Timing of Long COVID Improvement in Prospectively Followed RECOVER-Adult Participants

BACKGROUND: Long COVID (LC) is widespread; however, limited information has been reported on the likelihood that symptoms remit over time. OBJECTIVE: To evaluate the likelihood of improvement among persons with likely LC. DESIGN: Prospective, multisite cohort study (RECOVER-Adult [Researching COVID to Enhance Recovery]). SETTING: 83 U.S.-based sites across 33 states; Washington, DC; and Puerto Rico. PARTICIPANTS: 1019 persons in RECOVER-Adult with likely LC (LC Research Index [LCRI] ≥11) 12 months after first SARS-CoV-2 infection. MEASUREMENTS: The primary outcome was time until 2 consecutive study visits with LCRI less than 11. Secondary outcomes were time until LCRI measure reduced 50% or more and quality of life was good or better, and LCRI decreased to 0. Unadjusted estimates of cumulative incidence and adjusted marginal cumulative incidence by age, sex, SARS-CoV-2 wave, and LC subtype were reported across all follow-up time points. RESULTS: An estimated 36.2% (95% CI, 33.0% to 39.5%) met the primary outcome by 24 months after infection, and 50.1% (CI, 46.1% to 54.0%) met the primary outcome by 36 months. An estimated 56.4% (CI, 52.2% to 60.4%) and 26.9% (CI, 23.3% to 30.5%), respectively, met the 2 secondary outcomes by 36 months. Among persons who still reported likely LC at 18 months and 24 months after first infection, relative timing of subsequent symptom improvement was similar. LIMITATION: Findings in this observational cohort are interpretable in a population with prevalent likely LC and do not address causal relationships between individual characteristics and symptom improvement. CONCLUSION: Among persons with likely LC 12 months after initial SARS-CoV-2 infection, one half experience meaningful reductions in symptoms by 36 months, whereas a quarter experience complete remission of symptoms. These findings underscore both the potential for natural recovery and the urgent need for placebo-controlled therapeutic intervention trials. PRIMARY FUNDING SOURCE: National Institutes of Health.

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Journal
Annals of Internal Medicine
Published
2026-11-02
DOI
https://doi.org/10.7326/annals-25-05275
Primary Topic
Long-Term Effects of COVID-19
Type
article
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article

Timing of Long COVID Improvement in Prospectively Followed RECOVER-Adult Participants

Grace A. McComsey, Jarrod M Mosier, Andrea B. Troxel, Adolfo Garcı́a-Sastre et al.
3 links
Annals of Internal Medicine
Long-Term Effects of COVID-19
article

Timing of Long COVID Improvement in Prospectively Followed RECOVER-Adult Participants

Grace A. McComsey, Jarrod M Mosier, Andrea B. Troxel, Adolfo Garcı́a-Sastre, Tanayott Thaweethai, Ai-ris Yonekura Collier, Andrew J. Vasey, Jeffrey N. Martin, Paul J. Utz, Naomi M. Hamburg, Barbara Sieck Taylor, Andrea S. Foulkes, Melissa M. Cortez, Abeer Moanna, Jason D. Goldman, Thomas F. Patterson, A. Blythe Ryerson, Zaki A. Sherif, Alem Mehari, Paul A. Goepfert, Alicarmen Alvarez, James R. Heath, Juan Pablo Wisnivesky, Caitlin Ann Selvaggi, Joel Douglas Trinity, Adam M. Spivak, Alan C. Seifert, Matthew E. Modes, Alexandria M. Duven, Adeyinka O. Laiyemo, Michael J. Peluso, Janet M. Mullington, Zanthia Wiley, Valerie J. Flaherman, Bruce David Levy, Alfredo E. Urdaneta, Andra L. Blomkalns, Hyagriv N. Simhan, Mady Hornig, RALPH P. REECE, Harrison Thomas Reeder, Emily B. Levitan, Rebecca J. Letts, Nathan B. Erdmann, Upinder Singh, Jerry A. Krishnan, Jenny E. Han, John Daniel Kelly, Sarah E. Jolley, Ighovwerha Ofotokun, Alexia Debrosse, Claudia Castillo Paredes, Alejandra González‐Duarte, Alan Tita, Hassan Ashktorab, Sarah E. Donohue, Vanessa L. Jacoby, Alice Perlowski, Torri D. Metz, Lynn M. Yee, Alexander W. Charney, Megumi J. Okumura, Ali Nezamloo, Ornina Atieh, Alexis Brown, Sara Warfield Kelly, Alejandra L. Ibanez, Aimee K. Peddie, Leora Idit Horwitz, Alexandra Koumanelis, Alexis Jinright, Akbar Solemani, Abeer M. Mahamed, Abhigna Madineni, Abdullah Serri, Alex Harteloo, Alexis Pinones, Brittany D. Taylor, Alex F. Hudgins, Elisheva Weinberger, Alexus Clark, Hassan Brim, Alex D. Truong, Aileen Baker, Alfredo Ramos, Alexander Vandeerlin, Abigail Pierse, Alex Gressley, Aghigh Banitaba, Aaron Martinez, Yu Chen, Aasma Shaukat, Meng Fang, Abigail Arruda, Abdullahi Yusuf, RECOVER-Adult Cohort, Alan Harris, C. Kim, Alan Mendelsohn, Akash Jain
article en

