Project Summary The proposed supplement will augment an established R24 Alcohol Research Resource, known as CoPARC (Colorado Pulmonary-Alcohol Research Collaborative), that has served as a human participant and patient biorepository supporting translational investigations at the intersection of alcohol misuse and pulmonary disease. CoPARC is centered at the University of Colorado, and has contributed to the research programs of established and junior investigators since 2011. Current CoPARC activities involve collection, processing, and assays in human respiratory biospecimens. This poses an increased risk for contracting the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. To address this issue, modifications to CoPARC's existing infrastructure are necessary to continue active collaborations. Further, extending approved research protocols to conduct investigations delineating alcohol's role in the pathogenesis of Coronavirus Disease (COVID)-19-associated respiratory failure and the acute respiratory distress syndrome (ARDS) are planned, and CoPARC's co-investigators have expressed unanimous support for expanded research in this area. Early reports in patients with COVID-19-associated respiratory failure and ARDS suggest that aberrations in the immune response influence severity of illness, contributing to multi-organ dysfunction and death. Importantly, harmful alcohol use has been associated with dysregulated pulmonary immunity and alveolar-capillary permeability that may explain its consistent association with severe ARDS. Nevertheless, the relationship between alcohol use and SARS-CoV-2-related respiratory illness remains unknown. This supplement will complement CoPARC's mission by enabling studies to delineate the impact of alcohol use on infection due to SARS-CoV-2, including the role of alcohol use on short- and long-term outcomes in respiratory failure and ARDS. Approximately 25% of patients hospitalized with severe COVID-19 at CoPARC's principal clinical site, the University of Colorado Hospital, endorse regular alcohol use, and alcohol misuse appears to be increasing across the US during the pandemic. Therefore, the role of alcohol consumption in COVID-19 disease pathogenesis warrants additional investigation. Aims for this supplement are in line with the NIAAA's notice of special interest to meet urgent research needs to further knowledge regarding how alcohol-associated organ damage may complicate health outcomes in COVID-19, and include: (1) Adapt the existing CoPARC infrastructure to safely and efficiently perform translational pulmonary investigations to understand the role of alcohol use on SARS-CoV-2 infection, and its impact on short-term (i.e. 28 day) outcomes among hospitalized in-patients with COVID-19-related respiratory failure and ARDS; and (2) In a cohort of ICU survivors, with and without COVID-19-associated respiratory failure and ARDS, who are recruited for CoPARC investigations, perform lon...