RECOVER Research Update: June 2025

Long-COVID incidence proportion in adults and children between 2020 and 2024 (Clinical Infectious Diseases, February 2025)

• By studying over 6 million EHRs from 3 different health networks, RECOVER researchers learned that between 10% and 26% of adults and 4% of children who had COVID-19 developed Long COVID.
• Researchers also identified several factors that may put some people at higher risk of developing Long COVID. The following groups of people were more likely to develop Long COVID:
  • Adolescents (individuals 12 to 17 years of age).
  • People over the age of 65.
  • Women.
  • People who were sick enough to be hospitalized due to their COVID-19 symptoms.
• Researchers also found that these risks did not decrease over time. The EHR data they examined showed that reported cases of Long COVID increased whenever a new variant of SARS-CoV-2, the virus that causes COVID-19, became responsible for large numbers of infections.
• These findings are important because they establish a better understanding of how common Long COVID is and who it most often affects. Earlier studies had not always agreed on how many people may have Long COVID. This understanding can inform future efforts to prevent Long COVID and make these efforts more effective.

The next 3 studies offer important insights into the specific effects Long COVID can have on children and adolescents. In each case, researchers examined millions of pieces of EHR data collected over the course of several years. What they learned fills important gaps in our knowledge of how different Long COVID symptoms can be in children and adolescents compared to adults, even when those symptoms affect the same parts of the body.

Cardiovascular post-acute sequelae of SARS-CoV-2 in children and adolescents: cohort study using electronic health records (Nature Communications, April 2025)

• Researchers found that a child’s or adolescent’s (a young person 12 to 20 years old) risk of experiencing a wide variety of heart problems can increase in the 6 months after they’ve had COVID-19.
• This increased risk can be significant. Researchers found that children without a history of heart problems who had COVID-19 were nearly 50% more likely to experience high blood pressure and irregular heartbeat, 84% more likely to experience chest pain, and 3.7 times more likely to experience swelling of the heart muscle (myocarditis), a condition which can lead to stroke or heart failure. Children with a history of heart problems faced even higher risks of experiencing these symptoms after having COVID-19.
• Overall, the nearly 297,920 children and adolescents in the study who had COVID-19 were 63% more likely to develop any of the heart problems the researchers investigated.
• Researchers also found that these risks varied by age. Children over the age of 5 and adolescents who had COVID-19 experienced higher risks of developing Long COVID.

Kidney function following COVID-19 in children and adolescents (JAMA Network Open, April 2025)

• Researchers found that having COVID-19 can increase a child’s or adolescent’s (a young person under the age of 21) risk of experiencing kidney problems, including developing chronic kidney disease.
• When the kidneys stop functioning properly, harmful substances can build up in the body. The kidneys normally filter these substances and create urine (pee) so they can be removed from the body. Kidney damage is not reversible, but it can be prevented from becoming worse. Kidney failure results in death.
• The researchers studied chronic kidney disease as a study outcome. This condition progresses through different stages. In stage 2, the damage to the kidneys is limited, and many people will not experience any symptoms at all. In stage 3, the damage to the kidneys has progressed. People with stage 3 chronic kidney disease can experience symptoms like high blood pressure and low red blood cell counts (anemia), which can cause them to feel weak or easily tired.
• Children and adolescents in this study were 17% more likely to develop stage 2 chronic kidney disease and 35% more likely to develop stage 3 kidney disease. This risk persisted for up to two years after they had recovered from COVID-19.
• The researchers also recommend that future studies should investigate possible causes of COVID-19-related kidney damage, including viral persistence (when SARS-CoV-2, the virus that causes COVID-19, remains in the body) and inflammation (swelling).

Pediatric gastrointestinal tract outcomes during the postacute phase of COVID-19 (JAMA Network Open, February 2025)

• Researchers found that having COVID-19 can increase a child’s or adolescent’s (a young person 12 to 18 years old) risk of experiencing stomach problems for up to 2 years after they’ve recovered from their initial illness.
• Children and adolescents in this study who had COVID-19 were 25% more likely to experience stomach problems like chronic belly pain, constipation, diarrhea, and vomiting than children or adolescents who did not get COVID-19.
• Children and adolescents in this study who had COVID-19 were also 19% more likely to develop acid reflux (gastroesophageal reflux disease, or GERD) than those who did not get COVID-19. GERD can be a risk factor for other health conditions like asthma and cancer of the esophagus (the part of the body that connects the throat to the stomach).
• Researchers also found that these risks varied by age. Children younger than 5 who had COVID-19 were more likely to develop stomach problems than older children who had COVID-19.

The results of these 3 studies show why long-term symptom monitoring is so important for children and adolescents who get COVID-19. Although other studies indicate that adults are more likely to experience Long COVID and its most burdensome symptoms, children and adolescents are still at risk. Moreover, we are still learning about the effects Long COVID can have on young people’s growth and development.

Identifying commonalities and differences between EHR representations of PASC and ME/CFS in the RECOVER EHR cohort (Communications Medicine, April 2025)

• Like Long COVID, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a health condition people can develop after experiencing a viral infection.
• To gain a better understanding of the similarities and differences between Long COVID and ME/CFS, RECOVER researchers looked for symptom patterns across 6.5 million EHRs.
• Researchers found that nearly half of people included in the study whose symptoms identified them as likely to have Long COVID also had symptoms that identified them as likely to have ME/CFS.
• Researchers also found that people with Long COVID were more likely to experience symptoms affecting their heart and lungs than people with ME/CFS. People with ME/CFS were more likely to experience symptoms such as chronic pain, difficulty getting a good night’s sleep, and brain fog (having trouble thinking, concentrating, or remembering things).
• Based on these findings, the researchers recommend that healthcare providers offer care for ME/CFS and Long COVID that is informed by these similarities and differences.

National COVID Cohort Collaborative data enhancements: A path for expanding common data models (Journal of the American Medical Informatics Association, February 2025)

• Although EHRs contain a wealth of valuable information, they have limitations. Certain information may be missing from the EHRs, or information may not be consistent from one EHR to another because different healthcare providers enter information into EHRs in different ways.
• In this study, researchers created clear, step-by-step instructions for adding Long COVID-specific information to EHRs. These instructions created what are called common data models for specific types of information, like whether a patient visited a Long COVID clinic or whether they needed extra oxygen during a hospital stay.
• By June 2024, 29 hospitals had begun following these instructions and applying at least one of these common data models to EHRs they share with RECOVER.
• This outcome is important because it could make it easier for researchers to group, compare, and look for patterns in millions of EHRs.
• Also, because these hospitals have begun collecting new information from and about their patients, researchers have access to a growing set of data that could prove useful for answering important questions about Long COVID.

Continue exploring RECOVER EHR study publications, RECOVER research summaries, and other resources related to RECOVER study findings.