2024 Update of the RECOVER-Adult Long COVID Research Index

Linda N. Geng; Kristine M. Erlandson; Mady Hornig; Rebecca Letts; Caitlin Selvaggi; Hassan Ashktorab; Ornina Atieh; Logan Bartram; Hassan Brim; Shari B. Brosnahan; Jeanette Brown; Mario Castro; Alexander Charney; Peter Chen; Steven G. Deeks; Nathaniel Erdmann; Valerie J. Flaherman; Maher A. Ghamloush; Paul Goepfert; Jason D. Goldman; Jenny E. Han; Rachel Hess; Ellie Hirshberg; Susan E. Hoover; Stuart D. Katz; J. Daniel Kelly; Jonathan D. Klein; Jerry A. Krishnan; Joyce Lee-Iannotti; Emily B. Levitan; Vincent C. Marconi; Torri D. Metz; Matthew E. Modes; Janko Nikolich; Richard M. Novak; Igho Ofotokun; Megumi J. Okumura; Sairam Parthasarathy; Thomas F. Patterson; Michael J. Peluso; Athena Poppas; Orlando Quintero Cardona; Jake Scott; Judd Shellito; Zaki A. Sherif; Nora G. Singer; Barbara S. Taylor; Tanayott Thaweethai; Monica Verduzco-Gutierrez; Juan Wisnivesky; Grace A. Mccomsey; Leora I. Horwitz; Andrea S. Foulkes

doi:10.1001/jama.2024.24184

2024 Update of the RECOVER-Adult Long COVID Research Index

Linda N. Geng, Kristine M. Erlandson, Mady Hornig, Rebecca Letts, Caitlin Selvaggi, Hassan Ashktorab, Ornina Atieh, Logan Bartram, Hassan Brim, Shari B. Brosnahan, Jeanette Brown, Mario Castro, Alexander Charney, Peter Chen, Steven G. Deeks, Nathaniel Erdmann, Valerie J. Flaherman, Maher A. Ghamloush, Paul Goepfert, Jason D. GoldmanJenny E. Han, Rachel Hess, Ellie Hirshberg, Susan E. Hoover, Stuart D. Katz, J. Daniel Kelly, Jonathan D. Klein, Jerry A. Krishnan, Joyce Lee-Iannotti, Emily B. Levitan, Vincent C. Marconi, Torri D. Metz, Matthew E. Modes, Janko Nikolich, Richard M. Novak, Igho Ofotokun, Megumi J. Okumura, Sairam Parthasarathy, Thomas F. Patterson, Michael J. Peluso, Athena Poppas, Orlando Quintero Cardona, Jake Scott, Judd Shellito, Zaki A. Sherif, Nora G. Singer, Barbara S. Taylor, Tanayott Thaweethai, Monica Verduzco-Gutierrez, Juan Wisnivesky, Grace A. Mccomsey, Leora I. Horwitz, Andrea S. Foulkes

Research output: Contribution to journal › Article › peer-review

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Abstract

Importance: Classification of persons with long COVID (LC) or post-COVID-19 condition must encompass the complexity and heterogeneity of the condition. Iterative refinement of the classification index for research is needed to incorporate newly available data as the field rapidly evolves. Objective: To update the 2023 research index for adults with LC using additional participant data from the Researching COVID to Enhance Recovery (RECOVER-Adult) study and an expanded symptom list based on input from patient communities. Design, Setting, and Participants: Prospective, observational cohort study including adults 18 years or older with or without known prior SARS-CoV-2 infection who were enrolled at 83 sites in the US and Puerto Rico. Included participants had at least 1 study visit taking place 4.5 months after first SARS-CoV-2 infection or later, and not within 30 days of a reinfection. The study visits took place between October 2021 and March 2024. Exposure: SARS-CoV-2 infection. Main Outcomes and Measures: Presence of LC and participant-reported symptoms. Results: A total of 13647 participants (11743 with known SARS-CoV-2 infection and 1904 without known prior SARS-CoV-2 infection; median age, 45 years [IQR, 34-69 years]; and 73% were female) were included. Using the least absolute shrinkage and selection operator analysis regression approach from the 2023 model, symptoms contributing to the updated 2024 index included postexertional malaise, fatigue, brain fog, dizziness, palpitations, change in smell or taste, thirst, chronic cough, chest pain, shortness of breath, and sleep apnea. For the 2024 LC research index, the optimal threshold to identify participants with highly symptomatic LC was a score of 11 or greater. The 2024 index classified 20% of participants with known prior SARS-CoV-2 infection and 4% of those without known prior SARS-CoV-2 infection as having likely LC (vs 21% and 5%, respectively, using the 2023 index) and 39% of participants with known prior SARS-CoV-2 infection as having possible LC, which is a new category for the 2024 model. Cluster analysis identified 5 LC subtypes that tracked quality-of-life measures. Conclusions and Relevance: The 2024 LC research index for adults builds on the 2023 index with additional data and symptoms to help researchers classify symptomatic LC and its symptom subtypes. Continued future refinement of the index will be needed as the understanding of LC evolves.

