Can a virus distinguish between genders? Yes, the coronavirus doesThe coronavirus shows the key role of gender during a pandemic and how it impacts men, women and LGBTI+ persons in the long run.
From the United States and China to Saudi Arabia and Denmark, a clear picture is emerging. Once a person develops serious symptoms of COVID-19, men have a higher risk of becoming severely ill and dying. On the other hand, women appear to be tested positive with corona virus in larger numbers than men do.
Thus, the coronavirus pandemic illustrates the key impact of gender on our survival and health. But why is that? As this article demonstrates, the answers lies in both biology and cultural norms. According to a paper in the medical journal The Lancet, this knowledge is important, because the better we understand the impact of the virus, the better we can fight it and prevent the spread.
‘Addressing the health needs of men and women equally will help societies recover and resist future human tragedies,’ writes The Lancet.
For example, knowledge about gendered variations in need can enable more effective and appropriate treatment of individual patients, more efficacious vaccines and assistance to those most at risk.
However, it is not only in relation to the ultimate question of life and death that the coronavirus affects different genders differently. All over the world, it is also clear that men, women and LGBTQIA+ persons are feeling the consequences of the ensuing crisis on their bodies, economics and rights differently. This article offers a review of the main trends.
More men die from COVID-19
Globally, 4.12 million people have been infected, and just about 300,000 have died while being infected with the coronavirus, according to official figures. These figures, however, do not paint the full picture.
While several countries, including the United Kingdom, the United States and Russia, do not include gender information in their national reports, other countries do. In China, men get more severely ill and are more likely to die from the coronavirus than women. 2.8 per cent of all Chinese men who have tested positive with COVID-19 have died, while the same is true of 1.7 per cent of infected Chinese women.
Other countries show a similar trend: According to the organisation Global Health 50/50, which gathers data from official national registers, 71 per cent of the people who died with the disease in Italy are men, while men account for 62 per cent of deaths in Germany. In Denmark, the trend is similar, yet less pronounced, as men account for 57 per cent of the 533 people who have died in Denmark according to Statens Serum Institute’s (SSI, the Danish national serum institute) daily report from 11 May 2020.
A study of the SARS outbreak in 2003 shows that the differentiated gender impact is not unique to the novel coronavirus but applies to coronaviruses in general. The infection rate for SARS was about the same for men and women, but as with the novel coronavirus, fatality rates were much higher for men. In Hong Kong, 22 per cent of infected men died, compared to 13 per cent of infected women. With a novel virus, as the current coronavirus, researchers rely on existing knowledge in their attempt to determine what they might be dealing with. Here, data from other diseases show that men typically have higher fatality rates than women. For example, men are 1.5 times more likely to die from tuberculosis and more than twice as likely to develop the chronic disease Hodgkins lymphoma, a form of cancer, if they are infected by the Epstein-Barr virus.
But why are men more likely to die when they are infected?
Cultural factors explaining why more men die from COVID-19
The explanation of the higher male fatality rates may lie in gendered behaviour differences.
Studies from the United States have found that men are less likely to wash their hands and less likely to use soap when they do, less likely to seek medical assistance and more likely to shrug off public health advice. These are broad generalisations, but they do suggest that lower hygiene standards and fewer doctor’s visits negatively impact men’s health and increases their risk.
Indeed, the data show that the vast majority of people who die with COVID-19 have other, underlying health issues. For example, data from Statens Serum Institute show that most of the people who have tested positive with COVID-19 and died in Denmark had been hospitalised for other diagnoses – including cancer, diabetes or chronic pulmonary disease – within the past five years.
This points to a trend related to men, cultural behaviour and health. A Chinese study suggests that smoking has a significant negative impact on fatality rates. In China, half of male adults smoke, compared only 2 per cent of women smoke. A similar trend is seen in Saudi Arabia, where shisha smoking has been identified as a source of increased fatality as well as infection because the mouthpiece is passed from person to person.
However, even if smoking is generally more common among men than women around the world, the difference is not as pronounced in other countries as it is in China. In Italy, 28 per cent of men smoke, compared to 19 per cent of women. In Denmark, figures from 2018 show that women and men are equally likely to lit a cigarette.
‘I don’t think smoking is the leading factor,’ says Sabra Klein, a professor at Johns Hopkins Bloomberg School of Public Health to The Guardian.
‘It makes me think that there must be something universal that’s contributing to this.’
Like other researchers and medical professionals within the field, she looks to genetics for an answer. The Canadian scientist and physician Sharon Moalem even argues that when it comes to survival, men are the weaker sex, as he writes in the New York Times in a counter-response to the many cultural explanations as to why pandemics, such as COVID-19, kill more men than women.
