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Sharing science to find answers

Find RECOVER Publications

Researchers within the RECOVER Initiative share their progress to understand, treat, and prevent Long COVID through research publications. Follow the latest science from RECOVER’s research studies below.

Visit the Research Summaries page to learn about RECOVER’s Long COVID research in a format that’s easy to understand.

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54 Results

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Pathobiology Adult
Wilcox, DR; Rudmann, EA; Ye, E; et. al., AIDS
Information
Epub ahead of print indicates that the article has completed the peer review process and has been published online in advance of the actual print journal issue being released.
Published:
Journal: AIDS
Abstract: Background: Data supporting dementia as a risk factor for coronavirus disease 2019 (COVID-19) mortality relied on ICD-10 codes, yet nearly 40% of individuals with probable dementia lack a formal diagnosis. Dementia coding is not well established for people with HIV (PWH), and its reliance may affect risk assessment. Methods: This retrospective cohort analysis of PWH with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) PCR positivity includes comparisons to people without HIV (… Continue reading
Authors: Douglas R Wilcox, Emily A Rudmann, Elissa Ye, Ayush Noori, Colin Magdamo, Aayushee Jain, Haitham Alabsi, Brody Foy, Virginia A Triant, Gregory K Robbins, M Brandon Westover, Sudeshna Das, Shibani S Mukerji
Keywords: Humans; COVID-19/complications; SARS-CoV-2; COVID-19 Testing; Retrospective Studies; HIV Infections/complications; Risk Factors; Cognition; Dementia
Pathobiology Adult
Cheong, JG; Ravishankar, A; Sharma, S; et. al., Cell
Information
Epub ahead of print indicates that the article has completed the peer review process and has been published online in advance of the actual print journal issue being released.
Published:
Journal: Cell
Abstract: Inflammation can trigger lasting phenotypes in immune and non-immune cells. Whether and how human infections and associated inflammation can form innate immune memory in hematopoietic stem and progenitor cells (HSPC) has remained unclear. We found that circulating HSPC, enriched from peripheral blood, captured the diversity of bone marrow HSPC, enabling investigation of their epigenomic reprogramming following coronavirus disease 2019 (COVID-19). Alterations in innate immune phenotypes and… Continue reading
Authors: Jin-Gyu Cheong, Arjun Ravishankar, Siddhartha Sharma, Christopher N Parkhurst, Simon A Grassmann, Claire K Wingert, Paoline Laurent, Sai Ma, Lucinda Paddock, Isabella C Miranda, Emin Onur Karakaslar, Djamel Nehar-Belaid, Asa Thibodeau, Michael J Bale, Vinay K Kartha, Jim K Yee, Minh Y Mays, Chenyang Jiang, Andrew W Daman, Alexia Martinez de Paz, Dughan Ahimovic, Victor Ramos, Alexander Lercher, Erik Nielsen, Sergio Alvarez-Mulett, Ling Zheng, Andrew Earl, Alisha Yallowitz, Lexi Robbins, Elyse LaFond, Karissa L Weidman, Sabrina Racine-Brzostek, He S Yang, David R Price, Louise Leyre, André F Rendeiro, Hiranmayi Ravichandran, Junbum Kim, Alain C Borczuk, Charles M Rice, R Brad Jones, Edward J Schenck, Robert J Kaner, Amy Chadburn, Zhen Zhao, Virginia Pascual, Olivier Elemento, Robert E Schwartz, Jason D Buenrostro, Rachel E Niec, Franck J Barrat, Lindsay Lief, Joseph C Sun, Duygu Ucar, Steven Z Josefowicz
Keywords: COVID-19; IL-6; PASC; epigenetic memory; epigenome; hematopoietic stem and progenitor cells; monocytes; peripheral blood mononuclear cell progenitor input enrichment; post-acute sequelae SARS-CoV-2 infection; single-cell; trained immunity; transcriptome
EHR Pediatric
Summary
Lorman, V; Razzaghi, H; Song, X; et. al., PLOS ONE
Published:
Journal: PLOS ONE
Abstract: As clinical understanding of pediatric Post-Acute Sequelae of SARS CoV-2 (PASC) develops, and hence the clinical definition evolves, it is desirable to have a method to reliably identify patients who are likely to have post-acute sequelae of SARS CoV-2 (PASC) in health systems data. In this study, we developed and validated a machine learning algorithm to classify which patients have PASC (distinguishing between Multisystem Inflammatory Syndrome in Children (MIS-C) and non-MIS-C variants) from… Continue reading
Authors: Vitaly Lorman, Hanieh Razzaghi, Xing Song, Keith Morse, Levon Utidjian, Andrea J Allen, Suchitra Rao, Colin Rogerson, Tellen D Bennett, Hiroki Morizono, Daniel Eckrich, Ravi Jhaveri, Yungui Huang, Daksha Ranade, Nathan Pajor, Grace M Lee, Christopher B Forrest, L Charles Bailey
Keywords: Child; Humans; Post-Acute COVID-19 Syndrome; COVID-19/diagnosis; SARS-CoV-2; Disease Progression; Machine Learning; Phenotype
Short Summary

