Long COVID Among Women In Bulgaria

The COVID-19 pandemic has exacerbated many inequalities, including those based on gender, with women in Bulgaria and around the world being disproportionately affected by job losses or finding themselves on the front lines of the fight against the virus as nurses, health and social workers. Women also bore greater burden in terms of caring for children and dependent adults in an environment where educational activities were conducted online and social service centres could not function normally. The pandemic also led to an increase in the cases of violence against women.

Women were also disproportionately affected by long COVID or post COVID-19 condition, which the World Health Organization defines as “the continuation or development of new symptoms 3 months after the initial SARS-CoV-2 infection, with these symptoms lasting for at least 2 months with no other explanation”.

The topic of long COVID among women, which is rarely discussed in the Bulgarian public space, was addressed at the event “Health: from women to women”, which Ekaterina Karavelova Foundation held at the end of March 2022. The organisation received feedback from many women who followed the discussion online that there was a need for more information and engagement with long COVID.  That was what inspired the work on a policy brief regarding the situation in Bulgaria.

Summary of the policy brief “Long COVID Among Women In Bulgaria”

In short, it can be said that the topic of long COVID and the fact that it affects mostly women does not provoke much interest in the Bulgarian public space, and a registry of people with ongoing or new symptoms after recovery from the active phase of the virus does not exist.

In order to address the lack of data on long COVID among women in Bulgaria, Ekaterina Karavelova Foundation conducted an online survey in November 2022. It got responses from 141 women from across the country, including a small percentage of women from Bulgaria who currently live abroad. Although it is not a nationally representative sample, it provides valuable information that can serve as a basis for subsequent larger scale studies.

Responses to the central survey question, “Did you (or do you still) have symptoms that continued after you recovered from COVID-19?” indicate that most respondents (79.4%) had or still have some type of ongoing symptoms, with only 19.9% stating that they had no such complaints, and a single respondent answering that she had asymptomatic COVID-19.

The persistent symptoms reported by respondents varied, but the top three were:

1) fatigue, exhaustion, tiring easily (66.9%);

2) cognitive and concentration problems (46.8%);

3) hair loss (37.9%).

Other common symptoms include memory problems, headaches, sleep problems, loss of taste and smell, muscle aches, coughing and difficulty breathing, as well as hormonal imbalance and changes in the menstruation cycle.

The gathered information shows that neither patients nor all professionals are well-informed about the post COVID-19 condition and no adequate comprehensive solutions taking into account gender differences are offered. In order to address this issue, Ekaterina Karavelova Foundation prepared a list of recommendations presented at the end of the policy brief.

Recommendations:

• Conduct nationally representative research to assess the prevalence of post COVID-19 syndrome in the country, as well as the gender specificities of the condition.
• Actively involve patients in the development of measures to address the impact of long COVID.
• Design a comprehensive interdisciplinary approach to address long COVID taking into account its medical, psychological and social aspects, as well as the fact that women are more often affected by ongoing symptoms.
• Create a national programme funded by the Ministry of Health rather than the NHIF and available to all those in need regardless of their health insurance status and whether or not they have been hospitalised in the active phase of the disease.
• Develop appropriate to the national context guidelines for health professionals, including GPs. 
• Prepare information materials on post COVID-19 syndrome aimed at the general public, to be made available both online on the COVID-19 Information Portal and in the form of leaflets to be distributed in the offices of the Regional Health Inspectorates, the Regional Health Insurance Funds, among GPs and health facilities.

More information can be found in the policy brief “Long COVID Among Women in Bulgaria” available in Bulgarian here.