Genetic explanations as to why men are more likely to die from COVID-19
Studies show that male and female bodies fight infections differently. Women have a stronger immune response, that is, a stronger defence against foreign antigens entering the body, for example a virus. Women’s bodies simply fight back harder against disease. According to some researchers, the reason is that women have two X chromosomes, while men carry one Y and one X chromosome. The strength of the X chromosome in relation to a virus is that it contains a higher number of genes pertaining to the immune system, thus enabling a stronger defence back against a virus.
Moreover, women’s higher production of the hormone oestrogen makes hips wider, breasts bigger and leads to a more effective immune defence than testosterone, a hormone that is generally higher in men and, for example, promotes greater muscle mass.
Experiments with mice have shown that raising oestrogen levels causes immune cells to respond more effectively to an invading virus. In fact, the male hormone testosterone tends to inhibit the immune response, while oestrogen increases the number of immune cells and the intensity of their response.
Because of genetic differences between men’s and women’s cellular and hormonal profiles, it seems that men get more severely ill and take longer to recover, which may explain why the coronavirus affects men the way it does and why they are at a much higher risk of succumbing to coronavirus and other infectious diseases.
Why women are tested positive with corona virus in larger numbers than men
While men are more likely to die, the organisation Global Health 50/50 emphasises that women test positive for COVID-19 at slightly higher rates than men. Thus, women account for 58 per cent of the cases in the Netherlands and 60 per cent in South Korea, and in Denmark, the daily report from Statens Serum Institute on 11 May 2020 shows that women account for 58 per cent of the cases.
The higher infection rates for women may reflect that more women are in closer contact with people who are infected with COVID-19. Globally, women make up 70 per cent of healthcare workers. In Shanghai, more than 90 per cent of nurses are women, while there is an equal number of male and female physicians involved in fighting the pandemic. In the United States, women hold 76 per cent of all healthcare jobs. Many women also work on the ‘front lines’ in the fight against the virus as cleaners in hospitals and residential institutions.
There are countries where the rate of infection is the same for men and women, or where men make up the majority. In Norway, the same number of men and women are tested positive; in China, 51 per cent of those testing positive are men; and in Iran, 57 per cent of infected patients are men. To understand these figures, we need to consider a number of factors.
First, all countries do not necessarily base their infection and fatality data on the same parameters. Thus, we need to be cautious when we make international comparisons. Also, the figures are not necessarily representative of a country’s population as a whole. Many countries do not undertake testing to achieve a representative national picture. Instead, the focus in Denmark, for example, has been on testing at-risk groups, such as healthcare workers who risk spreading the infection to others if they are infected themselves. Because there are more women working in the healthcare system and in the caring professions overall, more women have been tested in Denmark, according to Statens Serum Institute.
Nevertheless, the over-representation of women in the healthcare sector means that they are much more likely to have close contact and be involved in treating persons who are infected with COVID-19. They have a big responsibility for helping patients and are themselves at heightened risk of getting sick.
The gendered impact of the coronavirus pandemic
Thus, it is not only in matters of life and death that the coronavirus reveals gender differences in our roles during a crisis, such as the COVID-19 pandemic. Since the disease was discovered in China in December 2019, reactions and solutions have also had different consequences for men, women and LGBTQIA+ persons.
In the absence of comparable data, more actors have set out to gather material. Among other initiatives, researchers around the world have joined forces to create an online document that gathers data and experiences regarding the relationship between gender and the coronavirus to help showing what is at stake.
One of the most significant trends worldwide is the “hero worship” of healthcare workers, a profession where women, as already mentioned, make up the majority. This has led to renewed debate about whether healthcare workers, such as nurses and midwives, receive adequate pay.
At the same time, other trends are emerging. We see an increase in domestic violence following stay-at-home restrictions, more women show signs of depression and anxiety, and while the economic impact is hard on everyone, women are particularly struggling. Finally, some governments are using the coronavirus crisis as an excuse to reduce access to abortion and to undermine the rights of LGBTQIA+ persons. The following sections outline these prominent trends.
Why the coronavirus crisis has sparked debate about nurses’ pay
In the United Kingdom and Italy, people applaud them from their balconies, the Danish Queen highlights their contributions in an address to the nation, and photos of people with marks on their faces from prolonged use of protective masks go viral online: healthcare workers and carers are celebrated as heroes in the fight against the coronavirus.
However, this hero worship has also sparked debate – is the adoration translated into real appreciation, including pay levels that match their essential role?
