Making progress toward recovery
Together we can do more. The RECOVER Initiative brings together scientists, clinicians, patients and caregivers to understand recovery from the long-term effects of COVID and how to predict, treat, and prevent the disease.
RECOVER Research Components
RECOVER’s robust national research network has the depth and breadth of expertise needed to solve the mystery of Long COVID. The five RECOVER research components are at the core of RECOVER’s research efforts. Learn more.
How Research Works
Learn more about how RECOVER studies work, access RECOVER research protocols, and understand what to expect as a participant in RECOVER studies.
RECOVER includes community voices at all levels of the initiative, as we seek diverse experiences to inform our research.
RECOVER Research Questions
The goal of RECOVER is to understand, prevent, and treat the long-term effects of COVID-19. RECOVER has eight guiding research questions whose answers will help us achieve our goal. This summary represents the invaluable contributions of many people and communities and will be updated as new RECOVER findings are published.
The answers that follow summarize findings from RECOVER research publications. They are not intended to summarize, nor do they incorporate research on Long COVID beyond the RECOVER Initiative.
Post-COVID conditions have different names including Long COVID and post-acute sequelae of SARS CoV-2 infection (PASC), which includes Long COVID. The terms used below reflect those used in the specific studies that are summarized.
Content last reviewed October 2023.
Several RECOVER studies report on the symptoms of Long COVID. View studies , , , , , . RECOVER research shows there are symptoms that cluster and present together. View studies , , . In one study, researchers found six distinct symptom clusters. The clusters involve different body systems at the same time, including: the lung; brain and nervous system; heart and blood vessels. Some clusters include pain, and some are accompanied by abnormal laboratory findings. View the study. Another study found that four Long COVID symptom clusters (heart and lungs, neurological, gastrointestinal, and coexisting medical conditions) differed depending on the age of patients. In the study, children and teens were more likely to have gastrointestinal and upper respiratory problems (such as stomachache and cough); adults aged 21-45 years were more likely to have neurological problems (such as brain fog and fatigue); and adults aged 66 and older were more likely to have coexisting medical conditions (such as heart problems and diabetes). View the study.
RECOVER researchers are also examining how PASC diagnoses, underlying health conditions, and prescription medications might differ geographically. They compared electronic health records from four states (New York City, Florida, Georgia, and Alabama) and found differences in the number of PASC conditions reported across data sites. Researchers found a wide range of diagnosis and medication categories that suggest differences in PASC diagnoses, conditions, and medications among different populations based on neighborhood socioeconomic status, age, gender, race, and outbreak waves. View the study.
Researchers found ethnic and racial differences in PASC symptoms and conditions in a RECOVER study of adults with COVID-19 in New York City between March 2020 and October 2021. In the 30-180 days after infection, compared to White people hospitalized for COVID-19, Black and Hispanic people hospitalized for COVID-19 had higher rates of certain PASC symptoms such as shortness of breath, chest pain, joint pain, and newly diagnosed diabetes. Results also suggest that people from different racial and ethnic groups may experience different symptoms and conditions of PASC. View the study.
RECOVER researchers are studying large groups of people over a long period of time to gain a deeper understanding of Long COVID, how long its symptoms last, and whether it can have effects later in life. Learn more about RECOVER Longitudinal Observational Cohort Studies.
RECOVER researchers are studying if Long COVID affects other diseases or health problems that people may have. RECOVER researchers compared electronic health records (EHR) to examine the possible link between SARS CoV-2 infection and new diagnoses of type 2 diabetes. Patients who had at least 1 visit 6 months before their SARS CoV-2 infection and 6 months of EHR data post-infection were included in the analysis. Researchers found the number of new diabetes diagnoses to be lower in the months after SARS-CoV-2 infection than in the months before. New diabetes cases in the 6 months after infection were 83% lower than in the 6 months before infection. View the study.
RECOVER studies are examining risk factors for developing Long COVID.
RECOVER researchers have found that SARS-CoV-2 infection increases the risk of developing PASC and Long COVID. View studies , , . People who tested positive for SARS-CoV-2 between March and December 2020 and were hospitalized or received mechanical ventilation during their illness had a higher prevalence of multiple symptoms at 1 to 5 months after testing positive compared to those who tested negative. The symptoms included: shortness of breath, heart rate abnormalities, fatigue, brain fog, sleep disorder, type 2 diabetes, and muscle weakness. View the study. In another study, researchers found that 23% of people with SARS-CoV-2 infection developed PASC, while only 3.7% of people without a reported positive test developed symptoms consistent with PASC. View the study.
A large RECOVER study looked at risk factors associated with specific PASC conditions. Researchers found that the risk of PASC increases with hospitalization for acute infection and similarly with reinfections. View the study. Another study found that 39% of people hospitalized with acute COVID-19 developed PASC, compared to 22% of people not hospitalized for acute COVID-19. Among people infected with the Omicron variant, those that had reinfections were more likely to develop PASC (21%) compared to those with one infection (16%). View the study.
