Sex & Gender in COVID-19: It Makes a Difference, and So What? (Part I)
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.
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?
Sex and Gender Differences: A Reality
When we first started to study sex differences in Alzheimer disease, the question we were asked was “Are there really differences between men and women?” to which the answer tended to be “I don’t think so. I have never heard of this.” Then, after many studies published, the question slowly began shifting towards “Ok, there are differences between the sexes – now what?”
Once one accepts that diseases present differently in men and women – and COVID-19 has given a profound lesson to the world on the fact that this is indeed the case – the next level we have to address is: “What do we do with this information? Is it relevant? Is it a marginal issue, or a marginalized priority?”
Let’s break things down further.
COVID-19 mainly targets older people (true). This is a stage in life when males have more background/emerging illnesses, so is it not normal that more men will die?
There is a wide misconception that women, who live longer than men by 4.4 years on average worldwide are also healthier. Living a few years longer does not mean been healthier in older age. In fact, women older than 65 consistently show higher numbers of years lived with disability than men older than 65.
What is interesting, however, is that with COVID-19, specific comorbidities might be more common in men and put them at higher risk.
Why do we care?
If this is confirmed, we could identify such issues in advance, and specifically support men with certain comorbidities, thereby preventing the disease rather than waiting for it to develop. Efficient pre-exposure prevention, post-exposure prevention, and patient management need to be sex-adjusted, as men and women might need different interventions and treatments to prevent infection, to limit infection spread, and to avoid more severe complications when they test positive.
Women are more exposed to COVID-19, as caregivers and healthcare workers
Worldwide, 70% of the healthcare workforce is women, so they are more affected as they are more exposed to COVID-19 than men.
Why do we care?
This means that women are on average more exposed. Even if they are more resistant to the virus, they will as a result of the greater exposure get it more often, therefore:
1. They can spread it easily (especially being the caregivers in the families). To avoid this, women have to be isolated, and support for caregiving must be provided from other sources in their absence.
2. As we do not know the long-term consequences of the infection, women have to be inserted in registries and followed up with. When reaching menopause, a previous exposure to COVID-19 might be a risk factor to other serious diseases. So, it matters that a lot of women were exposed, even if they did not get sick or display symptoms; it means we can support these women later on and reduce mortality down the road.
Read the answer to the second half of the question in Part II of the blog, here.
Photo credit: Pixabay