Men of the COVID risk group? Yes, but the danger is greater in women

  • Does a corona infection affect the sexes differently? The answer is yes.
  • Men are more likely to die, but women suffer longer. Experts see not only biological reasons for this.
  • The social factors are alarming. One of them: women are taken less seriously.

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Is COVID-19 More Dangerous for Older Men? This is true when it comes to the severity of acute illness and the risk of death. But if you look at the long-term consequences of a COVID infection, things look very different – then the risk group is young and female.

Jördis Frommhold is head of the respiratory disease department of a rehabilitation clinic in Heiligendamm and recently published a book on Long COVID. “In the spring and summer of 2020, we mainly welcomed people who had survived a severe course of COVID,” he says. “It was more men. Then it changed. Now we treat about two thirds of women.”

How big is the difference between women and men?

The fact that women are more likely to develop long COVID than men is evidenced not only by the experience of clinical practice, but also by dozens of increasingly smaller studies. However, it is still unclear how much more frequently they get sick. According to a recent WHO estimate, women are twice as likely as men to contract Long COVID.

However, 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 Long COVID than men – 55 on 100 people who still suffer from symptoms more than four weeks after COVID-19 infection are women.

  • What do long COVID and Post COVID mean? Even more than two years after the appearance of the first cases, the term “long Covid” is not always used consistently. Symptoms that appear or persist for more than four weeks after COVID infection are generally referred to as long COVID and symptoms after more than twelve weeks are referred to as post COVID. I know Long COVID is the broader term: every Post-COVID case is also a Long-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

Gender differences were particularly large when it came to ENT symptoms such as loss of smell or taste, rheumatological problems such as joint pain and fatigue, i.e. extreme exhaustion and weakness that do not improve with rest.

These symptoms affected women more than twice as much as men. Digestive problems, skin problems, and psychiatric and neurological symptoms were also more common in women; Kidney problems and endocrine problems such as diabetes, on the other hand, were more common in men.

A large study published in “Nature Medicine” in July comes to a greater gender difference. The researchers evaluated data from 486,000 people from a UK database who had been infected with SARS-CoV-2 at least twelve weeks earlier and compared it to data from 1.94 million people without a confirmed corona infection.

Only people whose acute infection did not require hospital care were considered. According to the study, women among them contract Long COVID one and a half times more often than men. When factors such as previous illnesses are taken into account, people between the ages of 18 and 30 also had a higher risk than older people. Ethnic minorities and socio-economically disadvantaged people are particularly likely to experience long-term effects.

Where do gender differences come from?

Presumably the differences have something to do with the fact that women have more active immune systems than men. Estrogen strengthens the function of immune cells, while testosterone reduces them. Furthermore, many genes relevant to the immune response are found on the X chromosome and are therefore transcribed to a greater extent in women than in men.

Like COVID-19, many other infectious diseases are therefore on average more severe in men and boys than women and girls, such as tuberculosis or RS virus infections, which can cause severe respiratory disease in young children.

The downside: women are more likely to be affected by autoimmune diseases, i.e. diseases in which the immune system attacks their own body. This also applies to ME / CFS, a neuroimmunological disease known since the 1960s but little studied, which usually occurs as a result of viral infections and which can also develop serious long-term COVID-19 diseases.

Four possible causes of the long-standing COVID

The causes of Long COVID are still not entirely clear. There are several explanations, and researchers assume that Long COVID is not a single disease, but that SARS-CoV-2 can leave long-term traces in the body in various ways. This would explain why different patients with long COVID experience such different symptoms and disease course.

Marcus Altfeld is Director of the Institute of Immunology at the Hamburg-Eppendorf University Hospital 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-time cases of COVID:

  • Parts of the virus remain in the body after the acute infection subsides and continue to cause damage.
  • Tissue damage caused during infection, such as in the heart muscle or certain areas of the brain, leads to persistent symptoms.
  • The immune system is unable to cope with the virus, overreacts and produces autoantibodies directed against the body’s cells.
  • Viral infection changes the microbiome, that is the composition of the billions of bacteria that colonize our body and especially our intestine and which also affect the function of our immune system.

The last two points in particular are interesting if you want to understand the gender differences in Long COVID, says Marcus Altfeld. Once science understands the mechanisms behind Long COVID and is able to clearly distinguish the different forms, “it may turn out that autoimmune forms of Long COVID have a much wider gender difference than is now seen in the complex, “says Altfeld. “The late effects of tissue damage, on the other hand, are perhaps more common in men than in women.”

It is therefore important that researchers carry out further studies with large test groups and look for biomarkers, such as certain blood values, which can be used to distinguish between the various forms of long COVID and treat them in a targeted manner.

Social factor: Women are not taken seriously when they complain

In addition to biological factors, social factors could also play a role in women more often not recovering from a SARS-CoV-2 infection, says rehabilitation chief Jördis Frommhold, who has just opened his institute for long time COVID in Rostock. You think of two points:

  • First, there is only one method known to date for people with COVID-19 to reduce the long-standing risk of COVID-19: “It’s important to really rest during illness and then slowly return to everyday life and allow rest periods, “says Frommhold. “I think it’s more difficult for women with young children than for other groups.” This factor may also explain the increased long-term COVID risk of ethnic minorities and socio-economically disadvantaged people, who often work in precarious conditions, found in the “Nature Medicine” study.
  • Secondly, Frommhold observed a phenomenon that many women know from personal experience and which has also been shown by numerous studies: women (but also other marginalized groups) are taken less seriously when they report pain or other symptoms of illness. Doctors like to first look for the cause of their symptoms in the psyche or even assume that those affected are just imagining it. The problem is particularly serious in the case of diseases that – such as Long COVID and ME / CFS – are not immediately recognizable on MRI or CBC. As women struggle to get someone to believe their condition, precious time goes by that could be cured, or at least slow its progression.

And what about intersex, trans and non-binary people? Unfortunately, most medical practices ignore the existence of people outside the gender binary, including those mentioned here. As for the biological mechanisms that lead to long COVID, hormone levels and chromosome set are likely to be particularly relevant to queer people ‘long COVID risk.

In terms of social factors, people who care for young children or who otherwise have a hard time slowing down may be particularly at risk – and it is likely that being read as a boy by health professionals will make it easier to be taken seriously and quickly to get. a diagnosis.

The problem is particularly pronounced in younger women, says Frommhold: “We had a 24-year-old female student here who was perfectly healthy before the infection, sports, everything was fine. After the infection, she had huge problems concentrating, studying was not as long as possible, but she Her family doctor did not take it seriously, then she went on her own initiative to a COVID clinic for some time, but already then she was told: ‘Your values ​​are all normal, you have nothing. ‘She was diagnosed with post-traumatic stress disorder, although she said she felt mentally stable.’ Frommhold says more education and awareness among the medical profession is needed here.

According to Frommhold, he has now treated more than 5,500 patients with long-term COVID. She says that she regularly listens to stories like that of students from women. “I can’t remember a male patient once telling me that his family doctor classified his illness as psychosomatic.”

Sources used:

  • WHO website: At least 17 million people in the WHO European region have long experienced 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 Sequelae of COVID-19 Infection and Longstanding COVID Syndrome: A Review
  • Nature’s Medicine: Symptoms and Risk Factors for Long COVID in Non-hospitalized Adults
  • Medical Journal: Funding for Research on Gender-Specific Influences on Immune Diseases
This post comes from the RiffReporter journalism portal. On riffreporter.de, around 100 independent journalists report current affairs and background information together. RiffReporters received the Grimme Online Award for their offering.


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