Is the post-COVID-19 condition more common among women than men?

It gives me great pleasure to author another article for Bham Pharma Ltd as part of their Women’s Health online blog series. We seek to write about important and contemporary issues that affect the health of women across the globe to consider optimal health service delivery. For this reason, I am going to discuss the post-COVID-19 condition, otherwise known as ‘long COVID’, and its complex influence on the health of women. Specifically, I am going to attempt to answer the following question: does the post-COVID-19 condition affect more women than men? 

Throughout the development of the COVID-19 pandemic, it became apparent that a proportion of those infected with the SARS-CoV-2 virus experience complex and long-term health issues well after the acute infection phase of the disease. As the virus adapted, so too did the terminology for this long-term condition, with names including long COVID, long-haul COVID, post-COVID-19 syndrome, post-acute sequelae of COVID-19 (PASC), and chronic COVID syndrome (CCS). 

Evidence suggests that women, especially those within the 40 – 60 age bracket, have a higher risk of experiencing a range of debilitating and ongoing post-COVID-19 symptoms compared to men. More reported symptoms can include fatigue, breathlessness, muscle pain, anxiety, depression, and “brain fog” after hospital treatment for COVID-19 (2). Additionally, women are significantly more likely than men to report, weakness, thoracic pain, palpitations, and sleep disturbances, but not muscle aches and cough (Pelà et al: 2022). Women are also statistically more likely to experience persistent symptoms such as shortness of breath, fatigue, chest pain, and palpitations (3). Using multivariate regression analysis, Pelà et al., were able to demonstrate that biological sex was a powerful determinant of long-term post-COVID-19 symptoms (1). Sex appears to be a critical factor in determining the persistence of shortness of breath, fatigue, chest pain, and palpitations in women who contracted the SARS-CoV-2 virus during the pandemic (3). 

At the time of writing, there is not a definitive answer to the question above. However, it is speculated that sex-based differences in the human immune response may be accountable for the higher prevalence of post-COVID-19 condition symptoms in women (Torjesen: 2021). 

Evidence indicates that women do experience the post-COVID-19 condition more than men. The symptoms of the post-COVID-19 condition are challenging, debilitating, and clinically complex. Given the range of long-term health issues caused by the SARS-CoV-2 virus, there is a clear need for urgent and robust research to help understand the epidemiological basis and the underlying biological mechanism for the sex difference in patients living with the post-COVID-19 condition (5). Significantly more research is needed to better understand the underlying determinants of the post-COVID-19 condition and why it appears to disproportionately affect women more than men.