COVID: Battling in the sexes

In the acute phase, men with COVID experience more severe symptoms and higher mortality than women. In that way COVID is no different from many of the viruses that have attacked humans over the last century. 

The health of women is not just women’s health

Men are more attractive to viral infections than women. For example, hepatitis A and tuberculosis occur more in men than in women. Viral loads are also consistently higher in male patients with hepatitis C virus and human immunodeficiency virus (HIV). Women have stronger immune responses, especially to vaccines. These findings suggest a more robust ability among women to control infectious agents. 

Unfortunately, these sex-related advantages exhibited by women in the acute phases of COVID prevention and disease do not last as disproportionate numbers of women suffer from long COVID. In addition, evidence is now emerging that females are more vulnerable to develop post-COVID symptoms than men.

After the acute phase of COVID, women are more prone to suffer from shortness of breath. Exercising, walking and concentration are more difficult for women,  post-acute COVID. Females also exhibited higher depressive levels and poor sleep quality than males eight months after hospital discharge.

And it is not just adult women who are suffering more from long COVID, adolescent girls, already vulnerable to mental health problems, are experiencing higher levels of depression associated with long COVID.

Just as women respond differently to vaccines, so they will respond differently with the advent of treatments for COVID. There are already more than 50 commonly used drugs that affect women differently from men.

The health of women is broader than what is commonly  thought of as “women’s health.” Biological sex differences matter and they go beyond the female reproductive organs. We can no longer accept a health care world where these broader biological differences  are acknowledged but not acted upon.  The basic principles of communicating uncertainty, ensuring patient understanding, and managing patient expectations need to be gendered  to prevent the clinical disasters of ignoring these differences. COVID is a great catalyst to promote the provision of services that recognize biological sex differences. Female patients and all health-care professionals should demand more than just research on the effects of newer and evolving diseases and drugs on women, to work towards the incorporation of evidence-based gender differences in everyday diagnosis and treatment.  It is no longer only an issue of equality nor diversity, rather  practicality,  as women are the majority of the earth’s human inhabitants. 

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