Coronavirus Disease-19, also called COVID-19, resulted in a global pandemic, disrupting healthcare systems and affecting millions worldwide (1, 2). While the initial illness is often characterized by respiratory symptoms, growing evidence suggests that some individuals experience lingering effects beyond the acute phase. This condition, known as post-COVID syndrome or Long-COVID, can significantly impact various organ systems. Long COVID-19, also known as “post-acute sequelae of COVID-19,” is a multisystemic illness that develops after a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. This condition is characterized by multiple severe symptoms. Based on a conservative projected incidence of 10% of infected persons with more than 770 million recorded COVID-19 cases globally (as per World Health Organization’s data); at least 77 million people worldwide have Long COVID; the figure could be much higher due to numerous unregistered instances. 10%–30% of non-hospitalized cases, 50%–70% of hospitalized patients, and 10%–12% of vaccinated cases are thought to have the incidence (3, 4).

Most Long COVID cases are in non-hospitalized patients with mild acute illness, as this population represents most overall COVID-19 cases. Long COVID is associated with all ages and acute phase disease severities, with the highest percentage of diagnoses between the ages of 36 and 50 years (3). One of the most commonly used timeframes for Long COVID is symptoms present 4 weeks after the initial acute infection, as used by the CDC (Centers for Disease Control and Prevention) (5, 6). Literature indicates that Long-COVID can manifest in various physical and neuropsychiatric symptoms lasting much longer after recovery from the initial infection. The severity of the initial COVID-19 illness does not necessarily predict the likelihood of developing Long-COVID (7). The most frequently reported symptoms include fatigue, muscle weakness, headaches, joint pains, chest pain, cognitive decline and memory loss, and other neuropsychiatric disorders like anxiety, sleep disorders (3, 7–10). ICU admission in patients with COVID-19 further increases the risk of developing psychological issues like anxiety, depression, headache and post-traumatic stress disorder (PTSD) (11, 12).

Moreover, there could be various factors that cause differences between symptoms experienced during Long-COVID. One such factor could be gender related. Many studies have suggested that the prevalence of Long-COVID tends to be higher among females. Some suggest that certain hormones in females may be the cause behind the hyperinflammatory status of the acute COVID phase, which then lasts long after recovery, resulting in these symptoms (13).

While the exact cause of Long-COVID remains unclear, factors like age, underlying health conditions (comorbidities), and frailty might influence susceptibility (11, 14). Studies have shown that patients with pre-existing or chronic conditions, such as diabetes, chronic lung diseases, asthma, chronic kidney disease, would be at a higher risk of developing this syndrome (15).

Given the evolving nature of Long-COVID research, a comprehensive understanding of its prevalence and specific manifestations is crucial. A literature search showed a paucity of studies from Saudi Arabia assessing the frequency of this syndrome in this country. Therefore, this study aims to assess the presence of post-COVID symptoms among individuals who have previously contracted COVID-19 in Saudi Arabia and to investigate any potential gender differences.

For this cross-sectional study, we created an online questionnaire using Google Forms and distributed a URL to students via email and WhatsApp from April 5, 2023, until August 30, 2023. The targeted audience for this study was people who were diagnosed with COVID-19 (aged 18 years or older) living in Saudi Arabia.

To achieve the study’s goals, the developed questionnaire was modified from the paper “Characteristics and impact of Long Covid: Findings from an online survey” (16). Moreover, the questionnaire survey was submitted to 6 senior faculty members, and they filled the survey to identify any technical issues. Hence it enhanced the validity of the questionnaire, since the faculty reviewed its contents and ensured the survey was clear and concise. It was aimed at Saudi Arabian citizens and residents who were diagnosed with COVID-19, and all participants who did not meet those requirements were excluded from the study. With 32.2 million people living in Saudi Arabia, we estimated that our target sample should consist of 385–400 people to attain a 95% confidence level with a 5% margin of error using the standard formula for sample size calculation via the Raosoft calculator tool (17).

