Across the first two years of a pandemic that spared no one entirely, a quieter inequality took shape: women were twice as likely as men to carry COVID's longest shadow. A landmark study from the University of Washington's Institute for Health Metrics and Evaluation has given this disparity its clearest form yet, finding that 63 percent of global long COVID cases fell upon women — a burden that deepened further for those whose illness was severe enough to require hospitalization. The findings invite both science and society to ask not only how long COVID endures, but why it endures so differen
Women twice as likely to develop long COVID, major study finds
Women face disproportionate long-term health impacts from COVID-19, preventing return to work or school and requiring ongoing medical rehabilitation services.
Women bore a disproportionate burden of this challenge—twice the rate of men
Mark
Why would women be twice as likely to develop long COVID? Is it biological, or something about how they were treated during the pandemic?
Mimi
The study doesn't answer that directly. It documents the disparity clearly—63 percent of cases were women—but the mechanism is still unclear. It could be immune response differences, it could be that women were more likely to be hospitalized with severe cases, or it could be something about how symptoms were reported or diagnosed. That's the next question.
Mark
The hospitalization gap you mentioned—that women who were hospitalized had dramatically higher risk than men—that's striking. Does that suggest the virus itself hit women harder?
Mimi
It suggests something did. Whether it's biological vulnerability, pre-existing conditions, or something about the severity of infection in women who needed hospitalization, we don't know from this study. But yes, that gap is the real puzzle.
Mark
What about the symptom clusters? Why would fatigue and cognitive problems show up together so often?
Mimi
Thirty-eight percent had overlapping symptoms. That's not random. It suggests long COVID isn't three separate conditions but one condition expressing itself in multiple ways in the same person. A woman managing all three at once—fatigue, breathing problems, brain fog—that's a much heavier burden than any single symptom.
Mark
And 15 percent are still sick a year later. That's the group that really needs attention, isn't it?
Mimi
Absolutely. Nine months average for hospitalized patients is already long. But those 15 percent who hit the year mark—they're dealing with something chronic now, not acute. They need different kinds of support, different expectations about recovery.
Il Polso
- Women are developing long COVID at twice the rate of men, with hospitalized women facing a dramatically steeper risk than their male counterparts — a gap that science has yet to fully explain.
- The condition fractures into three overlapping clusters — crushing fatigue and pain, respiratory failure, and cognitive fog — with more than a third of patients managing all of them at once.
- Symptoms linger for an average of nine months in those who were hospitalized and four months in those who were not, but 15% of patients remain symptomatic a full year after infection, suggesting long COVID is not always a temporary disruption.
- Long COVID is pulling people out of workplaces and classrooms, driving sustained demand for medical rehabilitation, and placing a disproportionate economic and social weight on women.
- Researchers and policymakers are being urged to treat the sex disparity not as a footnote but as a central design question for any meaningful public health response.
Across the first two years of a pandemic that spared no one entirely, a quieter inequality took shape: women were twice as likely as men to carry COVID's longest shadow. A landmark study from the University of Washington's Institute for Health Metrics and Evaluation has given this disparity its clearest form yet, finding that 63 percent of global long COVID cases fell upon women — a burden that deepened further for those whose illness was severe enough to require hospitalization. The findings invite both science and society to ask not only how long COVID endures, but why it endures so differently depending on who carries it.
When the World Health Organization defined long COVID as symptoms persisting at least two months and present three months after initial infection, it was describing a condition that would not touch everyone equally. A major study from the Institute for Health Metrics and Evaluation at the University of Washington, published in JAMA, found that women were twice as likely as men to develop the condition — and that 63 percent of all global long COVID cases during the pandemic's first two years occurred in women.
The disparity grew sharper among those who had been hospitalized. Women admitted with SARS-CoV-2 faced a dramatically elevated long COVID risk compared to hospitalized men, pointing to differences in how the virus or the body's immune response behaves across sexes — differences that science is still working to understand.
Senior author Theo Vos identified three distinct symptom clusters reshaping patients' lives: roughly half reported persistent fatigue with pain or mood disturbances; 60 percent experienced breathlessness and chest pain; and 35 percent described cognitive difficulties — brain fog, unreliable concentration. More than a third of patients experienced these clusters simultaneously.
How long symptoms lasted depended heavily on initial severity. Hospitalized patients carried long COVID for an average of nine months; non-hospitalized patients, about four. Yet 15 percent of those still symptomatic at three months remained so at twelve — suggesting that for some, long COVID is not a temporary disruption but a sustained condition.
Lead author Sarah Wulf Hanson stressed that the condition's scale, severity, and duration carried real consequences for health systems and economies — keeping people from work and school and driving ongoing demand for rehabilitation services. The fact that women bore twice the burden, she argued, means any serious response must ask why that gap exists and ensure support reaches those most affected.
When the World Health Organization settled on a definition for long COVID—symptoms persisting at least two months and present three months after initial infection—it was describing a condition that would touch millions. But it would not touch them equally. A major study from the Institute for Health Metrics and Evaluation at the University of Washington found that women were twice as likely as men to develop the condition. During the first two years of the pandemic, researchers estimate that 63 percent of all long COVID cases globally occurred in women.
The disparity widened sharply among those who had been sick enough to require hospitalization. Women who were admitted to hospitals with SARS-CoV-2 faced a dramatically elevated risk of long COVID compared to men who had also been hospitalized—a gap that suggested something about how the virus or the body's response to it differed between sexes in ways science is still working to understand. The research, published in JAMA, represents one of the most comprehensive attempts to map the scale and shape of a condition that has reshaped millions of lives in ways both visible and invisible.
Theo Vos, a professor of health metrics at IHME and the study's senior author, noted that long COVID had created three distinct symptom clusters that prevented otherwise healthy people from returning to normal life. In 2020 and 2021, about half of long COVID patients reported persistent fatigue accompanied by bodily pain or mood disturbances. Sixty percent experienced respiratory problems—breathlessness, chest pain, the sensation of a body that would not quite work the way it used to. Thirty-five percent reported cognitive issues: brain fog, difficulty concentrating, the frustration of a mind that felt unreliable. In more than a third of cases, these symptom clusters overlapped, meaning a single person might be managing fatigue, breathing difficulties, and cognitive problems simultaneously.
The duration of these symptoms varied depending on how severely the initial infection had been. Those who had required hospitalization carried long COVID symptoms for an average of nine months. Those who had not been hospitalized typically experienced symptoms for about four months. But duration was not the full story. Fifteen percent of people who still had symptoms three months after infection continued to experience them even a year later—a stubborn persistence that suggested some cases of long COVID were not temporary disruptions but longer-term conditions requiring sustained medical attention.
Sarah Wulf Hanson, the study's lead author, emphasized that understanding the proportion, severity, and duration of long COVID symptoms was essential for health systems and policymakers. The condition was keeping people from work and school. It was driving people to seek ongoing medical care and rehabilitation services. It was, in other words, not merely a medical curiosity but a public health challenge with economic and social consequences. The fact that women bore a disproportionate burden of this challenge—twice the rate of men—suggested that any serious response would need to account for these differences, to ask why they existed, and to ensure that treatment and support services reached those most affected.
Citazioni salienti
Long COVID has prevented otherwise healthy people from fully recovering, keeping them from returning to work or school and forcing them to seek further medical attention or rehabilitative services— Theo Vos, Professor of Health Metrics at IHME
Understanding the proportion, severity, and duration of long COVID symptoms can help health communities and policymakers understand the need for proper medical treatment and adequate access to services— Sarah Wulf Hanson, lead author of the study
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