Working together to improve recovery

RECOVER Research Components

RECOVER is a first of its kind, patient-centered research initiative to understand, treat and prevent Long COVID. We will achieve this through a robust national research network with the depth and breadth of expertise needed to solve the mystery of this complex disease and provide lasting solutions. Observational cohort studies, analyzing electronic health records, pathobiology studies, and clinical trials are at the core of RECOVER’s research efforts. Learn more about RECOVER research components below.

In this Section

Autopsy and Tissue Pathology Studies

RECOVER researchers do autopsies and tissue pathology studies of people who have died after having COVID, including people who did and did not have Long COVID. By doing these studies, researchers can learn how and why Long COVID affects different parts of the body.

What is an autopsy?

An autopsy is a medical exam of a body after death. When RECOVER researchers do an autopsy, they carefully and respectfully look at the outside of the body to find any signs of health problems. They also do surgery to look at the inside of the body, like bones and organs and take small samples of blood, other body fluids, and tissues. RECOVER researchers do each autopsy within 24 hours after an enrolled patient dies.

What is tissue pathology?

Tissue pathology is the study of tissue samples in a lab to learn how a disease affects different parts of the body. After taking tissue samples during an autopsy, RECOVER researchers use various tests to search for patterns in how Long COVID damages different parts of the body, understand what may make some people more likely to get Long COVID, and discover clues about how Long COVID can be treated or prevented.

Clinical Trials

RECOVER researchers now better understand who is at risk for Long COVID and how these long-term symptoms affect people’s health. Based on what they’ve learned so far, researchers are planning clinical trials. Clinical trials are studies in which participants take a study drug, use a medical device, or try other approaches to help researchers learn about how the intervention affects health problems. RECOVER clinical trials may help find ways to treat Long COVID symptoms.

What will the RECOVER clinical trials study?

RECOVER clinical trials will study possible causes of Long COVID and multiple interventions (or possible treatments) for Long COVID symptoms. The RECOVER team identified areas for a suite of clinical trials based on researchers’ learnings from RECOVERY studies, and discussions with people living with Long COVID. The clinical trials are designed so multiple treatments and therapies can be studied across each of these 5 focus areas:

Viral persistence: The virus that causes COVID-19 stays in the body long after a person was first infected and causes the immune system (the system in your body that fights off illnesses) to overreact
Autonomic dysfunction: Changes in the body’s ability to control heart rate, body temperature, breathing, digestion, and feeling
Cognitive dysfunction: Trouble thinking clearly or “brain fog”
Exercise intolerance and fatigue: Changes in the body’s ability to do physical activities and feeling weak and tired, even after resting
Sleep disturbances: Changes in sleep patterns or ability to fall or stay asleep

Electronic Health Records

RECOVER researchers use real-world data from large groups of people to learn about Long COVID and why it affects people differently to find ways to treat or prevent it. One type of real-world data RECOVER researchers use is from electronic health records (EHRs), after excluding any information that could identify a specific person.

What are EHRs?

EHRs are digital versions of patients’ medical records. Each time a person gets healthcare, their doctor and other providers enter information into their EHR. This can include age, gender, and race; current and past health problems and symptoms; test results; and medicines and treatments. RECOVER follows strict data privacy rules to protect personal health information in the EHRs.

Where does RECOVER get EHRs and other health data?

RECOVER includes EHRs from three large healthcare networks within the United States and represents more than 60 million patients’ EHRs, including more than seven million people who’ve had COVID-19. RECOVER is also working with the National Institutes of Health’s (NIH) All of Us research program, that also has many health records. Together, this collection of EHR records is one of the largest in the world. RECOVER researchers are publishing EHR study results in scientific journals to share their findings with others. Read easy-to-understand summaries of the papers on recovercovid.org.

Longitudinal Observational Cohort Studies

RECOVER researchers are studying large groups of people, over several years, to better understand who gets Long COVID and why, what symptoms people have, and how Long COVID affects their health over time.

These longitudinal observational cohort studies do not give a treatment or medicine to participants or change their regular health care — participants keep living their lives as usual and share health information with researchers.

Who can participate in the observational cohort studies?

People of all ages have participated in RECOVER observational studies, whether they’ve had COVID-19 or not. RECOVER researchers are studying two main groups (or cohorts): adults aged 26 and older, including pregnant people, and children and young adults aged 25 and younger.

Learn more and find a study at studies.recovercovid.org.

What is the Collaborative Cohort of Cohorts for COVID-19 Research Initiative (C4R)?

The National Institutes of Health supports many other observational studies of people with chronic (long-term) health conditions such as heart or lung diseases. Through a special project called C4R, RECOVER researchers are working with several of these studies to identify people who have had Long COVID. Because these studies started before the COVID-19 pandemic, they can give another perspective on how Long COVID develops and how it may affect chronic health conditions, like diabetes, heart or lung disease. Learn more about this special collaborative effort.

Pathobiology Studies

RECOVER researchers collect samples from people with and without Long COVID to conduct pathobiology studies. The samples may include stool (poop), urine (pee), blood, spit, or nose fluid. These studies can help researchers understand what happens in the body to cause Long COVID, why some people get Long COVID while others don’t, and what treatments might work well.

What are pathobiology studies?

During a pathobiology study, researchers look for biomarkers, like an unusual blood test result, or other measurable signs that someone has a health condition or is likely to develop a health condition, such as diabetes or high blood pressure. Doctors and scientists can also use biomarkers to assess how well treatment is working. To date, RECOVER has funded more than 40 different pathobiology studies to understand how the virus that causes COVID-19 affects the body and can lead to Long COVID.

Whose samples are part of RECOVER pathobiology studies?

RECOVER-funded studies on the pathobiology of Long COVID use data and samples from a range of sources. Researchers will also compare the findings from pathobiology studies with the results of other RECOVER research, like electronic health record (EHR) studies and tissue pathology studies. This will help researchers more quickly find ways to diagnose, prevent, and treat Long COVID. View the list of RECOVER Pathobiology awards.