COVID-19 affects men, women differently: A look at the factors behind gender-specific health impacts

The COVID-19 pandemic has raised many questions around why the SARS-CoV-2 virus, COVID-19 infections, and the global job and economic crisis have impacted men and women differently.

A consistent pattern has emerged of higher death rates among men compared to women infected with COVID-19. Data shows that men are roughly twice as likely to die from a COVID-19-related illness than women are. Simultaneously, more women with COVID-19 are likely to get diagnosed early since in most countries, women account for the majority of health care workforce.

In a study published in the journal Nature on 26 August, scientists report that a neutralising immune response against COVID-19 was stronger in women, irrespective of age. The immune system workings that are detailed in the study are an "important basis for the development of a sex-based approach to the treatment and care of men and women with COVID-19," the authors say.

The research community has gathered some evidence – and come to a consensus – that differences in infection rates in men and women are not all that different, but the outcomes are.

This pattern seems to be repeated in nearly every countries’ reporting, and raises important questions concerning the spread and clinical impact of this pandemic:

Men and women equally likely to contract COVID-19?

Based on available data, experts say COVID-19 infection rates are similar for men and women. In other words, men and women are equally likely to contract a COVID-19 infection. However, a significantly higher proportion of men succumb to the disease than women.

However, India and many other countries do not report their COVID-19 cases and deaths separately for women and men, and many more do not report data disaggregated by both sex and age. This leaves little scope for independent data analysis on testing, infection rates or other factors affecting COVID-19 in men and women.

Also read: Study of 5 lakh women hints at oestrogen, birth control pills offering some protection against COVID-19

Once infected, are men more severely affected?

More so in India than the numerous other COVID-19-affected countries, data shows that men were found more likely to have grave complications from COVID-19, and death. Older men with underlying disease were also found more vulnerable than their female counterparts to COVID-19-related complications.

Countries around the world are reporting significantly higher mortality rates of COVID-19 in men than women. A recent study in Frontiers in Public Health concluded that men are at least twice as likely to die of COVID-19, regardless of age. Men were also less likely to survive critical cases of COVID-19.

Biological basis for gender differences in COVID-19 

The SARS, influenza, Ebola and HIV epidemics all affected men and women differently. Gender-specific information is vital to understanding how a virus affects the population because men and women are likely to have very different reactions to the virus, vaccines and treatment, experts told The New York Times. The reasons may be hormonal, genetic or even related to differences in intestinal bacteria.

These differences can have different basis on a biological level:

• hormonal: like effects of sex hormones testosterone, oestrogen or progesterone. The body's response may also vary in people undergoing hormonal therapy.
• genetic: like females have two X chromosomes, which include more immunity genes or differences in intestinal bacteria.
• immune response: a more vigorous immune response in women increases the capacity to fight off an infection, as well as the risk of autoimmune diseases. Early studies also report a higher number of antibodies of the sub-type IgG in women compared to men after a SARS-CoV2 infection sets in. There is also evidence that mast cells in women can initiate a more active immune response, which helps better fight infectious diseases.

Sociological COVID-19 impacts

Sex differences between women and men that play a role in severity and mortality from an acute COVID-19 infection in the short term. But sociological factors also have a big part to play.

Though trends show the infection rates and morbidity affecting more men, the emotional impact of the pandemic seems to disproportionately be falling on women’s shoulders in many countries. More unpaid care, domestic work, loss of jobs and income, and increase in gender-based violence are some factors contributing to more pandemic-linked stress and anxiety among women, according to a UN Women resource.

Behavioural COVID-19 impacts

Behavioural differences have also been put forward, for example, men are more likely to be smokers, and women wash their hands more often. At the same time, women also experience more side effects from medication than men do, which means dosing and sex-specific side effects of vaccines and therapeutics needs to be considered.

Data also shows that both men and women are finding it difficult to find necessary medical supplies, hygiene products and food. The proportion of people who could not see a doctor, experienced longer wait times or had difficulties accessing necessary products, shows that more women in developing countries were at a disadvantage.

Differences in sociological rights in many forms (cellphone ownership, access to the Internet, education history, etc) could prevent people from accessing potentially life-saving information. It so happens, women were found less likely to receive information about COVID-19 than men in developing nations, Bangladesh and Pakistan among them.

Health and safety impacts

With stay-at-home orders during lockdown, people with violent partners are at higher risk of abuse but find themselves isolated from helpful people or resources. France saw domestic abuse cases triple in the first week of lockdown, while Australia reported a 75 percent increase in cases and Lebanon saw calls to a local abuse helpline double in March this year compared to last year. While domestic violence can affect men or women, women are the victims in a disproportionate majority of cases.

Higher rates of tobacco consumption, a reluctance to seek proper and timely medical care play a role in who will be hit hardest. Women’s health services, such as access to contraception, are also precarious unless governments state that they are essential services.

Family planning organisation Marie Stopes has estimated that 9.5 million women and girls worldwide were at risk of losing access to their contraception and abortion services in 2020 due to the pandemic.

Implications for COVID-19 response

While there are several theories as to why COVID-19 might differently affect genders – ranging from lifestyle choices, to sociological factors, to differences in chromosomal structure to the complex workings of our immune systems – the evidence points to the most likely reason being biological.

Sex differences also affect the immune system's response to an infection. Verified by more independent studies, these differences could have implications across all levels of the world's COVID-19 response – from clinical trials, to treatment, to vaccinations strategies.

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