The coronavirus disease 2019 (COVID-19) pandemic has infected over 404 million people globally. The disease has affected patients physically, mentally, socially, and economically.
The physical and emotional impacts of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are not limited until the acute infection phase, but persist, and result in post-acute sequelae. People experiencing these post-acute sequelae, also termed as ‘long COVID’, ‘long-term COVID’ or ‘post-COVID syndrome’ are often called ‘long haulers’.
It has been reported by the United States (U.S.) Department of Health and Human Services that females constitute 80% of the long haulers. This pandemic has resulted in considerable physical, mental, social and economic distress among women worldwide, not only from the disease but also due to the social isolation during lockdowns, the extra stress of caring for family members, and an unstable income.
A study posted to the Research Square preprint, and under consideration at the BMC Publich Health journal, analyzed the impact of long-COVID on female long haulers with respect to various aspects of their social life.
This qualitative study was conducted in 2021 through an online health promotion intervention program and the participants were recruited mostly using social media. Women aged 18 years or older who had been infected by the SARS-CoV-2 virus and had experienced at least one post – COVID syndrome lasting four weeks or longer after the diagnosis were included in the study.
Overall, 15 participants met the eligibility criteria and were interviewed online via video teleconferencing. The interview covered questions on the background of COVID-19 infection, the symptoms experienced, the psychosocial impact on the participant, and their sources of social support and resilience.
Female long haulers admitted that persistent symptoms of long COVID have affected their social lives owing to the physical limitations imposed due to long-COVID; changes in their social relationships; instability of finances; and social stigma associated with the infection, along with conflicts in the various social roles played by them.
The physical limitations had two dimensions – effects on the body and those on the mental well-being. Decreased mobility, feelings of inactivity, or frequent doctor visits also had impacts on their minds which affected their recovery process. Participants complained of being tired of the healing process and showed resentment towards the use of spirometers after they were cured of the infection. Women also confided that they felt that their body image had changed, there was a sense of lack of identity and diminished physical inabilities.
Economic issues like job insecurity and financial hardships also impeded the recovery of this population. Participants reported having a fear of unemployment and were more invested in looking for a job than improving their health. According to them, jobs were more stressful than the pandemic itself. In a few cases, the women had to quit their jobs to take care of their families while many had to take up part-time jobs or work overtime to support their families. Many complained of difficulties accomplishing their tasks due to physical limitations, which even caused deductions in their salaries.
The effect on social relationships as reported by the participants was grouped into four themes – social isolation, societal reaction to the symptoms of long haulers, changes in communication methods, and a decrease in social capital. Social isolation due to decreased energy levels impacted their social relationships and led to increases in stress and anxiety. Many found it hard to get back to their social life due to physical and emotional conflicts. The participants also felt a change in their personalities during social interactions. Marital relations were also affected.
Participants faced varied reactions to long-COVID symptoms. Some people were doubtful about the persistence of their symptoms or unempathetic towards them, while others, even doctors, couldn’t understand their situation. The women felt that only those who had been infected could understand what they are feeling. The communication method changed too, with most of the women depending on online forums for emotional support.
In addition, differences in beliefs over vaccination choices caused a loss in social capital. Less than half of the participants reported that anti-vaccination choices were a major issue over which they terminated their relationships. This caused the withdrawal of social support and resulted in a limited social network.
Conflicts related to social roles that were reported by the participants could be categorized as – those related to their jobs and as the ones related to the family. At the workplace, participants were forced to work overtime, substitute for their infected colleagues, and were even in conflict with their employers due to poor performance as a result of fatigue. They also felt like ‘being neglected’ by their employers. Another problem faced during the pandemic was wearing masks at the workplace, especially for those with breathing problems.
At home, female long haulers had to struggle to fulfill the responsibilities of being the primary caretaker in the family, despite having long-COVID symptoms themselves. The participants also faced social stigma – stigma labels and stigma consequences. All women reported being labeled in various ways, for example – being called careless, overdramatic, being a danger to others, a risk factor, or the 'walking dead'. Such negative comments instilled a fear of being judged and led to self-blaming among them. Therefore, these long haulers restricted their social relationships to avoid this stigma and judgment from others.
This study is one of the first attempts to study the impact of COVID-19 on female long haulers. The results showed that COVID-19 affected female long haulers in all dimensions; vis, physically, mentally, socially, and economically. It was found that the conflicts in social roles faced by female long haulers were mostly consequences of expectations of others without considering their recovery status and persistent post-COVID symptoms.
The present study emphasized the need for social support and more refined social life-related advice for female long haulers and underlines the importance of more research on the impact of the COVID-19 pandemic on the social life of other groups, for instance – the elderly, immigrants, and people with disabilities.