I remember the devastating impact of the epidemic at its onset: once otherwise healthy people began to die quickly, the stigma surrounding the disease increased and the government was slow to respond. Without drugs to treat the disease, the only tools to help prevent it were changes in individual behavior. My job at the National Institute of Mental Health was then to stimulate a scientific research program on behavior change strategies, to convene the first conference of the National Institutes of Health (NIH) on women and AIDS and to contribute to the first report. of the Surgeon General warning all Americans about it. new infectious disease.
At that time, Dr. Anthony Fauci was at another NIH institute, the National Institute of Allergies and Infectious Diseases, working to find drugs to treat and prevent HIV / AIDS.
Initially, the research community did not recognize women as an important group to study. As a result, clinical trials of HIV / AIDS drugs and preventive interventions have excluded them. We continue to pay the price for this public health surveillance: women now make up almost 52% of people living with HIV worldwide. The disease disproportionately affects women of color: in 2018, 79% of new HIV diagnoses among women in America were from racial and ethnic minorities.
Now we see similar events unfolding with the Covid-19 pandemic. Again, the government is responding slowly. Again, vulnerable populations – especially people of color and the poor – are dying at a higher rate. Again, we need to modernize our health systems and mobilize the research community to develop effective screening, treatment and prevention strategies. And again, the response did not take into account significant gender differences in the impact of Covid-19 in America.
Regarding Covid-19, biological sex differences in the immune and endocrine systems may help explain the more severe cases and the higher death rates in men. Chromosomes and sex hormones influence the immune response to germs, and women in general develop stronger immune responses to infections and vaccinations.
Studies in mice infected with severe acute respiratory syndrome coronavirus (SARS) suggest that estrogens may have protective effects. For example, the female sex hormone decreased damage to the lungs during a cytokine storm, a fatal over-reaction of the body’s immune system in response to infection, by defusing that immune response. In the same study, female mice died at about the same rate as male mice when their ovaries were removed or the estrogen receptors were inhibited. Although it is far from a mouse to a woman or a man to determine the mechanisms of a disease, animal studies can help us understand the role that sexual differences play in hormones and the immune system in the presentation symptoms, severity of illness and death rates.
Women may also have increased immunity after infection. A comparison of 331 patients in Wuhan, China, found that in the most severe cases, higher levels of antibodies were found in women compared to men after recovering from Covid-19. The research has not yet been peer reviewed, and we need more studies to examine this correlation, which could potentially have a profound effect as scientists scramble to find effective treatments.
Although biology can protect women due to immunological or hormonal factors, they suffer the devastating social and economic consequences of Covid-19 more acutely. A recent report indicates that women are 16% more likely than men to say that the pandemic has had a negative impact on their mental health. Reports of domestic violence are also increasing – which disproportionately affects women as victims – some local media outlets reported a 46% increase in calls to the police in the United States. When isolated in Hubei, China, Jianli County police reported triple the number of domestic violence cases in February compared to the same period a year earlier.
In addition, more women than men are at the forefront of the healthcare response to Covid-19. According to the US Census Bureau, women make up 76% of all health care workers and 85% of all registered nurses, behavioral aides and home care workers. In some states, health workers account for 20% of all coronavirus cases and many of them die from the disease.
Women have also been hit hard by unemployment resulting from Covid-19. In the United States, women accounted for almost 60% of the 700,000 jobs lost in March alone, according to estimates by the Institute for Women’s Policy Research.
In addition, the economic repercussions of the pandemic could have a lasting impact on women at work and as caregivers. Our government must mobilize to respond to the hardest hit economically and focus on getting women back to work safely with equal pay and a risk premium for essential workers.
Women’s reproductive health services, including access to contraception, are also at risk. In Texas, abortion has been listed as a non-essential procedure that could be postponed until the governor reviews the order after a legal battle. Iowa, Ohio, Arkansas and Alaska also imposed restrictions on medical procedures during the pandemic.
We have also seen new data indicating that coronavirus disproportionately affects people of color, as well as the elderly. Unfortunately, in the midst of the Covid-19 pandemic, most countries, including the United States, still do not report data disaggregated by age, sex, race or ethnicity, with the breakdowns listed side by side in order to be able to compare them.
In response to congressional oversight, the Centers for Disease Control and Prevention have now added racial / ethnic data by age, where available from states. However, it should be noted that this important racial data is lacking for 64% of the reported cases. The CDC does not yet include side-by-side data on these three key demographic factors for comparison. In addition, there is an alarming omission of biological sex in the key table of demographic factors.
Although HIV and the new coronavirus differ in many ways, we can apply the lessons we have learned from HIV to this deadly new pandemic. As we strive to find effective treatments and a vaccine, the inclusion of women and minorities in clinical trials is essential.
Additional research is needed to investigate the potential impact of sex, as well as other demographic factors, on Covid-19 patients. It is also imperative to study these demographic factors together to better understand the mechanisms of coronavirus infection, its clinical course and the safety and effectiveness of interventions. In the meantime, research data collected on biological, social and environmental risk and protective factors around the world must be broken down and analyzed across these demographic categories.
In the fight against Covid-19, women and minorities must also be involved in the design and implementation of response plans for coronaviruses. It is a cornerstone to help curb the devastating impact of this disease on the health and economic well-being of women – and men – in our country.