Researching COVID to Enhance Recovery (RECOVER) adult study protocol: Rationale, objectives, and design.


Leora I Horwitz
Tanayott Thaweethai
Shari B Brosnahan
Mine S Cicek
Megan L Fitzgerald
Jason D Goldman, Division of Infectious Diseases, Providence Swedish Medical Center, Seattle, Washington, United States of America.Follow
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, Swedish Center for Research and Innovation, Providence Swedish Medical Center, Seattle, Washington, United States of America.Follow
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, Department of Bioengineering, Institute for Systems Biology, Seattle, Washington, United States of America.
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, Swedish Center for Research and Innovation, Providence Swedish Medical Center, Seattle, Washington, United States of America.
Sokratis N Zisis
Andrea S Foulkes

Document Type


Publication Date


Publication Title

PLoS One


washington; swedish; isb; covid-19


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 symptoms, organ dysfunction, natural history, and distinct phenotypes of PASC; (3) identify demographic, social and clinical risk factors for PASC onset and recovery; and (4) define the biological mechanisms underlying PASC pathogenesis.

METHODS: RECOVER-Adult is a combined prospective/retrospective cohort currently planned to enroll 14,880 adults aged ≥18 years. Eligible participants either must meet WHO criteria for suspected, probable, or confirmed infection; or must have evidence of no prior infection. Recruitment occurs at 86 sites in 33 U.S. states, Washington, DC and Puerto Rico, via facility- and community-based outreach. Participants complete quarterly questionnaires about symptoms, social determinants, vaccination status, and interim SARS-CoV-2 infections. In addition, participants contribute biospecimens and undergo physical and laboratory examinations at approximately 0, 90 and 180 days from infection or negative test date, and yearly thereafter. Some participants undergo additional testing based on specific criteria or random sampling. Patient representatives provide input on all study processes. The primary study outcome is onset of PASC, measured by signs and symptoms. A paradigm for identifying PASC cases will be defined and updated using supervised and unsupervised learning approaches with cross-validation. Logistic regression and proportional hazards regression will be conducted to investigate associations between risk factors, onset, and resolution of PASC symptoms.

DISCUSSION: RECOVER-Adult is the first national, prospective, longitudinal cohort of PASC among US adults. Results of this study are intended to inform public health, spur clinical trials, and expand treatment options.



Infectious Diseases


Institute for Systems Biology