To understand Long COVID, researchers must be able to figure out which patients have it. Our understanding of Long COVID is evolving and it has been difficult to know who had Long COVID, especially in children. We need a reliable method to identify who might have Long COVID using existing health data.  

The purpose of this study was to create and test a computer program, called an algorithm, to find out which children have Long COVID based on their electronic health records (EHRs). EHRs (digital medical charts that have health data like doctor visits, lab results, and other health history) are an important source of data for research studies on Long COVID. The algorithm looks at EHRs to find patterns in the diagnoses, prescribed medications, procedures, and lab tests children received after having COVID-19. These patterns can be described as a phenotype, or a set of measured or visible traits, that can tell us who had Long COVID.    

The algorithm correctly identified 67% of the patients who had a Long COVID diagnosis from the EHRs. Among the patients who the algorithm said had Long COVID, 91% had a Long COVID diagnosis. Overall, the algorithm was correct in identifying whether a patient had a Long COVID diagnosis 99% of the time. This means the phenotype can be used to recognize which children have Long COVID in EHR data for future studies, or to screen patients to participate in clinical trials. 

EHR Adult
Pfaff, ER; Girvin, AT; Crosskey, M; et. al.N3C and RECOVER Consortia, Journal of American Medical Informatics Association
Published:
Journal: Journal of American Medical Informatics Association
Abstract: Machine learning (ML)-driven computable phenotypes are among the most challenging to share and reproduce. Despite this difficulty, the urgent public health considerations around Long COVID make it especially important to ensure the rigor and reproducibility of Long COVID phenotyping algorithms such that they can be made available to a broad audience of researchers. As part of the NIH Researching COVID to Enhance Recovery (RECOVER) Initiative, researchers with the National COVID Cohort… Continue reading
Authors: Emily R Pfaff, Andrew T Girvin, Miles Crosskey, Srushti Gangireddy, Hiral Master, Wei-Qi Wei, V Eric Kerchberger, Mark Weiner, Paul A Harris, Melissa Basford, Chris Lunt, Christopher G Chute, Richard A Moffitt, Melissa Haendel,
Keywords: SARS-CoV-2; electronic health records; machine learning; phenotype
EHR Pediatric
Summary
Mejias, A; Schuchard, J; Rao, S; et. al., The Journal of Pediatrics
Published:
Journal: The Journal of Pediatrics
Abstract: Using an electronic health record-based algorithm, we identified children with Coronavirus disease 2019 (COVID-19) based exclusively on serologic testing between March 2020 and April 2022. Compared with the 131 537 polymerase chain reaction-positive children, the 2714 serology-positive children were more likely to be inpatients (24% vs 2%), to have a chronic condition (37% vs 24%), and to have a diagnosis of multisystem inflammatory syndrome in children (23% vs <1%). Identification of… Continue reading
Authors: Asuncion Mejias, Julia Schuchard, Suchitra Rao, Tellen D Bennett, Ravi Jhaveri, Deepika Thacker, L Charles Bailey, Dimitri A Christakis, Nathan M Pajor, Hanieh Razzaghi, Christopher B Forrest, Grace M Lee
Keywords: COVID-19 serology; PEDSnet; anti-N antibodies; anti-S antibodies; chronic COVID-19 syndrome; late sequelae of COVID-19; long COVID; long-haul COVID-19; long-term COVID-19; post-acute COVID-19; post-acute sequelae of COVID-19; post-acute sequelae of SARS-CoV-2 infection; post–COVID-19 syndrome
Short Summary

