Females Are More Likely to Have Long COVID. But We Need Data to Prove It

Early in the COVID-19 pandemic, researchers found that males are more likely to experience severe outcomes and death from COVID than people who are female.

However, the reasons for these differences, and how they work, are not yet fully understood. There are also questions about the role biological sex might play in post-acute sequelae of SARS-CoV-2 infection (PASC) or long COVID.

A study conducted in 2020 found that females have a higher risk of developing long COVID. A literature review published in Current Medical Research and Opinion in early 2022 reported the same finding.

Experts say that collecting and analyzing data from males and females separately (sex-disaggregated data) is crucial to ensuring that different courses in COVID outcomes are identified and addressed.

Is Long COVID Different for Men and Women?

Marc Sala, MD, a pulmonary and critical care specialist at Northwestern Medicine Comprehensive COVID-19 Center, told Verywell that researchers have been seeing these COVID differences for a while at recovery centers.

At Northwestern, Sala said they’ve observed that “there is a higher proportion of women than men being afflicted by persistent COVID-19 symptoms.”

The literature review authors also outlined how the clinical manifestations of long COVID tend to be different between male and female patients.

For example, male patients were more likely to experience renal disorders, but female patients were more likely to experience:

• Psychiatric conditions or mood disorders
• Ear, nose, and throat symptoms
• Respiratory symptoms
• Musculoskeletal pain

Do Researchers Have Any Hypotheses?

Biological factors likely play a role in the observed sex differences for long COVID patients, but they aren’t likely to be the only factors.

“Long COVID—or what it is now called PASC—is a complex group of disorders that do not have a single cause,” Sabra Klein, PhD, professor in the department of molecular microbiology and immunology at the Johns Hopkins Bloomberg School of Public Health, told Verywell. “How females are more likely to report symptoms and often have a greater number of symptoms is currently not known.”

According to Klein, there are a couple of sex-specific hypotheses when it comes to long COVID:

• Autoantibodies: Females make up nearly 80% of all autoimmune disease patients. Given this fact, researchers have one hypothesis relating to the autoantibodies generated during infection. Researchers think these autoantibodies could be associated with long COVID. The hypothesis centers on how infection drives the production of antibodies that target the body’s own tissues and organs (like what happens with an autoimmune disease).
• Immune response: The second hypothesis centers on persistent viral RNA in tissues caused by suboptimal immune responses to the virus. This would mean they’re not completely cleared from the body. However, Klein said that this hypothesis seems less feasible because females generally clear viruses better (or faster) than males.

Overall, Klein said these are still just hypotheses, and the exact reason for the differences has yet to be understood.

Sala added that “studies to find the causes, treatments, and preventative strategies for long COVID need to pay careful attention to enroll both men and women. It can help explain the biology of the illness as well as help personalize medical decisions.”

According to a study published in Social Science and Medicine in February 2022, socio-contextual factors such as gendered health behaviors, occupation, and location, also shape sex disparities in COVID risks and outcomes.

Why Do We Need Sex-Disaggregated Data?

According to the authors of the literature review, sex-disaggregated data analysis and reporting in medical research are lacking. We need more studies that include sex as an analytical variable.

Experts say that sex-disaggregated data is as important as knowing how age and obesity affect symptom manifestations and responsiveness to treatments, as well as how race and socioeconomic status are vital determinants of health.

Vincent Hsu, MD, executive director of infection control at AdventHealth Orlando, told Verywell that understanding specific populations where long COVID is more likely to occur gives insight on how to target appropriate resources and provide the best outcomes for the condition.

The use of sex-specific methodologies in research and clinical trials is expected to fill existing information gaps about how biological sex influences COVID illness and long COVID.

Klein added that “even if trials were not designed in advance to test hypotheses about sex differences, it is important to [break down] outcome data by sex—even if only in supplemental tables—because these data could prove useful for meta-analyses.”

According to Klein, sex differences are often “data hiding in plain sight, because most people do not disaggregate and compare results between the sexes.”

For example, the male-female differences in symptoms may give insights into the mechanisms of long COVID.

Do Sex Differences Affect COVID Vaccines?

COVID vaccine uptake, side effects, and effectiveness have all been linked to different risk factors, including sex and gender. Having sex-disaggregated data on vaccines is needed—but it’s out of researchers’ reach.

In a correspondence letter published in The Lancet in July, the authors pointed out that “of the 157 countries that reported on COVID-19 vaccine coverage to WHO in April 2022, only 21 (13%) provided sex-disaggregated data.”

The authors also emphasized that while the gaps in COVID data along the biological sex binary are worrisome, there are even larger health disparities within the wider gender and sexuality spectrum.

Persistent gaps in racial, ethnic, and socioeconomic data make the disparities even starker for many groups that are at the highest risk of getting COVID and potentially having long-term health effects.

Why Does Understanding COVID Sex Differences Matter?

Beyond getting a grasp on how biological sex might drive the disease process underlying COVID and what may come after, there are also other crucial missing pieces that sex-disaggregated data could help us address.

For example, we know that gender also plays a role in the diagnosis of diseases—especially chronic conditions. Research has shown that women are usually diagnosed with these conditions later than men.

Sala said that the availability of sex-disaggregated data is necessary for increasing recognition and reducing the stigma of long-term COVID outcomes in women.

“Women have historically been under-diagnosed and under-treated with nearly every domain of medicine, including heart disease,” said Sala. “Any efforts to prevent the worst-case scenario that a woman suffering from anxiety or depression after her COVID-19 is written off as ‘this is all in your head’ are worthwhile.” 

Hsu said that if you’re experiencing lasting COVID-19 symptoms, reach out to providers who have experience with managing patients who have long COVID. At the same time, Hsu warns patients to avoid clinics or individuals who tout “quick fixes” for COVID or its long-term effects.

“If you suspect you have long COVID, recognize that we are still in very early stages of being able to understand and manage this disease,” said Hsu. “There is no magic pill or therapy that can cure this. Recovering from long COVID can take significant time.”

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.