IJFAB: International Journal of Feminist Approaches to Bioethics

In May of 2020, reports of so-called "long-COVID" began to surface. Long COVID (or "post-acute" COVID; see Greenhalgh et al. 2021) is a collection of post-COVID-19 physical, cognitive and psychological symptoms, such as depression, brain fog, fatigue, and dizziness. As long-COVID is considered a "new" disease, it is not always covered by health insurance or government programs, moreover it is a set of constantly evolving symptoms.

While severe cases of COVID-19 itself tend to be mostly in males over fifty-years-old, those individuals affected by long-COVID tend to be mainly female (roughly three and out of four cases) and younger in age (see Torjesen 2021). Data supporting the existence of the long-COVID syndrome and its gender distribution is global. The fact that women are more likely to be affected has played into the historical narrative of women's "hysteria" or imaginary illnesses, which—in its turn—has meant that sufferers are sometimes hesitant to search for treatment as they believe they will not be taken seriously. Alternatively, some researchers theorize that men—due to their gender socialization—are less likely than women to seek out medical help and therefore these gender differences may be illusory.

Thus, gender functions as the pivotal analytic lens for the examination of long-COVID, although—obviously—it will intersect with other multiple lenses of race, class, et cetera. However, whatever the reason for the gendered differences in the numbers of "longhaulers," it is important to recognize the very real material effects on women sufferers.

Long-COVID affects the future work options of the sufferer, who sometimes cannot return to work at all or will need future accommodations to continue full-time work. Long-COVID has not yet been recognized as an occupational illness, even though it disproportionately affects the large range of workers designated as essential, who are often women (especially healthcare workers) and/or from racial minority groups. In addition, women are disproportionately represented among the poor and thus have decreased access to healthcare and other social support systems they need during long-COVID. Moreover, women [End Page 189] themselves typically provide the "invisible" healthcare at home that supplements the healthcare system, so the existence of long-COVID could compound the healthcare crisis of COVID-19 itself.

In an interesting twist on the usual approach to medical research where women's supposedly more complex biology has meant they are often not research subjects, the gendered numbers of long-COVID has meant that research into the syndrome has focused on women rather than men. However, some of this research is currently focused on the relationship between women's hormonal system and susceptibility to long-COVID. Whether or not this relationship turns out to be true, feminists should be concerned that such research flattens out environmental differences among women due to race and class, while reinforcing strict binary thinking about sex.

Philosophers are already publishing work on COVID-19; for example, Greg Pence (2021), Pandemic Bioethics. Overall, however, such work is coming from mainstream bioethics (e.g., Verduco-Gutierrez et al. 2021).¹ One notable exception is Layla J. Branicki's (2020) call for a care-based feminist approach to crisis management as an alternative to "rationalist"—typically utilitarian—approaches (see Branicki 2020).

Thus far, the work of mainstream bioethics has focused on the "new" ethical issues raised by the pandemic, such as whether it is ethical to transplant organs from those who were infected with COVID-19. But mainstream bioethics cannot quite get a purchase on the ethical issues of long-COVID. It is not a syndrome that fits well into a framework of rights and the primacy of autonomy. Long-COVID issues are an interconnected web rather than a set of separable issues that can be answered through an application of the four pillars of autonomy, beneficence, non-maleficence, and justice. Not only is long-COVID not yet fully identified as part of the pandemic crisis, and thus ethical conversations around the pandemic, but mainstream rationalist/quantifiable thinking does not allow for the type of thinking that we need to consider long-COVID...