Original language	English (US)
Pages (from-to)	694-700
Number of pages	7
Journal	JAMA - Journal of the American Medical Association
Volume	333
Issue number	8
DOIs	https://doi.org/10.1001/jama.2024.24184
State	Published - Feb 25 2025
Externally published	Yes

ASJC Scopus subject areas

General Medicine

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10.1001/jama.2024.24184

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Geng, L. N., Erlandson, K. M., Hornig, M., Letts, R., Selvaggi, C., Ashktorab, H., Atieh, O., Bartram, L., Brim, H., Brosnahan, S. B., Brown, J., Castro, M., Charney, A., Chen, P., Deeks, S. G., Erdmann, N., Flaherman, V. J., Ghamloush, M. A., Goepfert, P., ... Foulkes, A. S. (2025). 2024 Update of the RECOVER-Adult Long COVID Research Index. JAMA - Journal of the American Medical Association, 333(8), 694-700. https://doi.org/10.1001/jama.2024.24184

Geng, LN, Erlandson, KM, Hornig, M, Letts, R, Selvaggi, C, Ashktorab, H, Atieh, O, Bartram, L, Brim, H, Brosnahan, SB, Brown, J, Castro, M, Charney, A, Chen, P, Deeks, SG, Erdmann, N, Flaherman, VJ, Ghamloush, MA, Goepfert, P, Goldman, JD, Han, JE, Hess, R, Hirshberg, E, Hoover, SE, Katz, SD, Kelly, JD, Klein, JD, Krishnan, JA, Lee-Iannotti, J, Levitan, EB, Marconi, VC, Metz, TD, Modes, ME, Nikolich, J, Novak, RM, Ofotokun, I, Okumura, MJ, Parthasarathy, S, Patterson, TF, Peluso, MJ, Poppas, A, Quintero Cardona, O, Scott, J, Shellito, J, Sherif, ZA, Singer, NG, Taylor, BS, Thaweethai, T, Verduzco-Gutierrez, M, Wisnivesky, J, Mccomsey, GA, Horwitz, LI & Foulkes, AS 2025, '2024 Update of the RECOVER-Adult Long COVID Research Index', JAMA - Journal of the American Medical Association, vol. 333, no. 8, pp. 694-700. https://doi.org/10.1001/jama.2024.24184

@article{4ce3327602b2492c8919d442bb7c3e54,

title = "2024 Update of the RECOVER-Adult Long COVID Research Index",

abstract = "Importance: Classification of persons with long COVID (LC) or post-COVID-19 condition must encompass the complexity and heterogeneity of the condition. Iterative refinement of the classification index for research is needed to incorporate newly available data as the field rapidly evolves. Objective: To update the 2023 research index for adults with LC using additional participant data from the Researching COVID to Enhance Recovery (RECOVER-Adult) study and an expanded symptom list based on input from patient communities. Design, Setting, and Participants: Prospective, observational cohort study including adults 18 years or older with or without known prior SARS-CoV-2 infection who were enrolled at 83 sites in the US and Puerto Rico. Included participants had at least 1 study visit taking place 4.5 months after first SARS-CoV-2 infection or later, and not within 30 days of a reinfection. The study visits took place between October 2021 and March 2024. Exposure: SARS-CoV-2 infection. Main Outcomes and Measures: Presence of LC and participant-reported symptoms. Results: A total of 13647 participants (11743 with known SARS-CoV-2 infection and 1904 without known prior SARS-CoV-2 infection; median age, 45 years [IQR, 34-69 years]; and 73% were female) were included. Using the least absolute shrinkage and selection operator analysis regression approach from the 2023 model, symptoms contributing to the updated 2024 index included postexertional malaise, fatigue, brain fog, dizziness, palpitations, change in smell or taste, thirst, chronic cough, chest pain, shortness of breath, and sleep apnea. For the 2024 LC research index, the optimal threshold to identify participants with highly symptomatic LC was a score of 11 or greater. The 2024 index classified 20% of participants with known prior SARS-CoV-2 infection and 4% of those without known prior SARS-CoV-2 infection as having likely LC (vs 21% and 5%, respectively, using the 2023 index) and 39% of participants with known prior SARS-CoV-2 infection as having possible LC, which is a new category for the 2024 model. Cluster analysis identified 5 LC subtypes that tracked quality-of-life measures. Conclusions and Relevance: The 2024 LC research index for adults builds on the 2023 index with additional data and symptoms to help researchers classify symptomatic LC and its symptom subtypes. Continued future refinement of the index will be needed as the understanding of LC evolves.",

