Care Triad

Sex and gender matter in COVID-19

Some people get extremely sick after infection with the novel coronavirus and other individuals remain asymptomatic or have a very mild course. We have no proven therapies (although there is some research that suggests an antiviral drug called remdesivir may help) and no short-term hopes for a vaccine. Clinical trials are in progress and public health strategies are being implemented. But, in order to combat COVID-19, the disease caused by the novel coronavirus, we need to look at the pandemic and the possible interventions through a sex and gender-based lens. Here’s why.

Early data from the coronavirus pandemic suggest that men are more likely to die from COVID-19 than women.  Some have suggested that men are more likely to be smokers, be exposed to air pollution or have underlying health problems such as obesity that predispose them to worse outcomes. By studying why women fare better than men we are likely to gain greater insight into how best to treat both men and women.

In a recent report looking at the 9,282 coronavirus infections of healthcare professionals, 73% have been women. While this could reflect the fact that women make up a larger proportion of the healthcare workforce, or that their jobs cause them to have greater exposure to the virus, we really don’t know.

Preliminary data also suggest that pregnant women who enter the hospital to deliver their babies have a low likelihood of exhibiting severe manifestations of coronavirus infection. In a study in which all pregnant women admitted for delivery in two New York City hospitals were screened for coronavirus, 15% were found to be infected and most of those who tested positive were asymptomatic. We need to understand whether pregnant women are protected in some way from COVID-19 compared with non-pregnant women and men, which may help us understand the way the virus causes disease.

The differences between men and women in the coronavirus pandemic likely go well beyond biologic differences and include gender-based societal issues. The novel coronavirus pandemic shines a light on the problem of disparities within our healthcare system and how these disparities result from, or are magnified by, the so-called “social determinants of health (SDOH)”. These social circumstances such as poverty, low literacy, inadequate food and housing play an important role in maintaining health.  African American and other communities of color have been disproportionately affected by the pandemic. Minority populations are more likely to be among essential workers, more likely to have underlying health conditions, less likely to be able to socially isolate and less likely to have access to adequate healthy food.

However, we must also study how these SDOH affect men and women differently in this pandemic. An article in the New York Times points out that women are more likely to be considered essential workers because they are overrepresented among the ranks of nurses, healthcare aides, food service workers; in fact one in three jobs held by women, especially non-white women, has been designated as essential. The result may be that many women are forced to go to work and risk infection. Women are also more likely to be single parents and family caregivers of sick or elderly family members. Perhaps women who are telecommuting are under more stress than men and therefore at greater risk of other diseases such as heart attack. Perhaps their job-related productivity is diminished. By studying these issues, we are likely to get a better understanding of how the pandemic is influencing society.

We also know that essential women’s health services are threatened in the face of this pandemic, such as family planning and abortion services.  Sheltering in place has raised concern about increases in domestic violence and greater challenges for women to seek help. We need to study these issues and intervene to maximize the health of women.

Finally, some suggest that women leaders are doing a better job than men at managing this pandemic. A popular meme on social media pictured the leaders of New Zealand, Denmark, Iceland, Germany, Belgium and Finland and asked what do these countries have in common? While we don’t know that these countries have fared better in this pandemic because they have female leaders, this is a question that warrants further study. At a minimum, we should study how gender has affected the response in various countries, states and cities. Women have certainly been underrepresented in the official US response to the pandemic.

We need to set up processes and studies to rapidly assess these sex and gender-related differences in COVID-19 and develop appropriate interventions and policies. The lives of all of us are at stake.