A new study by Western researchers has drawn a link between a higher body mass index (BMI) in women and the likelihood of contracting the Long COVID, but didn't find the same link in men. The impact of COVID-19 is still being felt around the world. In Europe, more than 60% of people affected by the virus experience persistent, often severe symptoms months after the acute infection has cleared, a condition known as “long COVID”.
Now, research conducted by Dr. Sarah Cuschieri with Dr. Saverio Stranges and Piotr Wilk indicates that there is a greater likelihood of women suffering from long-term COVID, and women at the higher end of the BMI spectrum are more likely to have these symptoms . Researchers from the Department of Epidemiology and Biostatistics at the Schulich School of Medicine & Dentistry analyzed data collected from surveys of middle-aged and older adults in 27 countries across Europe.
The document was recently published in the International Journal of Obesity.
Long Covid: why does it affect women more?
Covid-19 was a pandemic that affected all countries. Early on, it became clear that some of the individuals infected with COVID-19 were reporting delayed symptoms months after the acute infection had abated.
A substantial portion of the world's population falls into the obese category with a body mass index greater than or equal to 30 kg per square meter. These individuals are known to be susceptible to worse outcomes from COVID-19 infection. Therefore, our research aimed to find out whether these individuals were also more susceptible to long COVID and whether there was a difference between the sexes.
The project involved access to the SHARE database, a transnational survey based in Europe targeting the adult population aged 50 and above. These studies have been repeated for several years, including during the pandemic. Through collaborative work and analyses, we identified those who reported long COVID symptoms and linked them to their body mass index and gender.
Women were more likely than men to suffer from long COVID regardless of their BMI status. It appears that men on the higher BMI spectrum actually had a lower risk of getting long-term COVID than those with a lower BMI. It is important to understand that there may be other factors that influence this relationship and one cannot omit the fact that a high BMI predisposes individuals to develop other chronic diseases.
Understanding who is most susceptible to long-term COVID, including sex differences, allows healthcare providers and policymakers to establish a preventative care pathway and treatment plans targeting at-risk individuals with an expected better individual outcome. The study also highlights the importance of sex differences in assessing the potential long-term consequences of long COVID.
We are currently planning to continue exploring long COVID susceptibility in different countries and health states.
While there is a growing body of research on the long-term effects of COVID in the general adult population, little research has been conducted on the long-term impacts on those who contract long COVID during pregnancy.
In a new study to be presented today at the Society for Maternal-Fetal Medicine (SMFM) annual meeting, The Pregnancy Meeting, researchers will reveal findings that suggest that about 1 in 10 people who have COVID during pregnancy will develop long COVID.
The abstract was published in the American Journal of Obstetrics and Gynecology.
Researchers followed a group of individuals from 46 states plus Washington, D.C., who contracted COVID during pregnancy to see whether they developed long COVID and, if so, what factors put people at greater risk. The pregnancy cohort is part of a larger study, the NIH RECOVER initiative, which aims to learn more about the long-term effects of COVID in adults and children.
Of the 1,503 people in the pregnancy cohort, just over half (51%) were fully vaccinated before contracting COVID; and the average age at the time of infection was approximately 32 years. The study looked at a person's pre-existing conditions, socioeconomic status and the severity of COVID during pregnancy.
The researchers found that 9.3% of pregnant women developed long COVID when assessed six months or more after the initial infection. The most common symptoms people reported included feeling tired after even minimal physical or mental activity, also known as post-exertional malaise, fatigue, and dizziness.
The researchers also found that pregnant people who were obese or suffered from chronic depression or anxiety, as well as those who reported having trouble paying their bills, were all at greater risk of developing long-term COVID. People who had a more severe case of COVID and who required oxygen during pregnancy also had a higher risk of developing long COVID.
“The key takeaway for doctors caring for pregnant patients is that nearly 1 in 10 people who contracted COVID during pregnancy still have persistent symptoms six months later,” says study lead author Torri D. Metz, MD, MS, -fetal medicine specialist and associate professor of obstetrics and gynecology at University of Utah Health in Salt Lake City.
“The trimester of infection was not associated with the development of long COVID, so it did not seem to matter when during pregnancy people were infected.”
The researchers also compared their findings with those of the larger NIH RECOVER-Adult cohort, which includes non-pregnant people, and found that the rate of long COVID appeared to be lower in pregnant people than in non-pregnant adults. “This could be due to a number of reasons that are worth investigating in the future,” notes Metz.
An important next step that is already underway, the researchers say, is to examine the outcomes of newborns of pregnant women who developed long-term COVID.
A team of researchers at UC San Francisco found that Paxlovid (Nirmatrelvir-ritonavir) did not reduce the risk of developing long COVID for vaccinated, non-hospitalized individuals during their first COVID-19 infection. They also found a higher proportion of individuals with rebound of acute symptoms and positive tests than previously reported.
Paxlovid treatment for the acute phase of COVID-19 has been shown to be effective for high-risk unvaccinated individuals. But the treatment's effect on long-term COVID risk, including whether it protects vaccinated people from getting COVID long-term, has been less clear.
The research team selected a group of people vaccinated from the UCSF COVID-19 Citizen Science study who had reported their first positive test for COVID-19 between March and August 2022 and who had not been hospitalized.
Some of these participants reported taking oral Paxlovid treatment during the acute phase of COVID-19 infection, while others did not. In December 2022, they were invited to respond to a follow-up survey with questions about long COVID, rebound COVID symptoms, and how long they continued to test positive.
The researchers found that the two groups were similar. About 16% of subjects treated with Paxlovid had long-term COVID symptoms compared to 14% of those who were not treated with the drug. Commonly reported symptoms included fatigue, shortness of breath, confusion, headache, and changes in taste and smell.
Those who took Paxlovid and then developed long COVID reported as many long COVID symptoms as those who were not treated with Paxlovid. A small percentage of people developed severe long-term COVID, and those who received Paxlovid were as likely to have severe long-term COVID symptoms as those who did not receive it.
Among individuals who experienced symptomatic improvement during treatment with Paxlovid, 21% reported rebound symptoms. And among those with rebound symptoms, 10.8% reported one or more long COVID symptoms compared to 8.3% without rebound symptoms. Among participants who repeated antigen testing after testing negative and completing treatment, 25.7% reported positive rebound testing. In total, 26.1% reported rebound symptoms or positive tests.
“We found a higher rate of clinical rebound than previously reported, but did not identify an effect of post-treatment rebound on long-term COVID symptoms,” said study first author Matthew Durstenfeld, MD, MAS, cardiologist and assistant professor of medicine at UCSF.
“Our finding that treatment with Paxlovid during acute infection is not associated with lower odds of long COVID surprised us, but is consistent with two other rigorously conducted studies that found no differences in post-COVID conditions between 4 and 6 months after infection.”
The authors note that the study may have been affected by limitations stemming from its observational nature, as researchers rely on patients' self-reporting of long-term COVID treatment and symptoms.
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