Long COVID incidence proportion in adults and children between 2020 and 2024: An electronic health record-based study from the RECOVER Initiative
Mandel, H; Yoo, YJ; Allen, AJ; et al., Clinical Infectious Diseases
Published
July 2025
Journal
Clinical Infectious Diseases
Abstract
Background: Incidence estimates of post-acute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, also known as long COVID, have varied across studies and changed over time. We estimated long COVID incidence among adult and pediatric populations in 3 nationwide research networks of electronic health records (EHRs) participating in the RECOVER (Researching COVID to Enhance Recovery) Initiative using different classification algorithms (computable phenotypes).
Methods: This EHR-based retrospective cohort study included adult and pediatric patients with documented acute SARS-CoV-2 infection and 2 control groups: contemporary coronavirus disease 2019 (COVID-19)-negative and historical patients (2019). We examined the proportion of individuals identified as having symptoms or conditions consistent with probable long COVID within 30-180 days after COVID-19 infection (incidence proportion). Each network (the National COVID Cohort Collaborative [N3C], National Patient-Centered Clinical Research Network [PCORnet], and PEDSnet) implemented its own long COVID definition. We introduced a harmonized definition for adults in a supplementary analysis.
Results: Overall, 4% of children and 10%-26% of adults developed long COVID, depending on computable phenotype used. Excess incidence among SARS-CoV-2 patients was 1.5% in children and ranged from 5% to 6% among adults, representing a lower-bound incidence estimation based on our control groups. Temporal patterns were consistent across networks, with peaks associated with introduction of new viral variants.
Conclusions: Our findings indicate that preventing and mitigating long COVID remains a public health priority. Examining temporal patterns and risk factors for long COVID incidence informs our understanding of etiology and can improve prevention and management.
Authors
Hannah Mandel, Yun J Yoo, Andrea J Allen, Sajjad Abedian, Zoe Verzani, Elizabeth W Karlson, Lawrence C Kleinman, Praveen C Mudumbi, Carlos R Oliveira, Jennifer A Muszynski, Rachel S Gross, Thomas W Carton, C Kim, Emily Taylor, Heekyong Park, Jasmin Divers, J Daniel Kelly, Jonathan Arnold, Carol Reynolds Geary, Chengxi Zang, Kelan G Tantisira, Kyung E Rhee, Michael Koropsak, Sindhu Mohandas, Andrew Vasey, Abu Saleh Mohammad Mosa, Melissa Haendel, Christopher G Chute, Shawn N Murphy, Lisa O'Brien, Jacqueline Szmuszkovicz, Nicholas Guthe, Jorge L Santana, Aliva De, Amanda L Bogie, Katia C Halabi, Lathika Mohanraj, Patricia A Kinser, Samuel E Packard, Katherine R Tuttle, Kathryn Hirabayashi, Rainu Kaushal, Emily Pfaff, Mark G Weiner, Lorna E Thorpe, Richard A Moffitt
Keywords
COVID; EHRs; electronic health records; long COVID; public health surveillance
Short Summary
This RECOVER study looked at how common Long COVID is in adults and children across the US. Researchers compared people who had COVID-19 to those who didn’t. They used data from 3 nationwide research networks that collect electronic health records (EHRs). Since there is no single definition for Long COVID yet, each network created its own working definition. These were based on earlier studies and symptoms that are commonly seen in people with Long COVID. Researchers then checked how many people had those symptoms between 1 and 6 months after having COVID-19. Findings were generally similar across the 3 networks. They found that about 4 out of every 100 children, and between 10 and 26 out of every 100 adults, developed Long COVID, depending on the definition of Long COVID used. The rates of Long COVID also changed over time, likely linked to new versions of the virus. Understanding how common Long COVID is and how this changes over time can help researchers learn who is most likely to get Long COVID.