Until now, that has not been the case, as documented in a 2019 study by IntraHealth International, Nursing Now and Johnson & Johnson on gendered barriers for nurses around the world. The report is based on a study of 2,537 nurses in 117 countries that featured both interviews and quantitative data.
The report shows that despite the critical role nurses play, the general perception is that they perform tasks that require little professional skill, and that nurses are motivated by altruism and a desire to show care rather than a desire to lead, deliver and improve their skills. In extension of this, the report shows that although women make up the majority of nursing staff all over the world, they still face a glass ceiling, as men are favoured for advancement and executive positions.
These findings reflect that nursing is viewed as a ‘female occupation’ with a focus on care rather than high pay or career opportunities. This is also reflected in an average gender pay gap of around 28 per cent in the health workforce, as documented in a 2019 study of conditions in 104 countries. The same study found that once differences in occupation and working hours are accounted for, the gender pay gap is 11 per cent.
The Danish writer and project manager Katrine Arnfred has raised this issue in relation to the coronavirus crisis in Denmark in several Danish media outlets, including the daily newspaper Politiken:
‘In a profit-driven capitalist society there is no focus on the role of the caring professions. Care and nurturing are not directly reflected in the curves of the market economy. The invisibility of professional care and nurturing have deep roots in history and in the alliance between capitalism and the patriarchy and, not least, in the patriarchy’s centuries-old ability to denigrate women and render them invisible,’ she writes.
According to Megan O’Donnell, an analyst at the American Center for Global Development, this underlying mentality has a harmful effect on women and the healthcare sector.
‘Underinvestment holds systems back from preparedness in times of crisis,’ she writes in a blog post on the website of the Center for Global Development.
On this topic, the British newspaper The Independent has published a story about the fact that masks and protective gear in the UK’s National Health Service, NHS, is generally designed to fit the size and shape of male bodies and thus is a poor fit for women, even though they make up 75 per cent of NHS staff.
Thus, she argues, the problem is not just that women do not receive a pay that reflects their contribution. It is also that on a global level, the healthcare sector is understaffed and has equipment shortages, and without the proper economic support adapted to match women’s position, there is going to be a shortage of nurses and other healthcare workers. In part, because there were already too few trained workers to meet the global demand, and in part, because they get infected and thus cannot work. Adding to this, women in many cases have to do much of the work in the home when societies shut down as they have during the coronavirus pandemic.
Why the economic crisis affects men and women differently
The coronavirus pandemic has led to millions of layoffs, is pushing companies to the brink of existence and is draining public budgets all over the world. Few people will be able to avoid the impact of the economic crisis that follows in the wake of the pandemic. However, the economic crisis has a differential impact on different income groups and, not least, different genders. In the short term, women seem to bear the brunt of the crisis, but some researchers and analysts believe that the crisis may help make remove gender barriers and disparities on the labour market.
In a column at VOX, a portal for economic research, the economists Titan Alon, Matthias Doepke, Jane Olmstead-Rumsey and Michèle Tertilt point out in past recessions men have faced greater risk of unemployment than women. Their point is based on American data, but it illustrates that due to the gender composition of different sectors of the economy, men are often more at risk in a recession. Part of the explanation, according to their data, is that a larger fraction of employed men in the United States, 46 per cent, than employed women in the United States, 24 per cent, work in construction, manufacturing, trade, transportation and utilities, which are typically hard hit during ‘normal’ recessions. On the other hand, 40 per cent of all working women in the United States are employed in the government or health or education sectors, compared to 20 per cent of working men; sectors that are less susceptible to economic fluctuations.
Another reason why men’s employment has typically been in more cyclical sectors is what the authors calls spousal insurance: when married men lose their jobs, their wives can choose to increase their working hours or enter the labour force, since a greater share of women work part-time or primarily carry out unpaid work in the home.
However, the economic crisis following the coronavirus pandemic appears to be taking a different course, because different sectors come under pressure this time. In assessing the risk, the VOX authors consider two factors in particular: whether an occupation is considered critical, and thus not affected by stay-at-home orders, and whether the nature of the work allows people to telecommute. Anyone who is not in a critical field and who is not able to work from home has a higher risk of being laid off as a result of the coronavirus pandemic. According to the VOX economists, this puts women at risk of unemployment during the current crisis, because fewer women meet the two criteria. This prediction is borne out by American data, where women account for 59 per cent of those registering for unemployment benefits.
The authors further underscore that being laid off during a recession has a long-term, negative impact on future earnings and job security. Thus, women’s higher unemployment rates may exacerbate the gender wage gap for many years to come.
