Long COVID Incidence Proportion in Adults and Children Between 2020 and 2024: An Electronic Health Record-Based Study From the RECOVER Initiative

doi:10.1093/cid/ciaf046

. 2025 Jul 18;80(6):1247-1261.

doi: 10.1093/cid/ciaf046.

Long COVID Incidence Proportion in Adults and Children Between 2020 and 2024: An Electronic Health Record-Based Study From the RECOVER Initiative

Hannah Mandel¹, Yun J Yoo², Andrea J Allen³, Sajjad Abedian⁴, Zoe Verzani⁵, Elizabeth W Karlson⁶, Lawrence C Kleinman⁷, Praveen C Mudumbi¹, Carlos R Oliveira^{8

9}, Jennifer A Muszynski¹⁰, Rachel S Gross¹¹, Thomas W Carton¹², C Kim¹³, Emily Taylor¹³, Heekyong Park¹⁴, Jasmin Divers¹⁵, J Daniel Kelly^{16

17}, Jonathan Arnold¹⁸, Carol Reynolds Geary¹⁹, Chengxi Zang⁵, Kelan G Tantisira^{20

21}, Kyung E Rhee^{21

22}, Michael Koropsak⁵, Sindhu Mohandas^{23

24}, Andrew Vasey¹⁹, Abu Saleh Mohammad Mosa²⁵, Melissa Haendel²⁶, Christopher G Chute²⁷, Shawn N Murphy²⁸, Lisa O'Brien¹³, Jacqueline Szmuszkovicz^{23

24}, Nicholas Guthe¹³, Jorge L Santana²⁹, Aliva De³⁰, Amanda L Bogie³¹, Katia C Halabi^{32

33}, Lathika Mohanraj³⁴, Patricia A Kinser³⁴, Samuel E Packard³⁵, Katherine R Tuttle^{36

37}, Kathryn Hirabayashi³, Rainu Kaushal⁵, Emily Pfaff³⁸, Mark G Weiner⁵, Lorna E Thorpe¹, Richard A Moffitt^{2

39}

Affiliations

¹ Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA.
² Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia, USA.
³ Applied Clinical Research Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
⁴ Information Technologies and Services Department, Weill Cornell Medicine, New York, New York, USA.
⁵ Department of Population Health Sciences, Weill Cornell Medical College, New York, New York, USA.
⁶ Department of Medicine, Brigham & Women's Hospital, Boston, Massachusetts, USA.
⁷ Department of Pediatrics and Child Health Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
⁸ Department of Pediatrics, Division of Infectious Diseases & Global Health, Yale University School of Medicine, New Haven, Connecticut, USA.
⁹ Department of Biostatistics, Yale University School of Public Health, New Haven, Connecticut, USA.
¹⁰ Division of Critical Care Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA.
¹¹ Department of Pediatrics, New York University Grossman School of Medicine, New York, New York, USA.
¹² Louisiana Public Health Institute, New Orleans, Louisiana, USA.
¹³ RECOVER Patient, Caregiver, or Community Advocate Representative, New York, New York, USA.
¹⁴ Research Information Science and Computing, Mass General Brigham, Somerville, Massachusetts, USA.
¹⁵ Department of Biostatistics, NYU Long Island School of Medicine, Mineola, New York, USA.
¹⁶ Department of Medicine, University of California, San Francisco, California, USA.
¹⁷ San Francisco VA Medical Center, San Francisco, California, USA.
¹⁸ Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
¹⁹ Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA.
²⁰ Division of Pediatric Respiratory Medicine, University of California San Diego, San Diego, California, USA.
²¹ Department of Pediatrics, Rady Children's Hospital, San Diego, California, USA.
²² Department of Pediatrics, University of California San Diego School of Medicine, San Diego, California, USA.
²³ Division of Infectious Diseases, Children's Hospital Los Angeles, Los Angeles, California, USA.
²⁴ Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
²⁵ Department of Biomedical Informatics, Biostatistics and Medical Epidemiology, University of Missouri School of Medicine, Columbia, Missouri, USA.
²⁶ Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
²⁷ Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
²⁸ Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA.
²⁹ School of Medicine, University of Puerto Rico, San Juan, Puerto Rico.
³⁰ Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA.
³¹ Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
³² Department of Infectious Disease, Nationwide Children's Hospital, Columbus, Ohio, USA.
³³ Infectious Diseases Division, Department of Pediatrics, Atlantic Health System, Goryeb Children's Hospital, Morristown, New Jersey, USA.
³⁴ Department of Adult Health and Nursing Systems, Virginia Commonwealth University School of Nursing, Richmond, Virginia, USA.
³⁵ Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA.
³⁶ Providence Medical Research Center, Providence Inland Northwest Health, Spokane, Washington, USA.
³⁷ Division of Nephrology and Kidney Research Institute Seattle, University of Washington School of Medicine, Seattle, Washington, USA.
³⁸ Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina USA.
³⁹ Department of Biomedical Informatics, Emory University, Atlanta, Georgia, USA.

