The sex and gender considerations of COVID-19 are crucial for the progression of precision medicine – here’s why
By Shayda Moyassari
The COVID-19 pandemic has proved that no one is exempt. Although we are all experiencing the pandemic simultaneously, it is clear that the impacts of COVID-19 are felt differently across various groups within society. From the perspective of ‘sex’, also known as our biological constitution, COVID-19 cases seem to progress to more severe forms of the disease in men.
Men account for 57% of deaths and 70% of intensive care admissions due to COVID-19.
On the other hand, gender, the culturally shaped expression of sexual differences, has placed women and girls at a disproportionate disadvantage due to deepened pre-existing inequalities and exposed vulnerabilities in social, political and economic systems.
Our starting point: Understanding sex and gender considerations
It is important that both sex and gender considerations are taken into account when creating transformative policies and responses in all aspects of society. A recent webinar hosted by the Women’s Brain Project (WBP); a Swiss-based non-profit international organisation founded in 2016, and the World Bank, set out to explore this.
The aim of the webinar was to inform the audience about up-to-date research in the COVID-19 sex and gender field, including insights from Kenya, as a country spotlight example.
Introduction to the WBP
The webinar kicked off with an introduction to the WBP, from Co-founder and CEO Dr Antonella Santuccione-Chadha. The WBP aims to integrate sex and gender differences in the heart of diagnostics, treatments, novel technologies and clinical trials to create better solutions for patients in order to achieve ‘precision medicine’.
So, what do we mean by ‘precision medicine’? Precision medicine is an emerging approach for disease treatment and prevention that takes into account individual variability in genes, environment and lifestyle. This approach allows doctors and researchers to accurately tailor treatments and prevention strategies for a particular disease, which will work in different groups of people. It is in contrast to the one-size-fits-all approach which often neglects the differences between individuals.
COVID-19: Sex differences from a scientific/biological standpoint
Co-founder and Chief Scientific Officer of the WBP, Dr Maria Teresa Ferretti introduced us to sex differences illustrated during the COVID-19 pandemic.
Dr Ferretti first asked the audience “Are you aware of sex and gender differences in COVID-19?”. After she received a mix of ‘No’, ‘Yes’ and ‘Kind of’ answers to the polling question, she went on to explain that there are indeed clear sex and COVID-19 trends within the data. For example, men are more severely impacted (ICU admission and death) by COVID-19.
Most interestingly, Dr Ferretti continued to explore novel research fields within the pandemic, such as inflammation and its links to sex, as well as COVID-19 vaccines and the implications of neglecting pregnant and lactating women from clinical trials, an issue not unique to COVID-19 but applicable to all disease areas.
Dr Ferretti concluded with a bold statement “Sex differences have hopefully shown us that we must move from a ‘one-size-fits-all’ medicine to precision medicine”. A very important point, considering that biologically men and women are differently impacted by the SARS-CoV-2 virus, as with other diseases.
So, what is the solution to achieving precision medicine? Dr Ferretti stressed the need to incorporate artificial intelligence (AI), digital solutions and non-biased predictive algorithms that can overcome the one-size-fits-all approach and achieve the fundamental aspects of the WBP philosophy, view and vision, to catalyse progression towards precision medicine.
COVID-19: Gender differences from a socio-economic standpoint
The next section of the webinar focused on COVID-19 and gender differences from a socioeconomic standpoint and was hosted by Dr Annemarie Schumacher Dimech, Co-founder and President of the WBP and psychologist at the University of Lucerne, Switzerland.
Dr Schumacher Dimech began her presentation with a raw and personal question that resonated with us all, “What comes to mind when you think of the impact of COVID-19 on mental health?”. The resulting ‘word cloud’ really captured the thoughts and feelings of the audience. Words such as ‘anxiety’ ‘loneliness’ and ‘uncertainty’ emerged… emotions we have all been too familiar with during this ever-evolving pandemic.
She continued to explain that beyond economics the pandemic has exposed more women to an increased risk of domestic violence. Both formally reported abuse and informal indicators have increased. Calls to domestic abuse hotlines doubled globally and rates of PTSD and depression in pregnant women have elevated since the onset of the pandemic.
COVID-19: Sex and Gender Differences from a Kenyan Context
The gendered impacts of COVID-19 were also supported by Ms Wambui Karanja a psychologist from the Global Brain Health Institute. She presented the gendered impacts of COVID-19 observed from a Kenyan perspective. She highlighted that there had been a reduced number of women seeking reproductive health services and perinatal care in Kenya as a result of the pandemic. This leads to the risk of unwanted pregnancy and potential for poorer birth outcomes. Barriers to accessing maternal and sexual services are a problem globally, but they have been exacerbated by ‘stay at home’ orders, appointment cancellations, women not wanting to burden the health system and risk catching or spreading COVID-19.
It was clear from both Ms Karanja and Dr Schumacher Dimech that the pandemic’s impacts are heavily gendered. Furthermore, the frontline workers which make up the healthcare workforce responding to COVID-19 are disproportionately represented by females (approximately 70%). Whichever way you look at it, women are experiencing huge burdens from the pandemic.
COVID 19: The link between transformative policies and gender
Dr Schumacher Dimech asked the audience “Do you think female leaders are more likely to implement transformative and inclusive policy?”. The results from the audience showed an overwhelming support for the ability of female leaders to implement transformative policy. Although it is a tough question, it has been heavily discussed within the media during the COVID-19 pandemic. Dr Schumacher Dimech outlined that there was no simple answer and most available data harbours contradictions. Yet, research is emerging to suggest that gendered-leadership styles and responses to ‘risk’ may provide answers into the varying levels of pandemic ‘success’ between countries.
Dr Sameera M. Al Tuwaijri, Global Lead Population and Development, Health, Nutrition and Population Global Practise at the World Bank moderated the webinar and highlighted the contributions from all speakers. The audience was highly engaged and some of the questions asked highlighted the dilemmas of including pregnant/lactating women in trials, evidence-based data behind the social behaviours of men and women and so on.
Overall, it was a highly interactive and insightful webinar hosted by the WBP and World Bank. It was clear that sex and gender are too often neglected in conventional medicine, informal and formal care settings and within the economy, all of which disproportionately impact women.
It is essential that future medicine, prevention, treatments and policy consider sex and gender as the ‘backbone’ of their creation in order to achieve successful responses and catalyse the progression towards precision medicine.