A meta-analysis by Johnson & Johnson’s, including data from some 1.3 million patients, has revealed that females are significantly more likely to suffer from long-COVID than males, and may experience substantially different symptoms.

The findings, published June 21st in the peer-reviewed journal Current Medical Research and Opinion, showed that the chance of females developing long-COVID, where complications persisted more than four weeks after initial infection, was 22% higher than males. 

The researchers, from the Chief Medical Officer’s Health of Women Team, also observed that female patients with long-COVID were far more likely to experience mood disorders such as depression; ear, nose, and throat symptoms; musculoskeletal pain, and respiratory symptoms.  

Male patients, however, were more likely to experience endocrine disorders, such as diabetes and kidney problems, during the early onset of the disease. 

Lead author, Shirley Sylvester, said the theory that long-COVID syndrome could be related to elevated autoantibodies, in response to initial infection, offered a potential explanation for why it appeared to be more common in female patients. 

“Differences in immune system function between females and males could be an important driver of sex differences in long-COVID syndrome,” Ms Sylvester said. 

“Females mount more rapid and robust innate and adaptive immune responses, which can protect them from initial infection and severity, however, this same difference can render females more vulnerable to prolonged autoimmune-related diseases.” 

These include neurological, skin, gastrointestinal and rheumatological disorders, as well as fatigue. 

The study pointed out that as gender-based differences in outcomes were reported during previous coronavirus outbreaks, similar differences in outcomes for people infected with COVID could have been anticipated.  

“Plenty of studies have examined sex differences in hospitalization, ICU admission, ventilation support, and mortality, but the research on the specific conditions that are caused by the virus, and its long-term damage to the body, have been understudied,” the researchers said. 

“Unfortunately, most studies did not evaluate or report granular data by sex, which limited sex-specific clinical insights that may be impacting treatment – there may be disparities in access to care based on gender that could affect the natural history of the disease, leading to more complications and sequela.” 

“Knowledge about fundamental sex differences – underpinning the clinical manifestations, disease progression, and health outcomes of COVID – is crucial for the identification and rational design of effective therapies and public health interventions that are inclusive of, and sensitive to, the potential differential treatment needs of both sexes.” 

During their search of academic papers, published between December 2019–August 2020 for COVID and to January 2020–June 2021 for long-COVID, only 35 of the 640,634 articles provided sex disaggregated data, in sufficient detail to understand how females and males experience the disease differently.