Sex & Gender in COVID-19: A marginalized priority (Part II)

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By Maria Teresa Ferretti, Chief Scientific Officer of the Women’s Brain Project (WBP)

In a recent Webinar WBP hosted about “Sex & Gender Differences in the COVID-19 Pandemic”, one question caught our attention. We will address the various issues it brings to light in this piece, to highlight the “so what?” around sex and gender differences not only in brain and mental health but in health overall. Read Part I of our answer here.

 

The question (as received, edited for typos only)

Not really sure what’s the big question here: I’m not a scientist like you but don’t males tend to die younger because of life style, such as smoking, stress, etc.? If so, and this illness mainly kill older people, meaning – a stage in life when male have more background illness, then it’s supposed to be normal that man will die more, no? Re the healthcare system – if 70% are women then what is left to explain? So I’m wondering if we are not dealing with a marginal issue here rather than other more interesting issues (in my opinion), such as: How come ppl without symptoms can infect others? How long can the virus survive outside the body? What’s the practical way of living with this virus without a lockdown on the world with such damage on our economies and lives? Why is the gender issue anywhere in the league of such issues?

What do we know about the COVID-19 virus?

Specifically: How come people without symptoms can infect others? How long can the virus survive outside a host? What is the practical way of living with this virus without a lockdown-type solution that has such an extreme impact on our lives and the global economy? And, most importantly, amidst the above questions, how does the sex and gender issue make the “top five” set of issues that are critical to address?

You cannot separate out sex and gender from all the other COVID-19 related issues. Sex and gender have an impact on all the questions posed, and that is why it is so crucial to understand COVID-19 through the sex and gender lens.

People without symptoms may infect others, true. But if women are more resistant, does that mean they are less infectious, even if they are hosts but aren’t displaying any symptoms? Understanding this can inform isolation strategies, to optimize who is exposed, who can interact with healthy individuals without putting them at risk, and more.

We need to understand who is more at risk in terms of age, sex and gender, and ethnicity. That way, every community, city, and nation can adapt in an evidence-based manner. This will reduce the chances of discrimination and racism.

We have to ensure protection of the groups at risk while allowing resistant groups to go back to work. In order to do that, we need to use a precision medicine approach rather than mass measures that impact everybody the same way. Gender will be one of the elements.

Why sex and gender are a marginalized priority

Here are four reasons why the sex and gender lens in the context of COVID-19 is not a marginal issue or a niche topic, but a marginalized priority:

1. It’s about improving basic research: If we know that women are resistant to downstream effects of the virus, we can identify specific pathways (receptors, enzymes, hormones) that are responsible for it and leverage them for ad hoc therapeutics for the whole population.

2. It’s about improving clinical practice: If we know what specific needs each patient has based on sex, age, and phenotype (physical characteristics), we can provide everybody with the best clinical service possible. For instance, gastrointestinal (GI) symptoms might be more common in women; not knowing this might result in missed diagnosis in women as compared to men.

3. It’s about improving drug development: There are currently over 300 clinical trials on COVID-19. There are strong reasons to believe that drugs that act on inflammatory pathways, like IL-6, will act differently on men and women.

What if we are discarding drugs that might be working, just because we are failing to analyze the data stratified by sex? By raising awareness on this issue, we want to make sure that signals – and opportunities – are not missed.

4. It’s about improving social support: Women and men have different roles and needs in our society. Women are particularly exposed right now, as caregivers and as the family “Chief Health Officer”. COVID-19 is impacting not only their physical health, but their mental health, the likelihood to be exposed to intimate violence, as well as their careers.

Considering the specific needs of men and women is crucial at this stage, from a perspective of better health for all and to ensure that all the progress made in gender equity to date are not in vain, but part of a stepping stone to an ever-improving society.

If you are interested in additional resources, below is a list of studies you can look up. Note that the Women’s Brain Project is working on additional material (perhaps even a book), so to stay up to date, follow us on social media (we’re on LinkedIn, Twitter, Instagram, and Facebook) or sign up for our mailing list.

 

Additional Resources

From WBP:

Ferretti et al., Nature Reviews Neurology 2018

Ferretti-Martinkova, EJN 2020

Cavedo et al., A&D 2018

 

By other groups:

Buckley et al., A&D 2018

Hohman et al., JAMA Neurology 2018

Sundermann et al., Neurology 2019

Sohn et al, Scientific Reports 2018

Arnold et al., Nature 2020

 

Photo credit: FreePik

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