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An Official Publication of the Indian Association of Oral and Maxillofacial Pathologists


 
  Table of Contents    
SHORT COMMUNICATION  
Year : 2022  |  Volume : 26  |  Issue : 4  |  Page : 555-557
 

COVID-19: A gender-biased pandemic


1 Department of Oral Pathology, Faculty of Dental Sciences, SGT University, Gurugram, Haryana, India
2 Dr. Ajay Madan, Fellow Minimal Access Surgery, BL Kapoor Hospital, New Delhi, India

Date of Submission11-May-2022
Date of Acceptance06-Jul-2022
Date of Web Publication22-Dec-2022

Correspondence Address:
Pulin Saluja
Department of Oral Pathology, Faculty of Dental Sciences, SGT University, Gurugram, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jomfp.jomfp_210_22

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   Abstract 


The world today is in the midst of its second wave of the coronavirus disease 2019 (Covid-19), which started as an outbreak first reported in December 2019, Wuhan City, the capital of Hubei Province in China. Then soon enough, it was declared as a public health emergency of international concern on January 30, 2020 by WHO and a pandemic on March 11, 2020. While initially greater emphasis was laid on the elderly and people with co-morbidities such as diabetes mellitus, hypertension, obesity, and immune-compromised states as being at high risk of contracting the Covid-19 disease and/or dying of it, but by now, it is clear that being male is also a factor. Data and studies from different countries across the globe involving China, the United States of America, and European nations such as Italy have showed that although there is no difference based on sex in the number of cases testing positive for the virus, more men died from the virus, and the case-fatality ratio is greater among men than women. Women are infected by the virus as frequently as men but men are more likely to contract severe forms of disease and succumb to it. The reason behind this sex-biased mortality seen in Covid-19 cannot be explained by a single genetic or social factor. The present short communication aims at enumerating the possible reasons behind this gender-biased pandemic.


Keywords: Covid-19, Covid-19 disease, gender bias, pandemic


How to cite this article:
Singh R, Saluja P, Madan A. COVID-19: A gender-biased pandemic. J Oral Maxillofac Pathol 2022;26:555-7

How to cite this URL:
Singh R, Saluja P, Madan A. COVID-19: A gender-biased pandemic. J Oral Maxillofac Pathol [serial online] 2022 [cited 2023 Jan 27];26:555-7. Available from: https://www.jomfp.in/text.asp?2022/26/4/555/364790




The world today is in the midst of its second wave of the coronavirus disease 2019 (Covid-19), which started as an outbreak first reported in December 2019, Wuhan City, the capital of Hubei Province in China. Then soon enough, it was declared as a public health emergency of international concern on January 30, 2020 by WHO and a pandemic on March 11, 2020. While initially greater emphasis was laid on the elderly and people with co-morbidities such as diabetes mellitus, hypertension, obesity, and immune-compromised states as being at high risk of contracting the Covid-19 disease and/or dying of it, but by now, it is clear that being male is also a factor.

Data and studies from different countries across the globe involving China, the United States of America, and European nations such as Italy have showed that although there is no difference based on sex in the number of cases testing positive for the virus, more men died from the virus, and the case-fatality ratio is greater among men than women. Women are infected by the virus as frequently as men but men are more likely to contract severe forms of disease and succumb to it.

The reason behind this sex-biased mortality seen in coronavirus disease 2019 (Covid-19) cannot be explained by a single genetic or social factor. Many possible reasons have been put forward trying to explain why men tend to suffer more by the novel coronavirus as most health patterns are a combination of factors. The factors that could be responsible can be classified under genetics, immunological, sociological and psychological, and behavioural aspects. And it has been seen that the interplay of these factors leads to adversity from the virus in particularly males.


   Genetics Top


Biologically, men and women are different. And this difference accounts for the many variations present in their innate and adaptive immune responses. The basic difference lies in their sex chromosome. It has been stated by Centers for Disease Control and Prevention (CDC) in its article “Men and Covid-19” dated July 16, 2020 that “The X chromosome contains a high density of immune-related genes; therefore, women generally mount stronger innate and adaptive immune responses than men.”[1] Studies shown that sex chromosomes and related hormones in females contribute to their greater immunity as X- chromosome encodes for certain immune-related genes and as women have two of these X- chromosomes, they pose an advantage and that explains how females are more resistant to infections than males.

