C4R is a “cohort of cohorts,” because it brings together 14 cohort studies that have been following up participants from across the U.S. for up to 40 years. Our goal is to improve understanding of what factors increase or decrease the likelihood of developing severe or prolonged COVID-19 illness. The cohorts are collaborating so that, together, they can help to examine both common and more rare COVID-19 outcomes.

C4R is just one of many studies regarding the health effects of COVID-19. C4R is unusual in that many of the participants in in C4R have been followed for decades, and they have undergone detailed health assessments regardless of whether they had any known health problems. For example, most individuals do not get imaging of their heart if their doctor does not suspect a heart condition; however, in some of the cohorts included in C4R, almost every participant was invited to have heart imaging. Similarly, many participants have imaging of their lungs and brains, as well as blood and genetic tests. So, C4R has a tremendous amount of information on participants’ health before the COVID-19 pandemic. This provides an important opportunity to understand how pre-COVID conditions may increase or decrease the risk of having severe or prolonged COVID-19 illness.

C4R includes over 50,000 adults in the US who are already participating in one of 14 collaborating cohort studies. The Framingham Heart Study is one of the collaborating cohort studies. So you as an FHS participant you may participate!

All Framingham Heart Study participants will be invited to complete a questionnaire regarding their experiences during the COVID-19 pandemic. Specifically, they will be asked if they tested positive for SARS-CoV-2, what symptoms they experienced and for how long, and whether they required hospitalization. The first wave of C4R questionnaires is currently being administered, and a follow-up survey, which will include questions about stress, fatigue, depression, and the potential impact of the pandemic on other health conditions, will be accomplished in 2021.

Medical records will be reviewed to assess what treatments they may have received for COVID-19 and whether they experienced complications such as heart attack, pneumonia, stroke, or blood clots.

All Framingham Heart Study participants will also invited to provide a small blood sample using an DBS kit sent to their home. The small blood sample, obtained through a finger stick at home, that will be analyzed for antibodies to SARS-CoV-2. This will allow the researchers to detect asymptomatic cases of COVID-19, which will offer a more accurate estimate of the number of individuals who were infected. The blood samples also may allow researchers to understand how the status of the immune system before the pandemic may be related to antibody responses and the severity of COVID-19 illness.

If you have not received or misplaced your study invitation please contact C4RFHS@bu.edu for assistance.

As an FHS participant you will receive an email or physical mail invitation to ask if you would like to be a part of the C4R study. This invitation will include a unique link for you to visit our C4R FHS data entry website in order to agree to participate and complete your questionnaires. At this website you will also be asked indicate if you agree to complete a Dried Blood Spot (DBS) kit at home. If you have not received or misplaced your invitation please contact C4RFHS@bu.edu for assistance.

C4R is using a “dried blood spot” to measure antibodies against SARS-CoV-2, the virus that causes COVID-19. We are asking participants to prick a finger and to drip a small amount of blood onto a special card. The card stores the dried blood in such a way that you can use it for antibody tests. This approach has been used safely for many decades and is even used in newborn babies for certain newborn screening programs.

Please check out this video on how to do the dried blood spot for C4R:

C4R Covid-19 vaccine study links post-vaccination side effects with stronger antibody response

Since February 2021, the Framingham Heart Study (Boston University) has been involved in the Collaborative Cohort of Cohorts for Covid-19 Research (C4R) in collaboration with Columbia University and the University of Vermont. Recently some early findings from the study data have been published in the Journal of the American Medical Association (JAMA) and CNN.

In an initial survey of participants who had received at least two doses of either the Pfizer/BioNTech or Moderna vaccines, 48% of participants self-reported systemic symptoms such as fever or muscle pain, 12% reported local symptoms such as pain at the injection site, and 40% reported no symptoms. The participants then submitted a dried blood spot (DBS) kit to test whether they had produced antibodies from the vaccines, which aid in fighting off the Covid-19 virus.

Based on the data collected from the initial survey and the DBS antibody results, researchers found that those who experienced side effects after receiving the Pfizer/BioNTech or Moderna vaccines exhibited stronger antibody levels in their DBS samples. These findings can reassure those who did experience side effects following their Covid-19 vaccines that it is their immune system positively responding and creating antibodies to fight against potential exposures to the virus. It is important to note that even if you did not experience any side effects from your vaccine, it does not mean you did not produce antibodies. In fact, antibodies were detected in 98% of study participants who reported no side effects after their vaccines compared to 99% in those who reported symptoms.

Thank you to our fabulous FHS participants who have contributed to the C4R study thus far. Your participation has allowed for the FHS/C4R researchers to continue valuable research and will continue improving our knowledge, benefiting health globally. We sincerely appreciated your contribution!