The questionnaire consisted of 17 questions classifying the respondent’s responses. We asked participants to answer questions regarding the symptoms they experienced when infected with COVID-19 and the long-term symptoms that stayed with them. The survey consisted of three sections. The first section addressed demographic aspects, including gender, age, current education level, monthly income, employment status, nationality, region they reside in, and whether they caught COVID-19 previously. The second section comprised questions querying participants about the frequency of their infections, their experience of symptoms, and the specific symptoms encountered. The third section included questions about their awareness of post-COVID-19 and other symptoms they encountered.

This study included a total of 490 participants, categorized by age, education level, social status, employment, income and nationality (Table 1). Out of these participants, 53.9% had prior exposure to COVID-19 (Table 2). Looking into genders, 195 females (55.1%) and 69 males (50.7%) had prior COVID-19 exposure, showing that over half of the participants had prior exposure. Amongst these participants, 16.9% of men and 15% of women had been exposed to COVID-19 at least twice. Moreover, 43.6% of females had experienced prolonged symptoms, along with 33.3% of males. And lastly, awareness of Long COVID was lower than anticipated, with 51.5% of females and 55.1% of males unaware of the condition.

During acute infection, tiredness was the most common symptom in participants, reported in 84.5% of people. The other common symptoms among the participants included fever (75%), soreness of throat (65.5%), headache (65.2%), body aches (63.6%), cough (55.3%), loss of taste/smell (48.1%) (Table 3). Participants also reported various symptoms related to mental health during the infection, with fatigue reported by 1/3rd of participants. Others included anxiety (21.2%), stress (18.9%), issues with sleep (18.9%), lack of focus (10.2%), and finally PTSD (1.9%). It was noted that some symptoms were more commonly reported by one gender over the other. Acne was reported in 15.9% of males versus 4.1% of females, a significant difference (p = 0.001). This could possibly be due to an underlying mechanism of biological and hormonal factors, as males typically have higher levels of androgens which are known to contribute to acne development. Further research needs to be conducted to further understand the biological mechanism behind this effect and its association with Long Covid. Furthermore, hair loss was reported more often in females (23.6%) than males (8.7%), a difference of 14.9% between the two (p = 0.008). This finding supports another study, which showed females (82.8%) having predominant hair loss after diagnosis of COVID-19 in comparison to males (17.2%) (18). Female sex hormones like progesterone and estrogen could have a role in underlying pathophysiology, and COVID-19 may cause a reduction in these systemic hormones in female patients (18). Future studies are needed to investigate a relationship between the extent of hair loss and female sex hormones.

When it came to symptoms faced after recovery from COVID-19, tiredness was once again the most dominant symptom among the participants (16.7%) (Table 4). The other common symptoms were loss of taste or smell (9.1%), body pain (7.6%), headache (7.2%), foggy memory (7.2%) and shortness of breath (6.4%).

Regarding mental-health related symptoms faced after recovery from infection, our study showed that almost 21.2% of participants faced anxiety/depression, and 18.9% of participants reported stress along with sleep problems (Table 5). This underscores the prolonged impact COVID has on mental health.

This study aimed to investigate the experience of Long-COVID symptoms among individuals who previously contracted COVID-19 in Saudi Arabia. The analysis revealed some interesting trends regarding demographics. There was a statistically significant difference in the age distribution (p = 0.008), with females more likely to be in the 18–29 age group compared to males. Social status showed a significant difference (p = 0.006), with a higher proportion of single individuals among females compared to males. Additionally, employment status differed significantly (p = 0.007), with more females being students and fewer being employed compared to males. Nationality also differed significantly (p = 0.011), with a higher proportion of non-Saudi participants being female.

Globally, more than 27 million people have recovered from COVID-19, but little is known about the disease’s long-term effects. According to preliminary research, some patients may have long-lasting anomalies in their physiological systems. Our results underscore the impact that COVID-19 has on patients long after they have been reported to be well from acute symptoms of the illness, along with the gender disparity in symptomatology experienced; they also show the necessity of a thorough, multidisciplinary approach to provide these patients with the best care possible. Nevertheless, larger and more diverse samples are needed to confirm these findings. Clinicians should be aware of the long-term effects of COVID-19, and the potential differences that may be observed between different genders. Studies investigating the biological mechanisms underlying these gender differences are warranted.