Study finds females are more prone to long Covid

LONG Covid is a persistent state of ill health that continues for more than three months after Covid-19 infection. Patients with long Covid have reported experiencing different combinations of symptoms such as fatigue, shortness of breath, coughing, anxiety, cognitive impairment or brain fog, and muscle pain, which become worse after physical activities.

These symptoms could be driven by a direct effect of virus infection and might be explained by several hypotheses, including abnormal immune response, hyper activation of the immune system, or autoimmunity. Additionally, indirect effects such as reduced social contact, loneliness, incomplete recovery of physical health, and loss of employment could affect psychiatric symptoms.

The Covid-19 Long-term Effects And Recovery (CLEAR) study team from Universiti Malaya, which conducted an online survey among Covid-19 survivors in the community from July to September 2021 during the nationwide movement control order (MCO) period, found that one in five of the 732 respondents experienced long Covid.

Females were found to have 58% higher odds of experiencing long Covid compared to males.

According to the autoimmune hypothesis, females have a stronger immune response than males due to genetic and hormonal factors. This contributes to a more active immune response where activation of white blood cells and production of inflammatory markers and antibodies are stronger than males. But this could be a double-edged sword because, while it appears to prevent severe symptoms and deaths from Covid-19, it brings about the emergence of autoimmune inflammatory symptoms in long Covid.

Patients with moderate and severe levels of acute Covid-19 had three to 3.6 times odds for long Covid compared to those without symptoms. A point to note here is that those without symptoms or with mild symptoms also reported experiencing long Covid (10% and 17.5% respectively) compared to those in the moderate (26.7%) and severe (30.4%) categories.

This may be explained by the immune response to the SARS-CoV-2 virus, which stimulates the production of cytokines and other inflammatory mediators with higher concentrations found in those with a more severe Covid-19 condition. The multi-systemic inflammatory response to the virus may also be responsible for persistent Covid-19 symptoms in survivors.

To avoid long Covid, we must avoid Covid-19 infection. We should get fully vaccinated and continue to practise measures such as mask-wearing and physical distancing.

PROF DR MOY FOONG MING

Department of Social & Preventive Medicine

Faculty of Medicine

Universiti Malaya