RECOVER research using electronic health records (EHR) suggests that obstructive sleep apnea may increase the risk for developing Long COVID after infection. Among people who had COVID-19, adults with obstructive sleep apnea were more likely to experience long-term symptoms suggestive of Long COVID than those without the sleep disorder. The analysis of EHR found that adults with sleep apnea may have up to a 75% higher risk of developing Long COVID after infection. View the study.
RECOVER researchers found that certain environmental factors related to where people live, like air quality, access to food, green spaces, neighborhood characteristics, and social factors, may increase the risk of having Long COVID symptoms. View the study.
RECOVER researchers are exploring whether variants of the SARS-CoV-2 virus and COVID-19 vaccines make a difference for developing Long COVID.
In a study following more than 9,000 people over time, RECOVER researchers found that PASC was more common and associated with more severe manifestations for adults infected before the Omicron variant emerged. View the study. Regardless of the variant, the rates of PASC among those fully vaccinated were lower than those who were unvaccinated. Researchers found the same pattern when they compared vaccinated and unvaccinated adults at three different points in time - in adults with post-acute COVID, pre-Omicron (31% vs. 37%), with acute Omicron infection (9.7 vs. 17%), and post-acute Omicron (16% vs. 22%). Similarly, in a large observational study, RECOVER researchers found that vaccination was consistently associated with lower rates of Long COVID, before and after Omicron emerged. View the study.
RECOVER researchers reviewed the electronic medical records of more than 15 million people (age 5 and older) to compare the risk of rare heart problems in people who had a SARS-CoV-2 infection with people vaccinated for COVID-19. They found that the risk of having a rare heart problem after having COVID is much higher than the risk after vaccination. The risk of rare heart problems after COVID-19 vaccination with an mRNA vaccine (Pfizer or Moderna) were very, very low, supporting the continued use of vaccination to prevent COVID-19. View the study.
In addition to the observational cohort studies that re-examine participants over time, RECOVER researchers are conducting more than 40 different pathobiology studies focusing on COVID-19's effects on different body tissues and organs.
At this time, the only known way to prevent Long COVID is to avoid getting COVID-19. The observational cohort studies and the RECOVER Pathobiology Research Program are investigating potential mechanisms for how some people may be protected from Long COVID or some of its symptoms.
RECOVER researchers are making progress toward understanding why some people develop Long COVID and how these long-term symptoms affect one’s health. Based on what the researchers have learned so far, RECOVER has launched clinical trials to test different interventions for Long COVID. Two RECOVER clinical trials have launched, with three more planned: RECOVER NEURO and RECOVER VITAL. RECOVER NEURO focuses on treatments for cognitive symptoms associated with Long COVID [learn more]. RECOVER VITAL (viral persistence and reactivation, and immune dysregulation) focuses on treating viral persistence—which is when the SARS-CoV-2 virus stays in the body and damages organs or the immune system. Viral persistence or reactivation are possible explanations for what causes Long COVID symptoms. This trial focuses on treatments to stop the virus from causing continued damage and to resolve symptoms caused by the virus [learn more]. Learn more about RECOVER Clinical Trials.
Multisystem Inflammatory Syndrome in Children (MIS-C) is a type of Long COVID that may develop in children and young adults. In a small study with seven outpatient children diagnosed with MIS-C, outpatient treatment alone was sufficient, and they did not need hospitalization. View the study.
Progress takes the best science.
The RECOVER Initiative will collect data from many patients across the country. This will include studies that:
- Use data from medical records to understand how people are experiencing Long COVID.
- Examine tissues from research participants to understand changes inside the body.
- Test different treatments for symptoms experienced by patient participants with Long COVID.
By exploring different ways that people’s bodies are affected by COVID and looking at which treatments may be effective, we can better understand Long COVID. We will then combine all of these data to help answer big questions about PASC, including Long COVID.
The detailed study plan—called the main protocols—is the same for each type of RECOVER study. Using the same study plan for each study type lets us combine data from those studies even though they are taking place at multiple locations. This helps us get answers to important questions faster.
We designed RECOVER so that each type of study brings specific kinds of information that will help us predict, treat, and prevent Long COVID. Various groups of people—known as cohorts—will be included in RECOVER observational cohort studies and RECOVER clinical trial studies. These groups include adults, children and their caregivers, and pregnant women and their newborn babies. Including many different people in RECOVER cohorts will help us understand how different people experience the long-term effects of COVID.
Improving Understanding Through Collaboration
The NIH All of Us Research Program offers COVID-related data and research tools to RECOVER investigators to help drive understanding of the long-term effects of COVID, including Long COVID and other types of PASC (post-acute sequelae of SARS-COV-2 infection). Through the All of Us Researcher Workbench, interested researchers can access the COVID-19 Participant Experience (COPE) survey, electronic health records (EHR), wearable, and genetic data. To explore the kinds of data available through All of Us and register for access, visit the All of Us Research Hub.