Why Women Are 3x More Likely To Get Severe Long COVID

Long COVID is no picnic. See for example:

How To Triple Your Chances Of Getting The “Razorblade Throat” COVID Variant Or Long COVID

And for that matter, here’s an interesting guest article:

Can you die from long COVID? The answer is not so simple

Actually, the answer is quite simple:

• In practical terms, it’s “yes”.
• In pedantic terms, it’s much like how technically nobody dies of AIDS (one gets AIDS, one’s immune system flatlines, and then one dies of pneumonia, or flu, or a cold, or something like that).
  • So, on the books, people aren’t directly dying of long COVID, they’re dying of other things because they have long COVID which has compromised their ability to deal with the other things.

See also: falling doesn’t kill anyone!

What kills people is other events that transpire after falling (i.e., starting from when you stop falling).

So, onto the main topic…

Hormones & your gut

Researchers (Dr. Shima Shahbaz et al.) investigated why women seem to be much more likely to get severe long COVID, compared to men.

Specifically, women are 3x more likely than men to develop severe long COVID, particularly forms resembling chronic fatigue syndrome, despite often having only mild initial infections.

They analysed blood and genetic data from 78 long COVID patients (one year post-infection) and 62 controls without long COVID, and found that women with long COVID showed a distinct immune signature marked by heightened inflammation and gut permeability markers, namely:

• intestinal fatty acid binding protein
• lipopolysaccharide
• soluble CD14 (a particular kind of protein)

…all of which point to intestinal permeability (“leaky gut”) and systemic inflammation.

Notably, the female patients’ intestines were more prone to viral invasion during acute infection, allowing inflammatory molecules to circulate and sustain long-term immune activation.

This seems to have a hormonal basis. Generally speaking, sex hormones modulate immune function, often having pros and cons, and these factors are at least partially (sometimes entirely) responsible for why, as a general rule of thumb, many diseases affect men and women differently

See for example: Testosterone and estradiol reduce inflammation of human macrophages induced by anti-SARS-CoV-2 IgG

In the study cohort, women with long COVID had reduced testosterone, while men with long COVID had reduced estrogen; both had low cortisol. While normally not a problem, these shifts may have circumstantially impaired immune regulation and stress responses.

These findings overlap with myalgic encephalomyelitis/chronic fatigue syndrome, which also predominantly affects women.

To read the paper in full, see: Integrated immune, hormonal, and transcriptomic profiling reveals sex-specific dysregulation in long COVID patients with ME/CFS

We explored this connection previously, here: How To Be 7.5x More Likely To Develop Chronic Fatigue Syndrome

Already have long COVID?

Well, that sucks. You have our condolences. There has been some progress on treating this, though not as much as we’d like to see.

One of our earlier articles about it, for example: Support For Long COVID & Chronic Fatigue

And more recently: What Can Be Done About Long COVID? ← includes explanation about a potential treatment that has shown a lot of promise in trials so far

Take care!