To find another way to know if children had COVID, researchers compared health records of 2 groups of children: children who only had a positive antibody test and children who had a positive PCR test. A positive antibody test means a child had COVID in the past, had the COVID vaccine, or both. A positive PCR test means a child currently has COVID. Researchers used data from children’s hospitals in the National Pediatric Learning Health System (PEDSnet) network.

Antibody tests found 2,714 children who had COVID and didn’t have a positive PCR test or  COVID vaccine. If researchers used only PCR tests, they wouldn’t have known these children had COVID. Knowing if children had COVID is the first step to know their risk of Long COVID and if symptoms could be related to Long COVID.

Observational Cohorts Adult
Horwitz, LI; Thaweethai, T; Brosnahan, SB; et. al., PLOS ONE
Published:
Journal: PLOS ONE
Abstract: Importance: SARS-CoV-2 infection can result in ongoing, relapsing, or new symptoms or other health effects after the acute phase of infection; termed post-acute sequelae of SARS-CoV-2 infection (PASC), or long COVID. The characteristics, prevalence, trajectory and mechanisms of PASC are ill-defined. The objectives of the Researching COVID to Enhance Recovery (RECOVER) Multi-site Observational Study of PASC in Adults (RECOVER-Adult) are to: (1) characterize PASC prevalence; (2) characterize the… Continue reading
Authors: Leora I Horwitz, Tanayott Thaweethai, Shari B Brosnahan, Mine S Cicek, Megan L Fitzgerald, Jason D Goldman, Rachel Hess, S L Hodder, Vanessa L Jacoby, Michael R Jordan, Jerry A Krishnan, Adeyinka O Laiyemo, Torri D Metz, Lauren Nichols, Rachel E Patzer, Anisha Sekar, Nora G Singer, Lauren E Stiles, Barbara S Taylor, Shifa Ahmed, Heather A Algren, Khamal Anglin, Lisa Aponte-Soto, Hassan Ashktorab, Ingrid V Bassett, Brahmchetna Bedi, Nahid Bhadelia, Christian Bime, Marie-Abele C Bind, Lora J Black, Andra L Blomkalns, Hassan Brim, Mario Castro, James Chan, Alexander W Charney, Benjamin K Chen, Li Qing Chen, Peter Chen, David Chestek, Lori B Chibnik, Dominic C Chow, Helen Y Chu, Rebecca G Clifton, Shelby Collins, Maged M Costantine, Sushma K Cribbs, Steven G Deeks, John D Dickinson, Sarah E Donohue, Matthew S Durstenfeld, Ivette F Emery, Kristine M Erlandson, Julio C Facelli, Rachael Farah-Abraham, Aloke V Finn, Melinda S Fischer, Valerie J Flaherman, Judes Fleurimont, Vivian Fonseca, Emily J Gallagher, Jennifer C Gander, Maria Laura Gennaro, Kelly S Gibson, Minjoung Go, Steven N Goodman, Joey P Granger, Frank L Greenway, John W Hafner, Jenny E Han, Michelle S Harkins, Kristine S P Hauser, James R Heath, Carla R Hernandez, On Ho, Matthew K Hoffman, Susan E Hoover, Carol R Horowitz, Harvey Hsu, Priscilla Y Hsue, Brenna L Hughes, Prasanna Jagannathan, Judith A James, Janice John, Sarah Jolley, S E Judd, Joy J Juskowich, Diane G Kanjilal, Elizabeth W Karlson, Stuart D Katz, J Daniel Kelly, Sara W