Fibrotic-like abnormalities are present in 60% of a single-center, longitudinal, multi-ethnic cohort 3-years after severe COVID-19. They are independently associated with male sex, low BMI, shorter telomere length, increased severity of illness, and mechanical ventilation; Black race and asthma are protective. Participants with fibrotic-like abnormalities are more likely to have reduced diffusion capacity and 6-minute walk distance. Fibrotic-like abnormalities persist but modestly improve over time. Transbronchial biopsies show small airways histopathology, consistent with high prevalence of air trapping in expiration, and infrequent interstitial thickening. This study highlights the need for continued monitoring of patients with persistent fibrosis after severe COVID-19.

CMcG reports relationship with Boehringer Ingelheim outside the scope of this study. MS reports relationships with Boehringer Ingelheim, Genentech, Bioclinica, AbbVie, Lunglife AI, the France Foundation, and Peer View outside the scope of this study. KMC reports relationships with Cardinal Health and Guidepoint outside the scope of this study. AS reports relationships with Boehringer Ingelheim, Genentech, Gilead, AbbVie, and Veracyte outside the scope of this study. CKG reports a relationship with Rejuvenation Technologies, Inc. and Boehringer Ingelheim outside the scope of this study.

This work was supported by the NIH (T32HL105323 to SOM; UL1TR001873 to MRB; R01HL093096 to CKG) and the Department of Defense (PR202907 to CKG and MRB).

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Human Research Protection Office/Institutional Review Board of Columbia University IRB 5 gave ethical approval for this work.

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All data produced in the present study are available upon reasonable request to the authors