PMID: 39907495
PMCID: PMC12272849 (available on 2026-02-05)
DOI: 10.1093/cid/ciaf046

Long COVID Incidence Proportion in Adults and Children Between 2020 and 2024: An Electronic Health Record-Based Study From the RECOVER Initiative

Hannah Mandel et al. Clin Infect Dis. 2025.

. 2025 Jul 18;80(6):1247-1261.

doi: 10.1093/cid/ciaf046.

Authors

Affiliations

¹ Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA.
² Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia, USA.
³ Applied Clinical Research Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
⁴ Information Technologies and Services Department, Weill Cornell Medicine, New York, New York, USA.
⁵ Department of Population Health Sciences, Weill Cornell Medical College, New York, New York, USA.
⁶ Department of Medicine, Brigham & Women's Hospital, Boston, Massachusetts, USA.
⁷ Department of Pediatrics and Child Health Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
⁸ Department of Pediatrics, Division of Infectious Diseases & Global Health, Yale University School of Medicine, New Haven, Connecticut, USA.
⁹ Department of Biostatistics, Yale University School of Public Health, New Haven, Connecticut, USA.
¹⁰ Division of Critical Care Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA.
¹¹ Department of Pediatrics, New York University Grossman School of Medicine, New York, New York, USA.
¹² Louisiana Public Health Institute, New Orleans, Louisiana, USA.
¹³ RECOVER Patient, Caregiver, or Community Advocate Representative, New York, New York, USA.
¹⁴ Research Information Science and Computing, Mass General Brigham, Somerville, Massachusetts, USA.
¹⁵ Department of Biostatistics, NYU Long Island School of Medicine, Mineola, New York, USA.
¹⁶ Department of Medicine, University of California, San Francisco, California, USA.
¹⁷ San Francisco VA Medical Center, San Francisco, California, USA.
¹⁸ Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
¹⁹ Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA.
²⁰ Division of Pediatric Respiratory Medicine, University of California San Diego, San Diego, California, USA.
²¹ Department of Pediatrics, Rady Children's Hospital, San Diego, California, USA.
²² Department of Pediatrics, University of California San Diego School of Medicine, San Diego, California, USA.
²³ Division of Infectious Diseases, Children's Hospital Los Angeles, Los Angeles, California, USA.
²⁴ Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
²⁵ Department of Biomedical Informatics, Biostatistics and Medical Epidemiology, University of Missouri School of Medicine, Columbia, Missouri, USA.
²⁶ Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
²⁷ Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
²⁸ Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA.
²⁹ School of Medicine, University of Puerto Rico, San Juan, Puerto Rico.
³⁰ Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA.
³¹ Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
³² Department of Infectious Disease, Nationwide Children's Hospital, Columbus, Ohio, USA.
³³ Infectious Diseases Division, Department of Pediatrics, Atlantic Health System, Goryeb Children's Hospital, Morristown, New Jersey, USA.
³⁴ Department of Adult Health and Nursing Systems, Virginia Commonwealth University School of Nursing, Richmond, Virginia, USA.
³⁵ Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA.
³⁶ Providence Medical Research Center, Providence Inland Northwest Health, Spokane, Washington, USA.
³⁷ Division of Nephrology and Kidney Research Institute Seattle, University of Washington School of Medicine, Seattle, Washington, USA.
³⁸ Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina USA.
³⁹ Department of Biomedical Informatics, Emory University, Atlanta, Georgia, USA.

