COVID-19 affects people differently, in terms of infection with the virus SARS-CoV-2 and mortality rates. In this Special Feature, we focus on some of the sex differences that characterize this pandemic.
There are many ways in which the pandemic itself affects people’s day-to-day lives, and gender — understood as the ensemble of social expectations, norms, and roles we associate with being a man, woman, trans- or nonbinary person — plays a massive part.
On a societal level, COVID-19 has affected cis- and transwomen, for example, differently to how it has cismen, transmen, and nonbinary people. Reproductive rights, decision making around the pandemic, and domestic violence are just some key areas where the pandemic has negatively impacted women.
However, sex differences — understood as the biological characteristics we associate with the sex that one is assigned at birth — also play an undeniable role in an epidemic or pandemic.
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While sex and gender are, arguably, inextricably linked in healthcare, as in every other area of our lives, in this Special Feature, we will focus primarily on the infection rates of SARS-CoV-2 and the mortality rates that COVID-19 causes, broken down by sex.
In specialized literature, these effects fall under the umbrella term of ‘primary effects’ of the pandemic, while the ‘secondary impact’ of the pandemic has deeper social and political implications.
Throughout this feature, we use the binary terms ‘man’ and ‘woman’ to accurately reflect the studies and the data they use.
Before delving deeper into the subject of sex differences in COVID-19, it is worth noting that the picture is bound to be incomplete, as not all countries have released their sex-disaggregated data.
A report appearing on the blog of the journal BMJ Global Health on March 24, 2020, reviewed data from 20 countries that had the highest number of confirmed cases of COVID-19 at the time.
Of these 20 countries, “Belgium, Malaysia, Netherlands, Portugal, Spain, United Kingdom, and the United States of America” did not provide data that was ‘disaggregated,’ or broken down, by sex.
At the time, the authors of the BMJ report appealed to these countries and others to provide sex specific data.
Anna Purdie, from the University College London, United Kingdom, and her colleagues, noted: “We applaud the decision by the Italian government to publish data that are fully sex- and age-disaggregated. Other countries […] are still not publishing national data in this way. We understand but regret this oversight.”
“At a minimum, we urgently call on countries to publicly report the numbers of diagnosed infections and deaths by sex. Ideally, countries would also disaggregate their data on testing by sex.”
– Anna Purdie et al.
Since then, countries that include Belgium, the Netherlands, Portugal, and Spain have made their data available.
The U.K. have made only a part of the sex-disaggregated data available — for England and Wales, without covering Scotland and Northern Ireland — while Malaysia and the U.S. have not made their sex-disaggregated data available at all.
At the time of writing this article, the U.S. still have not released their sex-disaggregated data despite the country having the highest number of COVID-19 cases in the world.
Global Health 5050, an organization that promotes gender equality in healthcare, has rounded up the total and partial data that is available from the countries with the highest numbers of confirmed COVID-19 cases.
According to their data gathering, the highest ratio of male to female deaths, as a result of COVID-19, is in Denmark and Greece: 2.1 to 1.
In these countries, men are more than twice as likely to die from COVID-19 as women. In Denmark, 5.7% of the total number of cases confirmed among men have resulted in death, whereas 2.7% of women with confirmed COVID-19 have died.
In the Republic of Ireland, the male to female mortality ratio is 2 to 1, while Italy and Switzerland have a 1.9 to 1 ratio each.
The greatest parity between the genders from countries that have submitted a full set of data are Iran, with 1.1 to 1, and Norway, with 1.2 to 1.
In Iran, 5.4% of the women patients have died, compared with 5.9% of the men. In Norway, these numbers stand at 1.3% and 1.1%, respectively.
China has a ratio of 1.7, with 2.8% of women having died, compared with 4.7%