author = "Geng, {Linda N.} and Erlandson, {Kristine M.} and Mady Hornig and Rebecca Letts and Caitlin Selvaggi and Hassan Ashktorab and Ornina Atieh and Logan Bartram and Hassan Brim and Brosnahan, {Shari B.} and Jeanette Brown and Mario Castro and Alexander Charney and Peter Chen and Deeks, {Steven G.} and Nathaniel Erdmann and Flaherman, {Valerie J.} and Ghamloush, {Maher A.} and Paul Goepfert and Goldman, {Jason D.} and Han, {Jenny E.} and Rachel Hess and Ellie Hirshberg and Hoover, {Susan E.} and Katz, {Stuart D.} and Kelly, {J. Daniel} and Klein, {Jonathan D.} and Krishnan, {Jerry A.} and Joyce Lee-Iannotti and Levitan, {Emily B.} and Marconi, {Vincent C.} and Metz, {Torri D.} and Modes, {Matthew E.} and Janko Nikolich and Novak, {Richard M.} and Igho Ofotokun and Okumura, {Megumi J.} and Sairam Parthasarathy and Patterson, {Thomas F.} and Peluso, {Michael J.} and Athena Poppas and {Quintero Cardona}, Orlando and Jake Scott and Judd Shellito and Sherif, {Zaki A.} and Singer, {Nora G.} and Taylor, {Barbara S.} and Tanayott Thaweethai and Monica Verduzco-Gutierrez and Juan Wisnivesky and Mccomsey, {Grace A.} and Horwitz, {Leora I.} and Foulkes, {Andrea S.}",

year = "2025",

month = feb,

day = "25",

doi = "10.1001/jama.2024.24184",

language = "English (US)",

volume = "333",

pages = "694--700",

journal = "JAMA - Journal of the American Medical Association",

issn = "0098-7484",

publisher = "American Medical Association",

number = "8",

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TY - JOUR

T1 - 2024 Update of the RECOVER-Adult Long COVID Research Index

AU - Geng, Linda N.

AU - Erlandson, Kristine M.

AU - Hornig, Mady

AU - Letts, Rebecca

AU - Selvaggi, Caitlin

AU - Ashktorab, Hassan

AU - Atieh, Ornina

AU - Bartram, Logan

AU - Brim, Hassan

AU - Brosnahan, Shari B.

AU - Brown, Jeanette

AU - Castro, Mario

AU - Charney, Alexander

AU - Chen, Peter

AU - Deeks, Steven G.

AU - Erdmann, Nathaniel

AU - Flaherman, Valerie J.

AU - Ghamloush, Maher A.

AU - Goepfert, Paul

AU - Goldman, Jason D.

AU - Han, Jenny E.

AU - Hess, Rachel

AU - Hirshberg, Ellie

AU - Hoover, Susan E.

AU - Katz, Stuart D.

AU - Kelly, J. Daniel

AU - Klein, Jonathan D.

AU - Krishnan, Jerry A.

AU - Lee-Iannotti, Joyce

AU - Levitan, Emily B.

AU - Marconi, Vincent C.

AU - Metz, Torri D.

AU - Modes, Matthew E.

AU - Nikolich, Janko

AU - Novak, Richard M.

AU - Ofotokun, Igho

AU - Okumura, Megumi J.

AU - Parthasarathy, Sairam

AU - Patterson, Thomas F.

AU - Peluso, Michael J.

AU - Poppas, Athena

AU - Quintero Cardona, Orlando

AU - Scott, Jake

AU - Shellito, Judd

AU - Sherif, Zaki A.

AU - Singer, Nora G.

AU - Taylor, Barbara S.

AU - Thaweethai, Tanayott

AU - Verduzco-Gutierrez, Monica

AU - Wisnivesky, Juan

AU - Mccomsey, Grace A.