Kelly, Arthur Y Kim, John P Kirwan, Kenneth S Knox, Andre Kumar, Michelle F Lamendola-Essel, Margaret Lanca, Joyce K Lee-Lannotti, R Craig Lefebvre, Bruce D Levy, Janet Y Lin, Brian P Logarbo, Jennifer K Logue, Michele T Longo, Carlos A Luciano, Karen Lutrick, Shahdi K Malakooti, Gail Mallett, Gabrielle Maranga, Jai G Marathe, Vincent C Marconi, Gailen D Marshall, Christopher F Martin, Jeffrey N Martin, Heidi T May, Grace A McComsey, Dylan McDonald, Hector Mendez-Figueroa, Lucio Miele, Murray A Mittleman, Sindhu Mohandas, Christian Mouchati, Janet M Mullington, Girish N Nadkarni, Erica R Nahin, Robert B Neuman, Lisa T Newman, Amber Nguyen, Janko Z Nikolich, Igho Ofotokun, Princess U Ogbogu, Anna Palatnik, Kristy T S Palomares, Tanyalak Parimon, Samuel Parry, Sairam Parthasarathy, Thomas F Patterson, Ann Pearman, Michael J Peluso, Priscilla Pemu, Christian M Pettker, Beth A Plunkett, Kristen Pogreba-Brown, Athena Poppas, J Zachary Porterfield, John G Quigley, Davin K Quinn, Hengameh Raissy, Candida J Rebello, Uma M Reddy, Rebecca Reece, Harrison T Reeder, Franz P Rischard, Johana M Rosas, Clifford J Rosen, Nadine G Rouphael, Dwight J Rouse, Adam M Ruff, Christina Saint Jean, Grecio J Sandoval, Jorge L Santana, Shannon M Schlater, Frank C Sciurba, Caitlin Selvaggi, Sudha Seshadri, Howard D Sesso, Dimpy P Shah, Eyal Shemesh, Zaki A Sherif, Daniel J Shinnick, Hyagriv N Simhan, Upinder Singh, Amber Sowles, Vignesh Subbian, Jun Sun, Mehul S Suthar, Larissa J Teunis, John M Thorp, Amberly Ticotsky, Alan T N Tita, Robin Tragus, Katherine R Tuttle, Alfredo E Urdaneta, P J Utz, Timothy M VanWagoner, Andrew Vasey, Suzanne D Vernon, Crystal Vidal, Tiffany Walker, Honorine D Ward, David E Warren, Ryan M Weeks, Steven J Weiner, Jordan C Weyer, Jennifer L Wheeler, Sidney W Whiteheart, Zanthia Wiley, Natasha J Williams, Juan P Wisnivesky, John C Wood, Lynn M Yee, Natalie M Young, Sokratis N Zisis, Andrea S Foulkes
Keywords: Humans; COVID-19/epidemiology; Observational Studies as Topic; Post-Acute COVID-19 Syndrome; Prospective Studies; Retrospective Studies; SARS-CoV-2; Adolescent; Adult; Multicenter Studies as Topic
Observational Cohorts Adult
Summary
Thaweethai, T; Jolley, SE; Karlson, EW; et. al.RECOVER Consortium, JAMA
Published:
Journal: JAMA
Abstract: Importance: SARS-CoV-2 infection is associated with persistent, relapsing, or new symptoms or other health effects occurring after acute infection, termed postacute sequelae of SARS-CoV-2 infection (PASC), also known as long COVID. Characterizing PASC requires analysis of prospectively and uniformly collected data from diverse uninfected and infected individuals. Objective: To develop a definition of PASC using self-reported symptoms and describe PASC frequencies across cohorts,… Continue reading
