This study investigates the longitudinal immunological correlates of COVID-19 outcomes in 113 patients with moderate or severe disease. The analysis reveals an overall increase in innate cell lineages and a reduction in T cell numbers. Early elevation in cytokine levels is associated with worse disease outcomes. Patients with moderate COVID-19 show a progressive reduction in type I (antiviral) and type 3 (antifungal) responses, while those with severe COVID-19 maintain these elevated responses. Severe COVID-19 is also associated with increased levels of multiple type 2 (anti-helminths) effectors, including IL-5, IL-13, immunoglobulin E, and eosinophils. Unsupervised clustering analysis identifies four immune signatures that correlate with distinct disease trajectories: growth factors (A), type-2/3 cytokines (B), mixed type-1/2/3 cytokines (C), and chemokines (D). Patients who recovered from moderate COVID-19 had enriched tissue reparative growth factor signature A, while those with severe disease had elevated levels of all four signatures. The study highlights a maladapted immune response profile associated with severe COVID-19 and poor clinical outcomes, as well as early immune signatures that correlate with divergent disease trajectories.This study investigates the longitudinal immunological correlates of COVID-19 outcomes in 113 patients with moderate or severe disease. The analysis reveals an overall increase in innate cell lineages and a reduction in T cell numbers. Early elevation in cytokine levels is associated with worse disease outcomes. Patients with moderate COVID-19 show a progressive reduction in type I (antiviral) and type 3 (antifungal) responses, while those with severe COVID-19 maintain these elevated responses. Severe COVID-19 is also associated with increased levels of multiple type 2 (anti-helminths) effectors, including IL-5, IL-13, immunoglobulin E, and eosinophils. Unsupervised clustering analysis identifies four immune signatures that correlate with distinct disease trajectories: growth factors (A), type-2/3 cytokines (B), mixed type-1/2/3 cytokines (C), and chemokines (D). Patients who recovered from moderate COVID-19 had enriched tissue reparative growth factor signature A, while those with severe disease had elevated levels of all four signatures. The study highlights a maladapted immune response profile associated with severe COVID-19 and poor clinical outcomes, as well as early immune signatures that correlate with divergent disease trajectories.