PMID: 39907495
PMCID: PMC12272849 (available on 2026-02-05)
DOI: 10.1093/cid/ciaf046

Abstract

Background: Incidence estimates of post-acute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, also known as long COVID, have varied across studies and changed over time. We estimated long COVID incidence among adult and pediatric populations in 3 nationwide research networks of electronic health records (EHRs) participating in the RECOVER (Researching COVID to Enhance Recovery) Initiative using different classification algorithms (computable phenotypes).

Methods: This EHR-based retrospective cohort study included adult and pediatric patients with documented acute SARS-CoV-2 infection and 2 control groups: contemporary coronavirus disease 2019 (COVID-19)-negative and historical patients (2019). We examined the proportion of individuals identified as having symptoms or conditions consistent with probable long COVID within 30-180 days after COVID-19 infection (incidence proportion). Each network (the National COVID Cohort Collaborative [N3C], National Patient-Centered Clinical Research Network [PCORnet], and PEDSnet) implemented its own long COVID definition. We introduced a harmonized definition for adults in a supplementary analysis.

Results: Overall, 4% of children and 10%-26% of adults developed long COVID, depending on computable phenotype used. Excess incidence among SARS-CoV-2 patients was 1.5% in children and ranged from 5% to 6% among adults, representing a lower-bound incidence estimation based on our control groups. Temporal patterns were consistent across networks, with peaks associated with introduction of new viral variants.

Conclusions: Our findings indicate that preventing and mitigating long COVID remains a public health priority. Examining temporal patterns and risk factors for long COVID incidence informs our understanding of etiology and can improve prevention and management.

Keywords: COVID; EHRs; electronic health records; long COVID; public health surveillance.

© The Author(s) 2025. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.

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Conflict of interest statement

Potential conflicts of interest . H. P., K. G. T., C. R. O., A. V., L. E. T., J. D., R. A. M., J. D. K., E. W. K., P. A. K., R. S. G., C. R. G., A. D., T. W. C., M. H., and K. R. T. all reports funding from the NIH. Additionally, J. A. reports grants or contracts from Pfizer and Amgen. C. G. C. reports a leadership role on the World Health Organization (WHO) Medical Scientific Advisory Committee. P. A. K. reports a leadership role with the Commonwealth of Virginia Board of Health. L. C. K. reports owning shares in Amgen, Regeneron, Sanofi, and GLAXF. K. E. R. reports funding from the NIH (National Institute on Minority Health and Health Disparities [NIMHD]) and the US Department of Agriculture (USDA). C. R. O. reports holding leadership positions with the American Academy of Pediatrics, Eastern Society of Pediatric Research, and Journal of Pediatric Infectious Diseases Society. S. E. P. received funding from the National Institute of Mental Health (NIMH) and travel support from Columbia University Mailman School of Public Health. J. L. S. reports funding from NYU Langone. K. R. T. reports funding from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), NIMHD, NIH Director's Office, Centers for Disease Control and Prevention (CDC), Travere, and Bayer; consulting fees and/or payments/honoraria from Eli Lilly, Boehringer Ingelheim, AstraZeneca, Bayer, Novo Nordisk, Pfizer, Travere, and ProKidney; participation in a data safety monitoring or advisory board for NIDDK/NIH and AstraZeneca; and leadership roles with the American Society of Nephrology and Clinical Journal of the American Society of Nephrology. L. E. T. reports a leadership position with the American Journal of Public Health. L. M. reports a leadership position with the International Society of Nurses in Genetics. C. K. reports receiving payments from the NIH. J. D. K. reports funding from the VA and CDC. K. C. H. reports owning stock in Pfizer. M. H. reports being a founder of Alamya Health. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Update of

