As the shock and fear of COVID-19 wanes, health officials are turning their attention to long COVID and the threat it poses to the U.S. health care system.
Long COVID remains mysterious with health care providers unsure which symptoms can be directly attributed to a COVID-19 infection and how those symptoms may persist. There wasn’t a generally accepted definition for the condition until June when the National Academies of Sciences, Engineering and Medicine released an 187-page report.
“Long COVID (LC) is an infection-associated chronic condition (IACC) that occurs after SARS-CoV-2 infection and is present for at least 3 months as a continuous, relapsing and remitting, or progressive disease state that affects one or more organ systems,” the report said.
A possible 200 symptoms were listed, expanding on the well-understood symptoms of an initial COVID-19 infection.
Now, a new study from dozens of researchers across the country found that women, particularly those in middle age, have a higher risk of developing long COVID than men, muddying the medical water further.
Women 1.3-times higher risk
More than 12,000 people across 33 states and Puerto Rico and Washington, D.C., underwent medical exams and completed surveys between October 2021 and July, and reported whether they contracted COVID-19 and if their symptoms persisted, according to the study published Jan. 22 in the peer-reviewed journal JAMA Network.
Male participants reported “more severe acute COVID-19 and higher mortality than females,” researchers found, but women were more likely to have long-term “sequelae” or consequences from a previous infection.
“Overall, female sex was associated with a 1.31-times higher risk of long COVID,” researchers said. “In age-stratified analyses, female sex was associated with the highest risk of long COVID among adults aged 40 to 54 years followed by those aged 55 years or older.”
Age, hormones and more
Researchers offered a few possible explanations for the “significantly higher risk” among women.
For middle aged women, their menopause status may impact their risk, according to the study.
“There is immune activation with menopausal transition, as is seen in individuals with HIV infection; female sex hormone levels decrease with age; and both higher levels of estrogen and relatively lower levels of testosterone have been associated with high risk of long COVID in nonpregnant females,” according to the study.
These differing hormone levels for women during this period of their lives may impact their immune system’s ability to fight the COVID-19 infection, researchers said.
This also applies to women of any age, excluding those that were pregnant during the study.
Levels of sex hormones can change how receptors in your immune system respond to infection, researchers said, meaning women with different levels of sex hormones, notably estrogen and testosterone, compared to men may overall be more susceptible to COVID-19 infection and have a harder time recovering.
Another possible explanation is that some of the comorbidities for long COVID, meaning diseases or medical conditions that are present at the same time, are more common in women.
Conditions like myalgic encephalomyelitis/chronic fatigue syndrome and postural orthostatic tachycardia syndrome (increased heart rate after standing up causing dizziness and other symptoms) are more common in women and have also been identified as long COVID symptoms, according to the study.
“It is important to disentangle the role of aging, hormones, inflammatory response, and comorbidities underlying these differential long COVID risk profiles and to identify which groups may benefit from specific treatments,” researchers said. “Sex steroid-based therapies might be suggested to mitigate long COVID symptoms in females, as has already been suggested for acute COVID-19 in men.”
