- Does a corona infection affect the sexes differently? The answer is yes.
- Men die more often, but women suffer longer. Experts see not only biological reasons for this.
- The social factors are alarming. One: women are taken less seriously.
Is COVID-19 most dangerous for older men? That’s true – when it comes to the severity of the acute illness and the risk of death. But if you look at the long-term consequences of a COVID infection, it looks very different: the risk group is young and female.
Jördis Frommhold is chief physician in the respiratory disease department of a rehabilitation clinic in Heiligendamm and has recently published a book on Lung COVID. “In the spring and summer of 2020, we mainly included people who had survived a severe course of COVID,” she says. “It was more men. Then that changed. We now treat about two-thirds of women.”
What is the difference between women and men?
That women are more likely to get Lung COVID than men is not only apparent from experience from clinical practice, but also from dozens of smaller and larger studies. However, it is still unclear how much more often they get sick. According to a recent WHO estimate, women are twice as likely as men to get lung COVID.
According to a review article published in June in the journal Current Medical Research and Opinion, sponsored by the pharmaceutical company Johnson & Johnson, women are “only” 1.22 times more likely to be affected by lung COVID than men — 55 out of 100 people. who still have symptoms more than four weeks after their COVID-19 infection are women.
- What do Long COVID and Post COVID mean? Even more than two years after the first cases appeared, the term “Long COVID” is not always used consistently. Symptoms that appear or persist for more than four weeks after COVID infection are usually referred to as prolonged COVID, and symptoms beyond 12 weeks are referred to as post-COVID. So Lung COVID is the broader term – any Post-COVID case is also a Lung COVID case, but not the other way around.
Fatigue doesn’t improve even with rest: women are twice as likely to be affected as men
The sex differences were especially large when it came to ENT symptoms such as loss of smell or taste, rheumatological problems such as joint pain and fatigue, ie extreme exhaustion and weakness that does not improve with rest.
These symptoms were more than twice as common in women as in men. Digestive problems, skin problems, and psychiatric and neurological symptoms were also more common in women; In contrast, kidney problems and endocrine problems such as diabetes were more common in men.
A large study published in “Nature Medicine” in July finds a larger sex difference. Researchers evaluated the data of 486,000 people from a British database who had been infected with SARS-CoV-2 at least 12 weeks earlier and compared it with the data of 1.94 million people without a confirmed corona infection.
Only people whose acute infection did not require hospital treatment were considered. According to the study, among them, women are more than one and a half times more likely to get lung COVID than men. If factors such as previous illnesses are not taken into account, people between the ages of 18 and 30 also had a higher risk than the elderly. Ethnic minorities and socio-economically disadvantaged people in particular will suffer in the long term from the consequences.
Where do the gender differences come from?
Presumably the differences have something to do with the fact that women have a more active immune system than men. Estrogen enhances the function of immune cells, while testosterone reduces them. In addition, many genes relevant to the immune response are located on the X chromosome and are therefore transcribed to a greater extent in females than males.
Like COVID-19, therefore, many other infectious diseases in men and boys are on average more serious than in women and girls – for example, tuberculosis or infections with the RS virus, which can cause serious respiratory diseases in small children.
The flip side: Women are more likely to be affected by autoimmune diseases, ie diseases in which the immune system attacks its own body. So is ME/CFS, a neuroimmune disease known since the 1960s but poorly researched, which usually occurs as a result of viral infections and can also lead to severe long-term COVID-19 illness.
Four possible causes of long-term COVID
The causes of Lung COVID are still not fully understood. There are multiple explanations and researchers assume that Lung COVID is not a single disease, but that SARS-CoV-2 can leave long-lasting traces in the body in different ways. This would explain why different long-term COVID patients experience such different symptoms and disease course.
Marcus Altfeld is director of the Institute of Immunology at University Hospital Hamburg-Eppendorf and, together with his colleague Hanna Lotter, heads the research group “Gender-Specific Differences in Immune Responses”, funded by the German Research Foundation (DFG). For him, there are four plausible models, each of which could explain some of the long-term COVID cases:
- Parts of the virus remain in the body after the acute infection has cleared and continue to do damage.
