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A gender divide when it comes to COVID-19?

Image credit: tykhyi / 123rf. Illustration of gender.
The case fatality rate for COVID-19 rate is higher among women than men, new research suggests. Image credit: tykhyi / 123rf

Much has been made of how the COVID-19 pandemic affects groups of society differently – and fault lines may be there when it comes to gender and COVID-19 deaths, recent research suggests. 

More Indian men are diagnosed with COVID-19 and more COVID-19 deaths are reported among men. However, the case fatality rate (CFR) for COVID-19 is higher in women, as is the proportion of women tested who test positive compared to men who are tested, according to “Equal risk, unequal burden? Gender differentials in COVID-19 mortality in India”, published in the Journal of Global Health Sciences (JGHS). 

According to data compiled until May 20th, the case fatality rate (CFR) due to COVID-19 – the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), commonly referred to simply as the coronavirus – is higher among Indian women than among men. The CFR among females stands at 3.3 percent, compared to 2.9 percent of males. Men bear a higher burden of coronavirus infections according to the research, accounting for 66 percent of COVID-19 cases. The CFR for COVID-19 for India as a whole on May 20th stood at 3.1 percent. 

“The data till May 20, 2020, suggests that the overall risk of mortality among women is slightly higher than men,” said the study’s lead author William Joe, an assistant professor at the Institute of Economic Growth. This, he said, “is largely driven by a significantly higher risk of death among women in the age group 40-49 years. In all other age groups, including the elderly, we find that the mortality risk among men and women is more or less similar.” 

Meanwhile, men accounted for 67 percent of tests conducted between January 30th and April 30th. However, 4.2 percent of women who are tested test positive, compared to 3.8 percent of men who are tested.

It is important to note, as an IndiaSpend analysis observes, “the researchers acknowledged two limitations: One, that the data were crowdsourced, and two, that India’s testing numbers are low. A higher rate of testing could change the patterns.” The study observes that “greater focus on data collection and sharing of age-sex specific COVID-19 cases and mortality data is necessary to develop robust estimates of COVID-19 case fatality to support policy decisions.” 

Yet concerns over gender disparity during the pandemic are not new. A Lancet paper published in April noted, women are especially vulnerable to the secondary effects of the pandemic. “Women carry a different kind of burden from COVID-19,” the article stated. “Inequities disproportionately affect their wellbeing and economic resilience during lockdowns. Households are under strain, but child care, elderly care, and housework typically fall on women. Concerns over increased domestic violence are growing. With health services overstretched and charities under-resourced, women’s sexual and reproductive health services, as well as prenatal and postnatal care, are disrupted.” 

The risk extends to health workers. Accredited social health activists (ASHAs), for example, remain underpaid and undervalued despite the key role they play on the frontline of the pandemic. Often they are not afforded even basic protective equipment, leaving them vulnerable to infection. 

Health Issues India has reported at length about the gender-based disparities and issues facing Indian girls and women. This, Joe told The New Indian Express, could explain the sex-based differential in CFR. “The social determinants like access to healthcare and general health and nutrition status which are generally worse for women in India than their male counterparts could explain these differences that defy the global trend,” he said. Joe has noted that, at the global level, “some studies suggest higher mortality among men.” 

Study co-author S. V. Subramanian, a professor, in the Department of Social and Behavioral Sciences at the Harvard T.H. Chan School of Public Health, concurred, observing “Nutritional status is a key factor in immune response. Poor physical fitness and respiratory health because of the household and environmental conditions also affects women disproportionately. These are all gendered concerns and should receive policy attention.” Men, meanwhile, are more vulnerable to other risk factors for higher mortality such as certain underlying conditions and lifestyle habits. 

“Since a greater number of men are getting infected with COVID-19, we also expected that a greater number of men would be dying from this cause,” said Subramanian. “But the whole focus on numbers can undermine the risks that a woman may face if she gets infected with COVID-19.” 

The JGHS study concludes by highlighting that “evidence to understand the equity aspect of COVID-19 infection burden and mortality risk is an important area for further research.” The pandemic is an evolving health crisis and we will understand more in the months ahead. In the interim, research on the various determinants of risk during the crisis is the need of the hour. 

“Equal risk, unequal burden? Gender differentials in COVID-19 mortality in India” can be accessed here.

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