Research suggests women are more susceptible to long COVID

The World Health Organization (WHO) estimates there have been close to 540 million confirmed global COVID-19 cases.
 
And while much of the focus has been on hospitalisation and death, long COVID has also emerged as a major concern, with the WHO confirming it as a significant clinical condition in October last year.
 
The true number of people affected has so far remained unknown, as has whether the condition is more likely to affect men or women.
 
Now, new literature review research from the US may fill that gap, backing up recent Australian indications that women are more likely to experience the impact of long COVID.
 
The data analysis of a total sample size of almost 1.4 million patients across 35 publications found the odds of women developing the condition are ‘significantly greater’ than for males.
 
Of the publications identified, 23 met eligibility criteria for COVID-19 sequelae and 12 for long COVID, with differences between males and females observed.
 
However, the study authors said the lack of COVID-19 studies reporting gender-disaggregated data has also meant there is a need for further research on the specific conditions caused by the virus and how they affect males and females separately.
 
‘Sex differences in outcomes have been reported during previous coronavirus outbreaks,’ they wrote.
 
‘Unfortunately, most studies did not evaluate or report granular data by sex, which limited sex-specific clinical insights that may be impacting treatment.
 
‘Knowledge about fundamental sex differences underpinning the clinical manifestations, disease progression, and health outcomes of COVID-19 is crucial for the identification and rational design of effective therapies and public health interventions that are inclusive of and sensitive to the potential differential treatment needs of both sexes.’
 
According to the study, females are more likely to experience a variety of post-infection symptoms including low mood, fatigue, ear, nose and throat issues, as well as neurological, gastrointestinal and rheumatological disorders.
 
Males are more likely to experience endocrine disorders such as diabetes and kidney disorders.
 
Elsewhere, research on the causes of long COVID include the identification of two types of proteins created by cells in response to the virus, and ongoing damage or elevated autoantibodies in response to the initial infection.
 
Based on the theory that an elevated immune response is a causal factor, the US study suggests that this could potentially explain why long COVID is more common in females.
 
‘Differences in immune system function between females and males could be an important driver of sex differences in long COVID syndrome,’ the authors wrote.
 
‘Sex differences in immune response have also been reported in other viral and bacterial infections with chronic sequelae, such as SARS CoV, MERS CoV, and Lyme disease, as well as in numerous rheumatological conditions.
 
‘Females mount more rapid and robust innate and adaptive immune responses, which can protect them from initial infection and severity. However, this same difference can render females more vulnerable to prolonged autoimmune-related diseases.’
 
In Australia, the rise of people experiencing long COVID is placing further pressure on the healthcare system, with growing wait lists to access treatment and out-of-pocket costs for specialist care.
 
Specialist treatment for neuropsychological conditions – one of the symptoms of long COVID – is particularly in demand.
 
Dedicated long COVID clinics are beginning to open around the country, but experts recently warned of the ‘definite need’ for ongoing care and better access to services. The RACGP has also updated its guidelines in anticipation of the upcoming demand.
 
GP Dr Bernard Shiu, who opened Victoria’s first long-COVID clinic, told Nine Newspapers he currently has a long waiting list and treats around eight new patients a week with varying symptoms.
 
‘The most important thing we can do for them is validate their symptoms are real,’ Dr Shiu said. ‘Our job is then to separate what they had before COVID and determine it is definitely long COVID.’
 
Experts are also calling for more research to track long COVID diagnoses, with the US study stressing the need to break down data by gender.
 
The authors state that gender-based evidence will inform better management of COVID-19 and long COVID. They propose future studies to include gender as a variable in infectious outbreaks ‘to ensure optimal treatment’ of both females and males.
 
According to the researchers, their work has helped to uncover the variety of clinical presentations among both genders and ‘identify information gaps where additional research and data are needed’.
 
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