blood sample from 40,000 people from PURE countries and communities with high infection rates according to local reports. In this way, we will serologically identify participants who have been infected by SARS-CoV-2 (symptomatic and asymptomatic). Data collected during follow-up include vital status, incident heart failure, chronic lung disease, pneumonia, myocardial infarction, stroke and hospitalization. Anthropometrics, blood pressure, handgrip strength and lung function are being re-measured. Follow-up is planned for at least a further 3 years.

We will compare participants with serologic evidence of SARS-CoV-2 exposure (cases) with participants without exposure (controls) stratified by community to identify independent risk factors for SARS-CoV-2 infection. We will assess differences between SARS-CoV-2 cases and controls with respect to change in forced expiratory volume in 1 second (FEV1) and forced vital capacity between baseline and follow-up by using linear mixed effects models to identify possible effects of SARS-CoV-2 infection on lung function.

ESC 2021 Presentation - DOWNLOAD PDF
Study Type


Study Design

Prospective cohort

NO. of Countries


NO. of Sites


NO. of Participants


Study Period

2020 - 2022



Canadian Institutes of Health Research (CIHR)

International Development Research Centre (IDRC)

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