Abstract

BACKGROUND: Long COVID (LC) is widespread; however, limited information has been reported on the likelihood that symptoms remit over time. OBJECTIVE: To evaluate the likelihood of improvement among persons with likely LC. DESIGN: Prospective, multisite cohort study (RECOVER-Adult [Researching COVID to Enhance Recovery]). SETTING: 83 U.S.-based sites across 33 states; Washington, DC; and Puerto Rico. PARTICIPANTS: 1019 persons in RECOVER-Adult with likely LC (LC Research Index [LCRI] ≥11) 12 months after first SARS-CoV-2 infection. MEASUREMENTS: The primary outcome was time until 2 consecutive study visits with LCRI less than 11. Secondary outcomes were time until LCRI measure reduced 50% or more and quality of life was good or better, and LCRI decreased to 0. Unadjusted estimates of cumulative incidence and adjusted marginal cumulative incidence by age, sex, SARS-CoV-2 wave, and LC subtype were reported across all follow-up time points. RESULTS: An estimated 36.2% (95% CI, 33.0% to 39.5%) met the primary outcome by 24 months after infection, and 50.1% (CI, 46.1% to 54.0%) met the primary outcome by 36 months. An estimated 56.4% (CI, 52.2% to 60.4%) and 26.9% (CI, 23.3% to 30.5%), respectively, met the 2 secondary outcomes by 36 months. Among persons who still reported likely LC at 18 months and 24 months after first infection, relative timing of subsequent symptom improvement was similar. LIMITATION: Findings in this observational cohort are interpretable in a population with prevalent likely LC and do not address causal relationships between individual characteristics and symptom improvement. CONCLUSION: Among persons with likely LC 12 months after initial SARS-CoV-2 infection, one half experience meaningful reductions in symptoms by 36 months, whereas a quarter experience complete remission of symptoms. These findings underscore both the potential for natural recovery and the urgent need for placebo-controlled therapeutic intervention trials. PRIMARY FUNDING SOURCE: National Institutes of Health.

Annals of Internal Medicine
Boston University (US), West Virginia University (US), University of Iowa (US), Cedars-Sinai Medical Center (US), Boston Medical Center (US), Northwell Health (US), Beth Israel Deaconess Medical Center (US), Feinstein Institute for Medical Research (US), Harvard University (US), Howard University (US), University of Arizona (US), Emory University (US), The University of Texas at San Antonio Health Science Center (US), University of Pittsburgh (US), University of California, San Francisco (US), University of Washington (US), Washington University in St. Louis (US), University of Utah (US), Institute for Systems Biology (US), University of Alabama at Birmingham (US), University of Illinois Chicago (US), NYU Langone Health (US), Massachusetts General Hospital (US), Swedish Medical Center (US), Peoria campus of the University of Illinois System (US), Stanford Medicine (US), University of Iowa Health Care (US), Northwestern Medicine (US), University of Utah Health Care (US), University of Colorado Anschutz Medical Campus (US), New York University (US), Case Western Reserve University (US), University of Nebraska Medical Center (US), University of Colorado Denver (US), Stanford University (US), Icahn School of Medicine at Mount Sinai (US)
National Heart, Lung, and Blood Institute
Good health and well-being
Openalex Percentile: Top 16%
Long-Term Effects of COVID-19
DOISourceOpenAlex
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