The female burden of the long covid

“I can’t even take my son to school 200 meters from our house. I can cook my own meal but then I no longer have the strength to eat it… ”Since she contracted covid in November 2020, Sabine has seen her life upset. She was active then in her thirties, the virus caused her to lose all her strength, forces that she still cannot recover today. In addition to her intense fatigue, she has difficulty concentrating and remembering, shortness of breath and a feeling of difficulty in breathing. Like 10-25% of people who contract Covid-19, Sabine suffers from long covid, a now generic term to indicate the persistence of one or more symptoms three weeks or more after the initial infection.

Among these suffering people, the 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 female sex is a risk factor for the development of persistent symptoms following a Covid infection. . -19 Women would be nearly twice as likely to have a long covid than men.

Read also: In Switzerland, one in five infected people would be affected by covid for a long time

Faced with these figures, it would be quick to stick to purely sociological explanations regarding women and their health, summarized here by Claudine Burton-Jeangros, health sociologist at the University of Geneva: “The relationship with health is not the same in men and in women. Women are more attentive to their bodily feelings and their symptoms. They consult more, they seem more legitimate to report their complaints, while men tend to listen to each other less.

But for Mayssam Nehme this explanation is not sufficient to understand the greater prevalence of long 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 among men. and the women in front of the long covid. There are really physiological factors in this ”.

Different immune functioning

Therefore, it is precisely on the side of medicine that we must go to understand the gender differences in the face of the long covid. While the causes of this long-lasting bundle of symptoms are still unknown, several hypotheses are emerging, most notably that of different immune functioning in women and men. Mayssam Nehme explains: “Female sex as a risk factor is found in autoimmune diseases. This could alert us to the fact that the long covid could be linked to a deregulated immune reaction, the cause of which we do not yet fully understand. Thus, the immune response to SARS-CoV-2 infection may vary between men and women, and women appear to have a longer immune response duration.

Moreover, as the Genevan doctor explains: “Women seem, in general, more prone to the chronicization of symptoms as well as to so-called” functional “diseases, of which all the mechanisms are not yet known”.

Are hormonal factors involved? It is possible, as Milo Puhan, epidemiologist at the University of Zurich explains: “Sex hormones can also play a role, but we still don’t know how. It is the lack of gender difference in the long covid in children, where sex hormones play a minimal role, that leads us to this hypothesis.

Contamination medium in question?

If we cross sociology and medicine, another presupposition can be advanced: that of the contaminated environment exposed to a more or less important infectious viral dose that we know to be decisive in the chronicization of the initial symptoms. Statistically, women occupy more positions at high risk of massive contamination: teacher, cashier, waitress… But be careful here too: “It is possible that, through their profession, women with covid have long been exposed to more important viral infectious doses. We don’t have any supporting evidence yet and this hypothesis should be tested, ”says Mayssam Nehme.

Some doctors will be more careful while others will tend to reduce everything to psychosomatics and put complaints into perspective.

As for the symptoms and their variability according to sex, today there is no consensus. According to Mayssam Nehme: “There are no real differences between the symptoms reported by women and men with long covid at the HUG consultation. Women may be more likely to report anxiety, but this is potentially because they know it’s more socially accepted. And, if men report more wheezing or wheezing, it is because they are more at risk for severe forms in the acute phase of the disease.

For its part, a team of Italian researchers estimates, in a recently published article, that women experience fatigue that tends to worsen over time, while it is more constant in men. They would also be more prone to dyspnea and chest pain. Among other hypotheses, the Italian team advances that of a different perception of pain in women. But Milo Puhan is cautious: “Studies like these are not representative of all those who have been affected by covid for a long time and I would be cautious in interpreting the results.”

Possible lack of recognition

If, in physiopathological terms, the long female covid still retains its secrets, in social and public health terms, its consequences are now well defined. On an individual level, in the first place. “The question arises of the answers that the medical profession will provide to the symptoms of long covid in women. Some doctors will be more careful when others, when faced with a patient, will tend to bring everything back to psychosomatics and put the disorders into perspective, “explains Claudine Burton-Jeangros.

Read also: The long covid can also affect children

Mayssam Nehme agrees: “This gender difference in the face of the long covid exposes women to the risk of not recognizing their symptoms.” This in particular can pose real problems during medical assessments for AI, which is now open to people with covid for some time. AI registrations where women are more numerous, as Natalie Rangelov, project manager of Altea-Long Covid Network tells us: “In 2021 in Switzerland, 967 women and 810 men with covid have been enrolled in AI for some time. Since the beginning of 2022 there have been 273 women and 197 men.

By generating sick leave and working time agreements, gender inequalities in the face of long-term covid are likely to increase inequalities between men and women. “Overall, women are more precarious and less professionally integrated, inequalities are likely to increase,” sums up Claudine Burton-Jeangros. To overcome these inequalities, research advances promise to be crucial, both for providing relief to patients and for improving understanding of the disease through the prism of gender.

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