Development of a Definition of Postacute Sequelae of SARS-CoV-2 Infection.


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, Swedish Medical Center, Seattle, Washington.Follow
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, Swedish Medical Center, Seattle, Washington.Follow
Halle Grebe
Frank L Greenway
Mounira Habli
John Hafner
Jenny E Han
Keith A Hanson
James Heath, Institute for Systems Biology, Seattle, Washington.
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
RECOVER Consortium

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Publication Date


Publication Title

JAMA : the journal of the American Medical Association


washington; swedish; covid-19; isb


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, vaccination status, and number of infections.

DESIGN, SETTING, AND PARTICIPANTS: Prospective observational cohort study of adults with and without SARS-CoV-2 infection at 85 enrolling sites (hospitals, health centers, community organizations) located in 33 states plus Washington, DC, and Puerto Rico. Participants who were enrolled in the RECOVER adult cohort before April 10, 2023, completed a symptom survey 6 months or more after acute symptom onset or test date. Selection included population-based, volunteer, and convenience sampling.

EXPOSURE: SARS-CoV-2 infection.

MAIN OUTCOMES AND MEASURES: PASC and 44 participant-reported symptoms (with severity thresholds).

RESULTS: A total of 9764 participants (89% SARS-CoV-2 infected; 71% female; 16% Hispanic/Latino; 15% non-Hispanic Black; median age, 47 years [IQR, 35-60]) met selection criteria. Adjusted odds ratios were 1.5 or greater (infected vs uninfected participants) for 37 symptoms. Symptoms contributing to PASC score included postexertional malaise, fatigue, brain fog, dizziness, gastrointestinal symptoms, palpitations, changes in sexual desire or capacity, loss of or change in smell or taste, thirst, chronic cough, chest pain, and abnormal movements. Among 2231 participants first infected on or after December 1, 2021, and enrolled within 30 days of infection, 224 (10% [95% CI, 8.8%-11%]) were PASC positive at 6 months.

CONCLUSIONS AND RELEVANCE: A definition of PASC was developed based on symptoms in a prospective cohort study. As a first step to providing a framework for other investigations, iterative refinement that further incorporates other clinical features is needed to support actionable definitions of PASC.


Infectious Diseases


Institute for Systems Biology