Authors: Tanayott Thaweethai, Sarah E Jolley, Elizabeth W Karlson, Emily B Levitan, Bruce Levy, Grace A McComsey, Lisa McCorkell, Girish N Nadkarni, Sairam Parthasarathy, Upinder Singh, Tiffany A Walker, Caitlin A Selvaggi, Daniel J Shinnick, Carolin C M Schulte, Rachel Atchley-Challenner, George A Alba, Radica Alicic, Natasha Altman, Khamal Anglin, Urania Argueta, Hassan Ashktorab, Gaston Baslet, Ingrid V Bassett, Lucinda Bateman, Brahmchetna Bedi, Shamik Bhattacharyya, Marie-Abele Bind, Andra L Blomkalns, Hector Bonilla, Patricia A Bush, Mario Castro, James Chan, Alexander W Charney, Peter Chen, Lori B Chibnik, Helen Y Chu, Rebecca G Clifton, Maged M Costantine, Sushma K Cribbs, Sylvia I Davila Nieves, Steven G Deeks, Alexandria Duven, Ivette F Emery, Nathan Erdmann, Kristine M Erlandson, Kacey C Ernst, Rachael Farah-Abraham, Cheryl E Farner, Elen M Feuerriegel, Judes Fleurimont, Vivian Fonseca, Nicholas Franko, Vivian Gainer, Jennifer C Gander, Edward M Gardner, Linda N Geng, Kelly S Gibson, Minjoung Go, Jason D Goldman, Halle Grebe, Frank L Greenway, Mounira Habli, John Hafner, Jenny E Han, Keith A Hanson, James Heath, Carla Hernandez, Rachel Hess, Sally L Hodder, Matthew K Hoffman, Susan E Hoover, Beatrice Huang, Brenna L Hughes, Prasanna Jagannathan, Janice John, Michael R Jordan, Stuart D Katz, Elizabeth S Kaufman, John D Kelly, Sara W Kelly, Megan M Kemp, John P Kirwan, Jonathan D Klein, Kenneth S Knox, Jerry A Krishnan, Andre Kumar, Adeyinka O Laiyemo, Allison A Lambert, Margaret Lanca, Joyce K Lee-Iannotti, Brian P Logarbo, Michele T Longo, Carlos A Luciano, Karen Lutrick, Jason H Maley, Jai G Marathe, Vincent Marconi, Gailen D Marshall, Christopher F Martin, Yuri Matusov, Alem Mehari, Hector Mendez-Figueroa, Robin Mermelstein, Torri D Metz, Richard Morse, Jarrod Mosier, Christian Mouchati, Janet Mullington, Shawn N Murphy, Robert B Neuman, Janko Z Nikolich, Ighovwerha Ofotokun, Elizabeth Ojemakinde, Anna Palatnik, Kristy Palomares, Tanyalak Parimon, Samuel Parry, Jan E Patterson, Thomas F Patterson, Rachel E Patzer, Michael J Peluso, Priscilla Pemu, Christian M Pettker, Beth A Plunkett, Kristen Pogreba-Brown, Athena Poppas, John G Quigley, Uma Reddy, Rebecca Reece, Harrison Reeder, W B Reeves, Eric M Reiman, Franz Rischard, Jonathan Rosand, Dwight J Rouse, Adam Ruff, George Saade, Grecio J Sandoval, Shannon M Schlater, Fitzgerald Shepherd, Zaki A Sherif, Hyagriv Simhan, Nora G Singer, Daniel W Skupski, Amber Sowles, Jeffrey A Sparks, Fatima I Sukhera, Barbara S Taylor, Larissa Teunis, Robert J Thomas, John M Thorp, Paul Thuluvath, Amberly Ticotsky, Alan T Tita, Katherine R Tuttle, Alfredo E Urdaneta, Daisy Valdivieso, Timothy M VanWagoner, Andrew Vasey, Monica Verduzco-Gutierrez, Zachary S Wallace, Honorine D Ward, David E Warren, Steven J Weiner, Shelley Welch, Sidney W Whiteheart, Zanthia Wiley, Juan P Wisnivesky, Lynn M Yee, Sokratis Zisis, Leora I Horwitz, Andrea S Foulkes,
Keywords: Female; Adult; Humans; Middle Aged; Male; SARS-CoV-2; COVID-19/complications; Prospective Studies; Post-Acute COVID-19 Syndrome; Cohort Studies; Disease Progression; Fatigue
Short Summary

