“I can’t even take my son to school 200 meters from our house. I manage to cook my meal, but then I no longer have the strength to eat it…” Since she got covid in November 2020, Sabine saw her life turned upside down. When she was active in her thirties, the virus caused her to lose all her strength, a strength she still cannot recover today. In addition to intense fatigue, she has difficulty concentrating and remembering, shortness of breath and difficulty breathing. Like 10 to 25% of people who contract Covid-19, Sabine suffers from long-term covid, a now generic term for the persistence of one or more symptoms for three weeks or more after initial infection.
Among these suffering people are a majority of women. Mayssam Nehme, Head of Clinic at the Primary Care Medicine Service of the University Hospitals of Geneva (HUG), explains: “We find in many studies that the female gender is a risk factor for developing persistent symptoms after Covid infection. .-19 Women are almost twice as likely to have a long-term covid as men.
Faced with these numbers, I would be quick to stick to purely sociological explanations about women and their health, summarized here by Claudine Burton-Jeangros, a health sociologist at the University of Geneva: “The relationship with health is not the same in men and women. Women pay more attention on their physical feelings and their symptoms.They consult more, seem more legitimate to report their complaints, while men tend to listen to each other less.
But for Mayssam Nehme, this statement is not enough to understand the greater prevalence of long-term covid in women than in men: “Of course women are more likely to consult and participate in research, but this consultation bias does not explain the inequality between men and women. women in the face of long covid. This really has physiological factors.”
Different immune functions
So it is indeed on the side of medicine that we need to understand the gender differences in the light of the long covid. Even though the causes of this bundle of persistent symptoms are still unknown, several hypotheses arise, most notably that of a different immune system in women and in men. Mayssam Nehme explains: “Female gender as a risk factor is found in autoimmune diseases. This may indicate to us that the long-term covid may be associated with a dysregulated immune response, the cause of which we do not yet fully understand. Thus, the immune response to SARS-CoV-2 infection can vary between males and females, with the latter also appearing to have a longer immune response.
Moreover, as the doctor of Geneva explains, “Women generally seem more prone to chronic symptoms and to so-called ‘functional’ diseases, the mechanisms of which we do not yet understand.”
Are there hormonal factors at play? It is possible, as Milo Puhan, epidemiologist at the University of Zurich, explains: “Sex hormones may also play a role, but we don’t know how yet. It is the lack of gender difference in long-term covid in children, where sex hormones play a minimal role, that leads us to this hypothesis.
Contaminant in question?
If we cross sociology and medicine, another assumption can be advanced: that of the environment of contamination being exposed to a more or less important infectious viral dose that we know can be decisive in making the first symptoms chronic. . Statistically, women occupy more positions with a high risk of mass contamination: teacher, cashier, waitress… But again caution: “It is possible that women with long-term covid have been exposed through their occupation to infectious viral doses that are more important. We have no supporting evidence yet and this hypothesis needs to be tested,” Mayssam Nehme weighs.
Some doctors will be more observant, while others tend to reduce everything to psychosomatics and put complaints into perspective.
As for the symptoms and their variability according to gender, there is no consensus today. According to Mayssam Nehme: “There are no real differences between the symptoms reported by women and men with long-term covid at the HUG consultation. Women may be more likely to report anxiety, but that’s possible because they know it’s more socially accepted. And if men report more shortness of breath or dyspnea, it is because they are more at risk of severe forms in the acute phase of the disease.
For its part, a team of Italian researchers estimate in a recently published paper that women experience fatigue that tends to worsen over time, while in men it is more constant. They would also be more prone to shortness of breath and chest pain. Among other hypotheses, the Italian team proposes that of a different perception of pain in women. But Milo Puhan is cautious: “Studies like this are far from representative of everyone affected by covid and I would be careful in interpreting the results.”
Possible lack of recognition
If, in physiopathological terms, the long female covid still keeps its secrets, in social and public health terms, its consequences are now well defined. First on an individual level. “The question arises as to what answers the medical profession will provide to the symptoms of long-term covid in women. Some doctors will be more observant, while others, when confronted with a patient, tend to reduce everything to psychosomatics and put complaints into perspective,” explains Claudine Burton-Jeangros.
Mayssam Nehme agrees: “This gender difference in the face of long-term covid exposes women to a risk of lack of recognition of their symptoms.” This could pose particular problems in medical assessments with a view to getting AI, now open to those suffering from long-term covid. AI registrations where women are in greater numbers, as Natalie Rangelov, project manager of Altea-Long Covid Network tells us: “By 2021 in Switzerland, 967 women and 810 men suffering from covid have long registered with the AI. As of early 2022, there are 273 women and 197 men.
By generating sick leave and working time arrangements, gender inequality in the face of long-term covid is likely to widen inequalities between men and women. “In general, women are more insecure and less well-integrated into their professions, and inequalities are likely to increase,” Claudine Burton-Jeangros sums up. To overcome these inequalities, advances in research promise to be crucial, both to provide patients with relief and to improve understanding of the disease through the prism of gender.