Background Interpretations of ‘recovery’ from illness are complex and influenced by many factors, not least definitions of the illness in question and patient expectations and experiences. This paper aims to examine what ‘recovery’ means, and the practices it entails, in the aftermath of COVID-19 by comparing accounts from adults admitted to an ICU with COVID-19 with accounts from adults with Long COVID, defined as ongoing symptoms for at least twelve weeks post-infection.

Methods Qualitative interviews (n=95) were conducted using identical methods with 32 adults who had been admitted to an ICU with COVID-19 and with 63 adults with Long COVID. Interviews were audio- and/or video-recorded, transcribed verbatim and de-identified. Thematic analyses were initially conducted separately on each dataset. A comparative analysis was then conducted exploring themes relevant to experiences of illness and perspectives on ‘recovery’. Analysis was informed by theoretical literature on epistemic injustice and the ‘recovery imperative’ and aimed to explore how ‘recovery’ is understood and undertaken after COVID-19 infection in the two groups.

Four themes were evident: 1) losses and scars caused by COVID-19; 2) adjusting to changed selves; 3) ‘recovery’ trajectories; and 4) ‘recovery’ in a changing world. Underpinning all accounts was the novel and unknown nature of COVID-19 and the scant healthcare knowledge and services that existed when participants were interviewed. Perceptions of ‘recovery’ were therefore shaped by the uncertainty arising from there being no known ‘map’ to guide either group in regaining health. Many thematic commonalities served to complicate idealised notions of ‘recovery’, with participants questioning the achievability of full ‘recovery’, highlighting the heterogeneity of ‘recovery’ trajectories and describing the hard physical and emotional work of adjusting to changed selves. Differences between participants’ accounts often centred on other people’s responses to their ‘recovery’. Healthcare professionals, family and friends gave ICU participants permission and as much support as was possible within the disrupted service landscape to take time to recover. However, Long COVID participants often encountered others’ disbelieving and confused responses to their ‘failure’ to ‘recover’.

Conclusion Participants’ experiences did not reflect idealised notions of ‘recovery’ as a linear transition between binary states of illness and wellness but as practices done in different ways and with varying levels of support. The existence of a ‘recovery imperative’ means that some versions of ‘recovery’ are valued as more successful, leading to emotional challenges for participants whose trajectories contradict expectations that a full ‘recovery’ should/could have taken place.