RECOVER researchers used data from the RECOVER observational cohort study in adults ages 18 and over. They compared symptoms reported in surveys by participants who did and did not have COVID.  

Researchers found 37 symptoms that participants who had COVID reported more often after having COVID compared to participants who never had COVID. 12 of these symptoms could identify participants with Long COVID, including feeling tired and unwell after activity, feeling weak and tired (fatigue), and brain fog. A definition of Long COVID based on symptoms is important for future research, including to find treatments. 

EHR Adult
Summary
Brannock, MD; Chew, RF; Preiss, AJ; et. al.N3CRECOVER Consortia, Nature Communications
Published:
Journal: Nature Communications
Abstract: Long COVID, or complications arising from COVID-19 weeks after infection, has become a central concern for public health experts. The United States National Institutes of Health founded the RECOVER initiative to better understand long COVID. We used electronic health records available through the National COVID Cohort Collaborative to characterize the association between SARS-CoV-2 vaccination and long COVID diagnosis. Among patients with a COVID-19 infection between August 1, 2021 and January… Continue reading
Authors: M Daniel Brannock, Robert F Chew, Alexander J Preiss, Emily C Hadley, Signe Redfield, Julie A McMurry, Peter J Leese, Andrew T Girvin, Miles Crosskey, Andrea G Zhou, Richard A Moffitt, Michele Jonsson Funk, Emily R Pfaff, Melissa A Haendel, Christopher G Chute, ,
Keywords: United States/epidemiology; Humans; Post-Acute COVID-19 Syndrome; COVID-19/epidemiology/prevention & control; COVID-19 Vaccines; Cohort Studies; SARS-CoV-2; Vaccination
Short Summary

RECOVER researchers wanted to understand whether being vaccinated before having COVID lowered the chance of developing Long COVID. They used electronic health records (EHR) to study the effect of vaccination using EHR for two groups of people who had COVID. One group was based on clinic data and represented more than 47,000 people. In this group, 695 were diagnosed with Long COVID in clinics and more than 26,000 were fully vaccinated. The other group represented almost 200,000 individuals who had COVID. The researchers used a computer program to estimate who might have Long COVID in this group based on their medical and symptom information. In this group, more than 86,000 people represented were fully vaccinated. The researchers made sure that the people in the vaccinated and unvaccinated groups were as similar to each other as possible in terms of the same sex, age, race, and medical history.  

To test whether vaccination lowered the chance of developing Long COVID, they made comparisons within each group. They used several different definitions of Long COVID and several different statistical tests to figure out whether vaccination status affected Long COVID. For both of the study groups and for all definitions of Long COVID and each statistical test in the analysis, the researchers got the same answer: people who were vaccinated before having COVID were less likely to develop Long COVID.  

EHR Adult
Leese, P; Anand, A; Girvin, A; et. al., Journal of the American Medical Informatics Association
Published:
Journal: Journal of the American Medical Informatics Association
Abstract: Clinical encounter data are heterogeneous and vary greatly from institution to institution. These problems of variance affect interpretability and usability of clinical encounter data for analysis. These problems are magnified when multisite electronic health record (EHR) data are networked together. This article presents a novel, generalizable method for resolving encounter heterogeneity for analysis by combining related atomic encounters into composite "macrovisits." Encounters were… Continue reading
Authors: Peter Leese, Adit Anand, Andrew Girvin, Amin Manna, Saaya Patel, Yun Jae Yoo, Rachel Wong, Melissa Haendel, Christopher G Chute, Tellen Bennett, Janos Hajagos, Emily Pfaff, Richard Moffitt
Keywords: Humans; Electronic Health Records; COVID-19; Health Facilities; Algorithms; Length of Stay
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