Evolution of COVID-19 symptoms during the first 12 months after illness onset 4 99 INTRODUCTION The clinical spectrum of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), ranges from asymptomatic presentation to fatal illness. Although the acute symptomatology of hospitalised patients has been well documented[1-4], robust longitudinal data on the evolution of long-term symptoms across the full range of COVID-19 severity is scarce. Moreover, little is known about the risk factors that may affect recovery and provide opportunity for intervention or treatment. Observational studies have reported that more than half of hospitalised patients[5-7] and approximately one-third of non-hospitalised patients[8] reported at least one ongoing symptom four to twelve months after symptom onset. In addition, online patient-led support groups[9] have provided anecdotal evidence on the impact of long-term postCOVID-19 symptoms on quality of life, daily functioning and mental health. Indeed, postCOVID syndrome (i.e. long COVID or Post-Acute Sequelae of SARS-CoV-2 infection [PASC]) may have substantial adverse consequences for both individual quality of life and the economic productivity of society [5, 10, 11]. The RECoVERED study is a prospective cohort study of individuals with SARS-CoV-2 infection residing in the municipal region of Amsterdam, the Netherlands. We evaluated the incidence, severity and duration of symptoms up to 12 months after illness onset in participants with mild, moderate, severe and critical COVID-19, and examined baseline determinants of time to recovery from symptoms. METHODS Study design and participants The RECoVERED study is an ongoing cohort study of individuals with COVID-19 in Amsterdam, the Netherlands. The study aims to describe the immunological, clinical and psychosocial sequelae of SARS-CoV-2 infection. Enrolment began on 11 May 2020. Non-hospitalised participants were identified from notification data of laboratoryconfirmed (by polymerase chain reaction [PCR] or validated antigen test[12]) SARSCoV-2 infection at the Public Health Service of Amsterdam (PHSA). Trained study staff approached eligible patients by telephone up to seven days after SARS-CoV-2 diagnosis. Prospectively-enrolled hospitalised participants were identified from admission data and approached on the COVID-19 wards of two academic hospitals in Amsterdam. In
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