- Damage to tissue caused during the infection, such as in the heart muscle or in certain parts of the brain, leads to persistent symptoms.
- The immune system cannot handle the virus, overreacting and producing autoantibodies that target cells in the body.
- The viral infection changes the microbiome, ie the composition of the billions of bacteria that colonize our bodies, especially our gut, and that also affect the function of our immune system.
The last two points are especially interesting if you want to understand the gender differences in Lung COVID, says Marcus Altfeld. Once science understands the mechanisms behind Lung COVID and can clearly distinguish the different forms, “it may turn out that autoimmune-derived forms of Lung COVID have a much greater gender difference than is commonly seen now.” Altfeld says. “Late effects of tissue damage, on the other hand, may be more common in men than women.”
It is therefore important that researchers with large test groups conduct further research and look for biomarkers, for example certain blood values, that can be used to distinguish and treat the different forms of long-term COVID from each other.
Social factor: women are not taken seriously when they have complaints
In addition to biological factors, social factors may also play a role in the fact that women are more likely to fail to recover from a SARS-CoV-2 infection, says rehabilitation chief Jördis Frommhold, who has just opened her own institute for long-term COVID in Rostock. . She thinks of two points:
- First, there is only one method known so far for people suffering from COVID-19 to reduce their long-term COVID risk: “It is important to really rest during the illness and then slowly return to daily life and allow rest periods,” says Frommhold. “I think that’s harder for women with small children than it is for other groups.” This factor may also explain the increased long-term COVID risk of ethnic minorities and socioeconomically disadvantaged people, who often work in precarious conditions, found in the “Nature Medicine” study.
- Second, Frommhold noted a phenomenon that many women know from personal experience and that has also been proven by a number of studies: women (but also other marginalized groups) are taken less seriously when they report pain or other symptoms of disease. Doctors like to first look for the cause of their complaints in the psyche or even assume that those affected are only imagining it. The problem is especially great in diseases that – such as Lung COVID and ME/CFS – are not immediately recognizable in MRI or blood counts. As women struggle to get anyone to believe their condition, precious time passes that can be treated, or at least slow its progress.
And what about intersex, trans and non-binary people? Unfortunately, most medical studies ignore the existence of people outside of the gender binary — including those mentioned here. With regard to the biological mechanisms leading to long-term COVID, hormone levels and the chromosome set are likely to be particularly relevant to the long-term COVID risk of queer people.
In terms of social factors, people who care for young children or find it difficult to slow down are particularly at risk – and being read as male by health professionals will likely be easier to be taken seriously and quickly to a diagnosis.
The problem is especially pronounced in younger women, says Frommhold: “We had a 24-year-old student here who was perfectly healthy before her infection, sports, everything was fine. After the infection she had enormous concentration problems, studying was no longer an option Her GP didn’t take her seriously. She then went to a pulmonary COVID outpatient clinic on her own initiative, but even then she was told: ‘Your readings are all normal, you have nothing.’ She was diagnosed with a post-traumatic stress disorder, although she said she felt mentally stable.” Frommhold says there is a need for more education and awareness among the medical profession here.
According to Frommhold, he has now treated more than 5,500 long-term COVID patients. She says she regularly hears stories like that of women’s college students. “I don’t recall a male patient ever telling me that his primary care physician classified his illness as psychosomatic.”
- WHO website: At least 17 million people in the WHO European region have had long-term COVID in the first two years of the pandemic; millions may have to live with it for years to come
- Taylor & Francis Online: Gender Differences in Consequences of COVID-19 Infection and Long-Term COVID Syndrome: A Review
- Naturopathy: symptoms and risk factors for long-term COVID in non-hospitalized adults
- Medical Journal: Funding for Research on Gender-Specific Influences on Immune Disease
There were already indications that the blood group influences the risk of corona infection and the course of COVID. Now a recent study shows how blood types can influence the course of COVID-19.