Women represent the vast majority of people who suffer long-term symptoms of COVID-19. These long haulers could also develop a condition that is similar to an autoimmune disease and may need specialized treatment.

According to Nature, men are more likely to suffer severe COVID-19 complications and death. However a French study published in Clinical Microbiology and Infection found that female patients who reported recurring and lingering symptoms for months outnumbered their male counterparts four to one.

The researchers were surprised to discover that these long haulers were previously healthy women with an average age of 40 and no preexisting medical conditions.

“If you think who the long haulers are, we’re talking about young women who were mostly super healthy before,” said Noah Greenspan, P.T., a pulmonary physical therapist in New York City, according to Business Insider.

Greenspan developed a bootcamp to help long haulers manage their symptoms and he says 85% of the participants are women. He also conducted a study comparing 43 long haulers to those who fully recovered from COVID-19 and found that all but one were female who still battled lingering fatigue, chest pain, fever, headaches and shortness of breath. The scientists who conducted the French study reported symptoms of myalgia, tachycardia, and anxiety as well in the women they observed.

Researchers hypothesize that women have a more robust T-cell response to viral invaders than men. While this is beneficial to ward off initial illness, the ebullient response can lead to the T cells attacking the woman’s own immune system as well. This triggers a condition that resembles an autoimmune disease.

Dr. Anthony Fauci, director of the National Institutes of Allergies and Infectious Diseases, said that he believes post-COVID-19 symptoms closely resemble post-viral chronic fatigue syndrome or CFS, which also affects more women than men.

According to Business Insider, coronavirus long haulers often display the same characteristics as CFS, also known as myalgic encephalomyelitis. People with CFS feel weak after physical activity and the symptoms do not improve after sleep or rest. It is not a coincidence, perhaps, that women with CFS also outnumber men four to one.

“Women generally have a different immune response than men, which can be a double-edged sword,” said Dr. Jacob Teitelbaum, a CFS expert and board-certified internist. “It allows them to carry a baby for nine months without rejecting it but makes them 300% more prone to autoimmune illnesses.”

According to Business Insider, this stronger immune response may be why women are less likely to die from COVID-19. It could also explain why women tend to live longer than men, and adversely, why they are more susceptible to developing autoimmune diseases such as lupus, Crohn’s, or rheumatoid arthritis.

Teitelbaum, the author of the best-selling book, From Fatigued to Fantastic, and the lead author of four studies on effective treatment for CFS and fibromyalgia, learned about post-viral complications firsthand when he was hit by a post-viral infection while attending medical school, according to U.S. News and World Report. He went on to develop an innovative protocol that restored his own immune system, and has similarly helped over 90% of his patients. He calls his treatment SHINE which stands for sleep, hormones, immunity, nutrition, and exercise when possible.

Teitelbaum claims that his protocol for CFS may help restore the health and vitality of these long haulers. If you are still experiencing symptoms six weeks after recovering from COVID-19 or any other viral infection, he says, “it is time to be proactive to help your body recover.”