Sex, gender and COVID-19: a call to action

Abstract

An understanding of the influence of sex (biological attributes) and gender (socially constructed roles, behaviours, expressions, identities) factors on the risk of infection, hospitalization and death is of urgent importance in the COVID-19 pandemic response effort. Despite similar global rates of infection with Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2, the virus responsible for the COVID-19 pandemic), hospitalizations and mortality are higher in men than in women. Females may be less vulnerable to viral infection due to sex-based differences in immune responses and renin-angiotensin system activity. The response and side effects of currently studied potential therapies for COVID-19, such as hydroxychloroquine, likely differ by sex. Women form the majority of the health care workforce and a uniform approach to sizing of personal protective equipment may provide differing levels of protection from viral infection to health care workers of varying shapes and sizes. Important gender differences exist in the response to public health measures to prevent and contain spread of COVID-19, as well as presentation for testing and medical care, which may inadvertently propagate viral spread. Targeted approaches that consider both sex and gender, as well as measures of intersectionality, are urgently needed in the response efforts against COVID-19. Résumé Il est d'une importance primordiale, pour riposter à la pandémie de COVID-19, de comprendre l'influence des facteurs liés au sexe (les attributs biologiques) et au genre (les rôles, comportements, expressions et identités socialement construits) sur les risques d'infection, d'hospitalisation et de décès. Malgré la similarité mondiale des taux d'infection par le coronavirus du syndrome respiratoire aigu sévère 2 (SRAS-Cov-2, le virus responsable de la pandémie de COVID-19), les hospitalisations et la mortalité sont plus élevées chez les hommes que chez les femmes. Celles-ci pourraient être moins vulnérables à l'infection virale en raison de différences sexuelles dans les réponses immunitaires et dans l'activité du système rénine-angiotensine. Les réactions et les effets secondaires aux traitements possibles de la COVID-19 actuellement à l'étude, comme l'hydroxychloroquine, diffèrent probablement selon le sexe. Comme les femmes composent la majorité de la main-d'oeuvre des soins de santé, les tailles uniformes de l'équipement de protection individuelle offrent peut-être des niveaux de protection inégaux contre l'infection virale aux travailleurs de la santé de formes et de tailles différentes. Il existe des différences importantes entre les genres dans les réactions aux mesures de santé publique visant à prévenir et à contenir la propagation de la COVID-19 et dans la présentation aux tests et aux soins médicaux, ce qui pourrait par inadvertance favoriser la propagation virale. Dans la riposte à la COVID-19, il devient urgent d'adopter des approches ciblées, qui tiennent compte à la fois du sexe et du genre, ainsi que des mesures de l'intersectionnalité.

Prevalence of nutritional risk and malnutrition during and after hospitalization for COVID-19 infection: Preliminary results of a single-centre experience

“…Eighty-three male patients were enrolled on the present study (58.5% of total): this data is consistent with the higher rates of hospitalization for COVID-19 infection in men than in women [13,14]. Most of them were overweight or obese.…”

Depressive Symptomatology and Practice of Safety Measures among Undergraduate Students during COVID-19: Impact of Gender

“…About four-fifths of both male and female undergraduates reported that they cover their noses when sneezing, another vital precautionary behavior promoted by the government. Overall, male undergraduates were less likely to report protective actions against COVID-19, as observed in some other studies [ 24 , 26 ]. Young male undergraduates’ cultural and religious norms and beliefs, as well as their active lifestyles, may have influenced them in not adhering to personal protective measures against COVID-19 that seem to restrict their freedom.…”

“…Gender has been identified as a vital factor that needs to be considered in any health promotion activity. COVID-19-related safety practices promoted by international health agencies have been criticized due to their cultural insensitivity and implementation issues in non-Western societies where gender plays a major role [ 24 , 25 ]. Although hand hygiene practices and covering the nose when sneezing were prevalent behaviors in Western societies even before the pandemic, such practices were not as common in non-Western societies, especially among people in poor socio-economic brackets.…”

Analysis of 329,942 SARS-CoV-2 records retrieved from GISAID database

“…Also, as increased mortality risk is associated with cardiovascular diseases (Yang et al, 2020), the greater percentage of these disorders and thrombosis in men may contribute to fatality increase among males. A higher case fatality rate could also result from the fact that in general, among intubated patients, men are more likely to acquire ventilator-associated pneumonia (Cook et al, 1998, Ahmed, Dumanski, 2020).…”