Long COVID incidence in adults and children between 2020 and 2023: a real-world data study from the RECOVER Initiative.
Mandel H, Yoo Y, Allen A, Abedian S, Verzani Z, Karlson E, Kleinman L, Mudumbi P, Oliveira C, Muszynski J, Gross R, Carton T, Kim C, Taylor E, Park H, Divers J, Kelly J, Arnold J, Geary C, Zang C, Tantisira K, Rhee K, Koropsak M, Mohandas S, Vasey A, Weiner M, Mosa A, Haendel M, Chute C, Murphy S, O'Brien L, Szmuszkovicz J, Güthe N, Santana J, De A, Bogie A, Halabi K, Mohanraj L, Kinser P, Packard S, Tuttle K, Thorpe L, Moffitt R. Mandel H, et al. Res Sq [Preprint]. 2024 Apr 26:rs.3.rs-4124710. doi: 10.21203/rs.3.rs-4124710/v1. Res Sq. 2024. Update in: Clin Infect Dis. 2025 Jul 18;80(6):1247-1261. doi: 10.1093/cid/ciaf046. PMID: 38746290 Free PMC article. Updated. Preprint.

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1. Soriano JB, Murthy S, Marshall JC, Relan P, Diaz JV. WHO Clinical Case Definition Working Group on post-COVID-19 condition. A clinical case definition of post-COVID-19 condition by a Delphi consensus. Lancet Infect Dis 2022; 22:e102–7. - PMC - PubMed
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[1] Davis HE, McCorkell L, Vogel JM, Topol EJ. Long COVID: major findings, mechanisms and recommendations. Nat Rev Microbiol 2023; 21:133–46. - PMC - PubMed

[2] Davis HE, McCorkell L, Vogel JM, Topol EJ. Long COVID: major findings, mechanisms and recommendations. Nat Rev Microbiol 2023; 21:133–46. - PMC - PubMed

[3] Soriano JB, Murthy S, Marshall JC, Relan P, Diaz JV. WHO Clinical Case Definition Working Group on post-COVID-19 condition. A clinical case definition of post-COVID-19 condition by a Delphi consensus. Lancet Infect Dis 2022; 22:e102–7. - PMC - PubMed

[4] Soriano JB, Murthy S, Marshall JC, Relan P, Diaz JV. WHO Clinical Case Definition Working Group on post-COVID-19 condition. A clinical case definition of post-COVID-19 condition by a Delphi consensus. Lancet Infect Dis 2022; 22:e102–7. - PMC - PubMed

[5] National Heart, Lung, and Blood Institute (NHLBI) . Long COVID Research and Resources. NHLBI.NIH.gov. Available at: https://www.nhlbi.nih.gov/covid/long-covid. Accessed 5 February 2025.

[6] National Heart, Lung, and Blood Institute (NHLBI) . Long COVID Research and Resources. NHLBI.NIH.gov. Available at: https://www.nhlbi.nih.gov/covid/long-covid. Accessed 5 February 2025.

[7] Tartof SY, Malden DE, Liu ILA, et al. Health care utilization in the 6 months following SARS-CoV-2 infection. JAMA Netw Open 2022; 5:e2225657. - PMC - PubMed

[8] Tartof SY, Malden DE, Liu ILA, et al. Health care utilization in the 6 months following SARS-CoV-2 infection. JAMA Netw Open 2022; 5:e2225657. - PMC - PubMed

[9] Hanson W, Abbafati S, Aerts C, et al. Estimated global proportions of individuals with persistent fatigue, cognitive, and respiratory symptom clusters following symptomatic COVID-19 in 2020 and 2021. JAMA 2022; 328:1604–15. - PMC - PubMed

[10] Hanson W, Abbafati S, Aerts C, et al. Estimated global proportions of individuals with persistent fatigue, cognitive, and respiratory symptom clusters following symptomatic COVID-19 in 2020 and 2021. JAMA 2022; 328:1604–15. - PMC - PubMed

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Long COVID Incidence Proportion in Adults and Children Between 2020 and 2024: An Electronic Health Record-Based Study From the RECOVER Initiative

Affiliations

Long COVID Incidence Proportion in Adults and Children Between 2020 and 2024: An Electronic Health Record-Based Study From the RECOVER Initiative

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