Why are women more likely to get Long Covid than men?

There’s so much we still don’t know about Long Covid, but one thing we do know is that you’re more likely to get it if you’re a woman.

To be clear – Long Covid isn’t a female specific disease, and the number of women who contract it is only a small majority when compared to the number of men, but yet the disparity is there. And it begs the question – why?

According to the official government information about the chronic after-effects that can linger after catching the virus: prevalence of self-reported Long Covid is higher in women.

This disparity between men and women contracting Long Covid is part of a long history of a gender gap in health.

Studies have consistently shown that women have a higher rate of chronic diseases than men, however this is often downplayed as reporting bias – this idea that women are simply more likely to talk openly about their health, notice symptoms, and report it to a doctor.

However evidence shows that women do experience chronic illness more frequently, and are more likely to have multiple chronic illnesses than men. 80-90% of diagnosed cases of fibromyalgia are women, according to the International Association for the Study of Pain, while 90% of people with lupus are women.

This pattern is playing out with Long Covid, and as this condition starts to impact larger swathes of the population, it’s important to understand the disproportionate implications for women.

‘Research data from around the world has been accumulating which shows that women are more likely to develop Long Covid than men,’ Dr Deborah Lee from Dr Fox Online Pharmacy tells Metro.co.uk.

She points to two key findings of interest. Firstly, in March 2021, the BMJ reported on two UK Covid studies and concluded that women in middle age had a higher risk of developing Long Covid symptoms including fatigue, breathlessness, muscle pain, anxiety, depression, and brain fog.

‘Additionally,’ Dr Lee adds, ‘in the International Severe Acute Respiratory and Emerging Infections Consortium Study, women under the age of 50, who had been admitted to hospital with Covid, were five times less likely to be fully recovered, seven times more likely to still feel breathless, and twice as likely to be suffering from fatigue, as similarly aged males.’

Why is this happening – and is there anything women can do to protect themselves from this higher level of risk?

Differences between men and women

Dr Lee says expert respiratory consultants have suggested this inequality in rates of Long Covid may be due to biological differences between men and women – because of the way these differences effect the immune system and the immune response.

‘Most cases of Long Covid have been diagnosed in perimenopausal women,’ she explains. ‘Autoimmune diseases are well known to be more common in women between the ages of 40 and 60.

‘Perhaps men have a more intense, initial immune reaction to Covid infection, but in women, the duration of the immune response is prolonged. Patients with Long Covid have often been found to have raised levels of C-reactive protein – a marker of chronic inflammation.’

American immunologist Prof Akiko Iwasaki reported that T cells are more active early on in a Covid infection in women than in men -T cells are the white blood cells that seek out and destroy virally infected cells. Dr Lee says women may have a more aggressive T cell response because many of the genes encoding the immune response are on the X chromosomes – women have two X chromosomes, whereas men only have one.

‘Professor Iwasaki also believes that women are programmed to have a more aggressive immune system in view of their reproductive function and their need to protect a pregnancy,’ she adds.

Failure to clear the infection

Even though women are less likely to die from an acute Covid infection than men, it is thought that they are more likely to be left with remnants of viral particles after the infection has passed.

‘These have been discovered in many different organs of the body,’ says Dr Lee. ‘The presence of these viral remnants could then cause ongoing inflammation.

‘The symptoms of Long Covid have been compared to myalgic encephalitis (ME) – also known as chronic fatigue syndrome (CF), and chronic Lyme Disease – medical conditions thought to be precipitated by either a viral or bacterial infection, which lingers.’

Another school of thought about why Long Covid affects more women, is that Covid triggers the onset of autoimmune disease.

Research from September 2021 found that Covid could ‘boost production of autoantibodies that had previously only existed in the body at very low levels,’ – meaning that the body starts to produce antibodies that attack its own tissues.

And there’s a reason why this is more common in women than in men.

‘It may be that Covid infection in women who have a genetic predisposition, “switches on” the immune system, which then fails to “switch off” again – leading to chronic symptoms,’ says Dr Lee. ‘Men, on the other hand, are protected from this as high testosterone levels are known to dampen B cell function – B cells being the white blood cells that produce autoantibodies.’

