Two-year trajectories of COVID-19 symptoms and their association with illness perception: A prospective cohort study in Amsterdam, the Netherlands 6 175 BACKGROUND Millions worldwide have been infected with SARS-CoV-2[1], of whom an estimated 1275% develop long-lasting symptoms [2, 3], also known as “long COVID” or post-acute sequelae of COVID-19 (PASC). The World Health Organization (WHO) defines long COVID as reporting one or more symptoms beyond 3 months after infection, which last for at least 2 months and cannot be explained by an alternative cause[4]. As a consequence, most studies on long COVID focus on the duration of long COVID symptoms. However, data suggest that trajectories of long COVID symptoms may vary over time[5, 6]. Some individuals may experience repeated cycles or fluctuation in long COVID symptoms, implying long COVID could present as a relapsing-remitting condition. Among these individuals, the duration of long COVID symptoms could be underestimated if the first date that symptoms are absent is defined as recovery. Furthermore, research to date has not consistently complemented data on duration of symptoms with information on the type, total number, or severity of symptoms. Standardised questionnaires that help measure subjective features of the lived experience of long COVID have also been under-utilised. Examining illness perception builds a bridge between patient perspectives and clinical outcomes, providing detailed insight into the role of the lived experience in reporting symptom data. For other long-term conditions, for instance, a more optimistic illness perception has been independently linked to improved prognosis, including lower mortality[7], whilst more negative illness perception has been associated with stress and reduced quality of life[8]. Illness perception may be an important determining factor of the progression of long COVID symptoms over time, and therefore may help further characterise the condition and identify individuals most severely affected. We used data from a prospective cohort of individuals infected with SARS-CoV-2 to identify longitudinal trajectories of long COVID symptoms over two years of follow-up. We assessed baseline determinants of belonging to a given trajectory, and evaluated the association between the clinical trajectories identified and a validated measure of participants’ own illness perceptions. METHODS Study design and population RECoVERED is a prospective cohort study of adults with laboratory-confirmed SARSCoV-2 infection. Participants experienced mild to critical COVID-19 and were enrolled in
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