Another biological contributing factor is the role of angiotensin-converting enzyme-2 (ACE 2). It has been found that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) uses the angiotensin-converting enzyme coded by ACE2 gene for its entry into the host cells. The virus attaches to these ACE2 gene receptors and paves its way into the respiratory epithelial cells, from where disease progression takes place. Men have higher plasma ACE2 levels than women do, which explains how men are more susceptible to infection and/or the consequences of SARS-CoV-2.


   Immunology Top


In building a stronger immune system among females, the female sex hormones play a major role. Hormone such as oestrogen stimulates the body's immune system to act against the disease–causing microorganisms that enter the host, whereas in males, testosterone acts as an inhibitor of body's defences against the pathogen.[2]

Another factor that sabotages the immunity among men is the higher prevalence of certain pre-existing conditions. Men suffer more often from hypertension, diabetes, cardiovascular diseases, and chronic renal disorders that lead to increased mortality among men.


   Sociology Top


Men in the social environment

In a country such as India where the population of men far exceeds the population of women, the demographics are naturally leaned towards men.

However, it cannot be ignored that men are still the sole breadwinners in the majority of households and are forced to step outside for various chores that makes them more prone towards contracting the virus.

A history of male-biased research

The fact that when it comes to a scientific research, it is mostly males who have been studied more compared to females cannot be ignored while we discuss the effects of a disease on a particular gender. The question that arises here is if the disparity that exists between biological sex differences in research is likely to be a major reason why we still know relatively little about sex differences in immunity, including the current COVID-19 pandemic? It is only recently that National Institutes of Health has required sex differences data to be collected in researches.[3]

This actively demonstrates that while there has not been much growth and advancements in women's health but has also posed a challenge in understanding men's status in comparison.


   Psychology and Behavioural Habits Top


We have seen sex differences that exist based on biological, immunological, and sociological aspects, but there are also certain psychological and behavioural habits that differ in men and women that can account for how men are at greater risk from the coronavirus.[4],[5]

Compared to women, men tend to engage in more high-risk behaviours such as smoking, consuming alcohol, and tobacco chewing. It has also been noticed by experts that men also tend to have lower rates than women of hand washing, social distancing, wearing masks, and delay in seeking medical help.[1] These are the behavioural habits that put men at higher risk of contracting the virus and severe form of infections from it.

To sum up everything that has been stated so far, the biological sex of an individual does play a role in determining the outcome of infection by Covid-19. Several factors contributing to this fact include the differences in immune system, sex hormones, expression of more ACE2 receptors by men, and prevalence of high-risk behaviours among men compared to women.

Although it is important to identify these factors, it is equally important to determine ways of eliminating the growing mortality because of Covid-19 among men. For this, CDC had proposed the following strategies:

  1. Health education, community engagement, and public health outreach
  2. Health promotion and preventive care;
  3. Sex-disaggregated data in clinical practice and policy;
  4. Rehabilitation and health care delivery infrastructure; and
  5. Health policy and legislative interventions.[1]


These measures, when undertaken at national levels, can bring about significant changes in the data numbers. But with the current ongoing scenario, much emphasis has been laid on individual efforts and the three gold standard practices of face masking, hand washing, and social distancing seem like the only hope for individuals.

There is no denial that the pandemic has been tough on everyone but as we know even in the tough times, tough gets going. In unpredictable times such as these, hope and faith is what keeps the world going. The tireless efforts made every day, every minute by all the front line workers and people who stepped up to face the challenges, with acts both big and small, give us the hope for a better future that is not far away.

”Although the world is full of suffering, it is also full of overcoming of it.”

–Helen Keller

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Griffith DM, Sharma G, Holliday CS, Enyia OK, Valliere M, Semlow AR, et al. Men and COVID-19: A biopsychosocial approach to understanding sex differences in mortality and recommendations for practice and policy interventions. Prev Chronic Dis 2020;17:E63.  Back to cited text no. 1
    
2.
Mukherjee S, Pahan K. Is COVID-19 Gender sensitive? J NeuroimmunePharmacol 2021;6:1-10.  Back to cited text no. 2
    
3.
Freund A. Why do more men die from COVID-19? Available from: https://p.dw.com/p/3eNPe. [Last accessed on 2021 May23].  Back to cited text no. 3
    
4.
Peckham H, Gruijter NM, Raine C, Radziszewska A, Ciurtin C, Lucy R, et al. Male sex identified by global COVID-19 meta-analysis as a risk factor for death and ITU admission. Nat Commun 2020;11:6317.  Back to cited text no. 4
    
5.
Bwire GM. Coronavirus: Why men are more vulnerable to Covid-19 than women? SN ComprClin Med2020;2:874-6.  Back to cited text no. 5
    




 

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