Timing of Long COVID improvement in prospectively followed RECOVER-Adult participants
Reeder, HT; Donohue, SE; Martin, JN; et al., Annals of Internal Medicine, November 2026
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Publication Details
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: 1,019 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.
Authors
Harrison T Reeder, Sarah E Donohue, Jeffrey N Martin, Mady Hornig, Jarrod M Mosier, Hassan Ashktorab, Ornina Atieh, Andra L Blomkalns, Hassan Brim, Yu Chen, Melissa M Cortez, Nathan B Erdmann, Meng Fang, Valerie J Flaherman, Paul Goepfert, Jason D Goldman, Naomi M Hamburg, Jenny E Han, James R Heath, Vanessa L Jacoby, Sarah E Jolley, J Daniel Kelly, Sara W Kelly, C Kim, Jerry A Krishnan, Rebecca J Letts, Emily B Levitan, Matthew E Modes, Grace A McComsey, Torri D Metz, Janet M Mullington, Igho Ofotokun, Megumi J Okumura, Claudia Castillo Paredes, Thomas F Patterson, Michael J Peluso, Rebecca Reece, Caitlin Ann Selvaggi, Zaki A Sherif, Hyagriv N Simhan, Upinder Singh, Barbara S Taylor, Brittany D Taylor, Tanayott Thaweethai, Joel D Trinity, Andrea B Troxel, Paul J Utz, Andrew J Vasey, Elisheva Weinberger, Zanthia Wiley, Juan P Wisnivesky, Lynn M Yee, Leora I Horwitz, Andrea S Foulkes, Bruce D Levy, RECOVER-Adult Cohort
Keywords
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