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Patients were included if they were admitted to 1 of 3 hospitals because of severe coronavirus disease 2019 (COVID\u201019), required endotracheal intubation for at least 7\u2009days, and experienced impairment of consciousness (Glasgow Coma Scale motor score &lt;6).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Five hundred seventy\u2010one patients of the 795 patients recovered command\u2010following. The median time to recovery of command\u2010following was 30\u2009days (95% confidence interval [CI]\u00a0=\u00a027\u201332\u2009days). Median time to recovery of command\u2010following increased by 16\u2009days for patients with at least one episode of an arterial partial pressure of oxygen (PaO<jats:sub>2<\/jats:sub>) value \u226455\u2009mmHg (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), and 25% recovered \u226510\u2009days after cessation of mechanical ventilation. The time to recovery of command\u2010following\u00a0 was associated with hypoxemia (PaO<jats:sub>2<\/jats:sub>\u2009\u226455\u2009mmHg hazard ratio [HR]\u00a0=\u00a00.56, 95% CI\u00a0=\u00a00.46\u20130.68; PaO<jats:sub>2<\/jats:sub>\u2009\u226470 HR\u00a0=\u00a00.88, 95% CI\u00a0=\u00a00.85\u20130.91), and each additional day of hypoxemia decreased the likelihood of recovery, accounting for confounders including sedation. These findings were confirmed among patients without any imagining evidence of structural brain injury (n\u00a0=\u00a0199), and in a non\u2010overlapping second surge cohort (N\u00a0=\u00a0427, October 2020 to April 2021).<\/jats:p><\/jats:sec><jats:sec><jats:title>Interpretation<\/jats:title><jats:p>Survivors of severe COVID\u201019 commonly recover consciousness weeks after cessation of mechanical ventilation. Long recovery periods are associated with more severe hypoxemia. This relationship is not explained by sedation or brain injury identified on clinical imaging and should inform decisions about life\u2010sustaining therapies. 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