AU - Horwitz, Leora I.

AU - Foulkes, Andrea S.

PY - 2025/2/25

Y1 - 2025/2/25

N2 - Importance: Classification of persons with long COVID (LC) or post-COVID-19 condition must encompass the complexity and heterogeneity of the condition. Iterative refinement of the classification index for research is needed to incorporate newly available data as the field rapidly evolves. Objective: To update the 2023 research index for adults with LC using additional participant data from the Researching COVID to Enhance Recovery (RECOVER-Adult) study and an expanded symptom list based on input from patient communities. Design, Setting, and Participants: Prospective, observational cohort study including adults 18 years or older with or without known prior SARS-CoV-2 infection who were enrolled at 83 sites in the US and Puerto Rico. Included participants had at least 1 study visit taking place 4.5 months after first SARS-CoV-2 infection or later, and not within 30 days of a reinfection. The study visits took place between October 2021 and March 2024. Exposure: SARS-CoV-2 infection. Main Outcomes and Measures: Presence of LC and participant-reported symptoms. Results: A total of 13647 participants (11743 with known SARS-CoV-2 infection and 1904 without known prior SARS-CoV-2 infection; median age, 45 years [IQR, 34-69 years]; and 73% were female) were included. Using the least absolute shrinkage and selection operator analysis regression approach from the 2023 model, symptoms contributing to the updated 2024 index included postexertional malaise, fatigue, brain fog, dizziness, palpitations, change in smell or taste, thirst, chronic cough, chest pain, shortness of breath, and sleep apnea. For the 2024 LC research index, the optimal threshold to identify participants with highly symptomatic LC was a score of 11 or greater. The 2024 index classified 20% of participants with known prior SARS-CoV-2 infection and 4% of those without known prior SARS-CoV-2 infection as having likely LC (vs 21% and 5%, respectively, using the 2023 index) and 39% of participants with known prior SARS-CoV-2 infection as having possible LC, which is a new category for the 2024 model. Cluster analysis identified 5 LC subtypes that tracked quality-of-life measures. Conclusions and Relevance: The 2024 LC research index for adults builds on the 2023 index with additional data and symptoms to help researchers classify symptomatic LC and its symptom subtypes. Continued future refinement of the index will be needed as the understanding of LC evolves.

AB - Importance: Classification of persons with long COVID (LC) or post-COVID-19 condition must encompass the complexity and heterogeneity of the condition. Iterative refinement of the classification index for research is needed to incorporate newly available data as the field rapidly evolves. Objective: To update the 2023 research index for adults with LC using additional participant data from the Researching COVID to Enhance Recovery (RECOVER-Adult) study and an expanded symptom list based on input from patient communities. Design, Setting, and Participants: Prospective, observational cohort study including adults 18 years or older with or without known prior SARS-CoV-2 infection who were enrolled at 83 sites in the US and Puerto Rico. Included participants had at least 1 study visit taking place 4.5 months after first SARS-CoV-2 infection or later, and not within 30 days of a reinfection. The study visits took place between October 2021 and March 2024. Exposure: SARS-CoV-2 infection. Main Outcomes and Measures: Presence of LC and participant-reported symptoms. Results: A total of 13647 participants (11743 with known SARS-CoV-2 infection and 1904 without known prior SARS-CoV-2 infection; median age, 45 years [IQR, 34-69 years]; and 73% were female) were included. Using the least absolute shrinkage and selection operator analysis regression approach from the 2023 model, symptoms contributing to the updated 2024 index included postexertional malaise, fatigue, brain fog, dizziness, palpitations, change in smell or taste, thirst, chronic cough, chest pain, shortness of breath, and sleep apnea. For the 2024 LC research index, the optimal threshold to identify participants with highly symptomatic LC was a score of 11 or greater. The 2024 index classified 20% of participants with known prior SARS-CoV-2 infection and 4% of those without known prior SARS-CoV-2 infection as having likely LC (vs 21% and 5%, respectively, using the 2023 index) and 39% of participants with known prior SARS-CoV-2 infection as having possible LC, which is a new category for the 2024 model. Cluster analysis identified 5 LC subtypes that tracked quality-of-life measures. Conclusions and Relevance: The 2024 LC research index for adults builds on the 2023 index with additional data and symptoms to help researchers classify symptomatic LC and its symptom subtypes. Continued future refinement of the index will be needed as the understanding of LC evolves.

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2024 Update of the RECOVER-Adult Long COVID Research Index

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