Gender bias in healthcare

A 2021 report by the British Medical Association found that although women live longer than men, they spend more of their life in poor health.

The report found: ‘Adult women are over twice as likely as men to suffer from depression, and are more likely than men to suffer from chronic conditions such as arthritis and migraines.’

This isn’t just a case of bad luck for women, systemic inequalities play a part in it.

A US study published in November 2020 found that the American National Institutes of Health ‘applies a disproportionate share of its resources to diseases that affect primarily men, at the expense of those that affect primarily women.’

So, there are fewer resources, studies and treatments for diseases that more women suffer with. As many as fourteen female-dominant conditions were found to be underfunded relative to their disease burden.

There are real-world impacts that stem from this kind of inequality.

It takes an average of eight years for a woman to be diagnosed with endometriosis – a debilitating condition where cells like the ones in the lining of the womb are found elsewhere in the body.

In diseases that both men and women can get, women are often diagnosed many years later than men. A 2019 study of 6.9 million people found that the same conditions were recognised in men when they were about four years younger than the age at which women were diagnosed.

Part of the delay in diagnosis comes down to a tendency to dismiss diseases that impact more women as being psychological in origin. Over the years, both ME and chronic Lyme disease have been ridiculed by some in the medical community as forms of hypochondria.

Can you protect yourself against Long Covid?

Dr Lee says the best way to reduce your risk of Long Covid is by getting vaccinated.

‘Being vaccinated against Covid helps stop you from becoming infected in the first place,’ she says. ‘After vaccination, if you do become infected with Covid, the infection is likely to be much less severe.’

A 2021 study found that those who were vaccinated had around a 50% reduced chance of still having symptoms 28 days after being infected with Covid.

‘Experts have proposed that this may be because, after vaccination, the prompt antibody response results in a smaller viral load,’ says Dr Lee. ‘This means there are fewer viruses in the body that are able to infect vital organs such as the brain and the heart.’

In order to protect yourself to the best of your abilities, Dr Lee says it’s important to know the other risk factors for developing Long Covid.

Other than being a woman, the condition has been found to be more likely in those who are older, already have an autoimmune disease, have previously been infected with Epstein Barr Virus (EBV), or have type-2 diabetes or chronic obstructive pulmonary disease (COPD).

‘To reduce your chances of getting Long Covid, therefore, you need to think long-term about how you can make major improvements to your health,’ says Dr Lee.

‘Try to avoid being diagnosed with type-2 diabetes. This may mean needing to lose weight. Aim to get your BMI within the normal range – 21-25 – and keep it there.

‘Don’t smoke – this is a major cause of COPD. Visit NHS Smokefree for free advice and support. Take advice and manage COPD as well as you can if you already have it.’

She adds that the similarities between menopausal symptoms and Long Covid symptoms have also been noted by many experts in the field.

‘Whether HRT might have a preventative role for the development of Long Covid is unknown, but taking HRT is highly effective for the relief of menopausal symptoms,’ says Dr Lee. ‘Women suffering from Long Covid symptoms may well benefit from a menopause consultation.’

Long Covid – what you need to know

Most infections with Covid resolve within the first four weeks. Long Covid is a term commonly used to describe symptoms that continue or develop after you’ve had the initial virus.

An estimated 1.5 million people in the UK (2.4% of the population) have reported experiencing Long Covid symptoms.

The recovery time is different for everyone. The length of your recovery is not necessarily related to the severity of your initial illness, or whether you were in hospital.

According to the latest reports, Long Covid is most common in people aged 35-69 years, women, people living in more deprived areas, those working in health care, social care, or teaching and education, and those with another activity-limiting health condition or disability.

Common Long Covid symptoms include:

• Extreme tiredness (fatigue)
• Shortness of breath
• Chest pain or tightness
• Problems with memory and concentration (“brain fog”)
• Difficulty sleeping (insomnia)
• Heart palpitations
• Dizziness
• Pins and needles
• Joint pain
• Depression and anxiety

If new or ongoing symptoms do occur and they are causing you concern, you should always seek medical advice and support.

For more information and support you can apply to join the Long Covid Support Group on Facebook, which currently has more than 50,000 members.

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