Right now, in the US, data shows that women make up 55 per cent of the people who have become unemployed following coronavirus’ impact on the labour market. Yet, in Denmark, numbers paint a slightly different picture of who is becoming unemployed right now. Here, men make up 55 per cent of the unemployed following the crisis of coronavirus, and the men are 30 to 59 years of age and with limited education. However, the Danish Agency for Labour Market and Recruitment notes that the current distribution may be due to differences in terms of notice; thus, the situation may change over the coming months, as persons with one to six months’ notice register as unemployed.
With or without a job, many people, regardless of gender, have been sent home, whether they are furloughed, laid off or are required to work from home.
Looking after children is an added challenge for working parents. Schools, preschools and after-school programmes are closed, and the grandparents are encouraged to keep a safe distance. According to the American economists in the VOX article, this leaves single parents with the biggest challenge. In the United States, 19 million children live with single parents. Without access to paid leave from their work, many single parents will be forced to quit their jobs because they cannot work and care for their children at the same time.
Moreover, studies show that in two-parent households, even in 2020, the mother often does most of the work related to cooking, cleaning, helping the children with homework and so forth – also in Denmark. This may hamper their job performance or the workload they are able to take on, compared to men, which may affect their chances of keeping their jobs, either because they quit or because they are laid off.
This a trend that many organisations, all over the world, recognise. In Morocco, it has made the organisations FLDF and LDDF-Injad encourage men to do their share of the household chores, now that they have the opportunity, for example in a Facebook campaign.
Why the occurrence of domestic violence is on the rise as a result of the coronavirus pandemic
In a less encouraging direction, the Moroccan organisations have also had to set up a hotline during the coronavirus pandemic, to help victims of domestic violence reaching them while they are in lock-down at home. Unfortunately, this kind of situation often leads to an uptick in domestic violence. Psychological as well as physical. Both men and women are exposed to abuse, but experience and data show that women are particularly at risk of domestic psychological, physical and sexual abuse.
The problem is not limited to Morocco. According to the United Nations’ World Health Organization, WHO, violence increases dramatically, when families are forced to spend more time together. This effect is particularly pronounced in relationships with a history of abuse; however, it may also occur unrelated to prior conditions as family members spend more time in close contact, and families cope with additional stress and potential economic or job losses. The tendency is known from holidays such as Christmas, Ramadan and summer holidays.
Accordingly, the Moroccan organisations are not alone in confirming that the societal situation following the coronavirus pandemic fits this pattern. Crisis centres from the Middle East and Europe to the United States and South America report busy telephone hotlines.
In France, domestic violence has increased by 30 per cent since the lockdown order came into effect on 17 March. In Paris alone, the increase is 36 per cent. In Brazil, domestic violence is believedto have increased by 40 to 50 per cent, while Catalonia in northern Spain saw an increase of 20 per cent during the first days of lockdown, according to the regional government. In Cyprus, calls increased by 30 per cent.
In Denmark, women are more than three times more likely than men to be the victims of domestic violence, and the Danish organisation Landsorganisationen for Kvindekrisecentre (LOKK, National Association of Women’s Crisis Centers) anticipated the same trend that has been seen the world over. Instead, they saw the opposite: Danish crisis centres have received fewer calls than normal. In fact, only about half volume. The director of the Krisecenter for Kvinder (Crisis Centre for Women) in the Danish city of Aalborg, Lone Skov Møller, explains to TV2 Nord that she still expects that there is an increase in domestic violence.
‘Normally, the women reach out to us when they are on their own, for example when the man is away at work. But today, the families are together all the time, and this may mean that the women don’t have a way to contact us safely,’ she says to the TV station.
Victims of violence are often closely monitored by their partners. In order to address this situation, several crisis centres also operate e-mail-based and chat hotlines, as it can be easier to contact the centres by text than in a phone call without being detected.
What happens to our mental health during a time of crisis such as the current pandemic
Pressures at home, uncertainty about when the world is going to come out ‘on the other side’ and the potential economic losses mean that the coronavirus crisis contains all the stuff that creates anxiety: uncertainty, fear, isolation. This is documented in a Danish study.
The study was conducted by a team including Professor Søren Dinesen Østergaard in the Department for Depression and Anxiety Disorders at Aarhus University Hospital.
‘With the current corona crisis we are seeing more symptoms in people with mental disorders, and in addition, the crisis is also pushing healthy individuals over the edge, in particular to severe depression,’ he says to the national weekly newspaper Weekendavisen.
As part of his work, Østergaard conducted a study in early April 2020, where he asked about 3,000 Danes how they are feeling. The same study was previously carried out in 2016. The screening shows that more women in particular are now showing signs of depression. In 2016, that was true of 25 per cent, today the number is 29 per cent: an increase of 17 per cent.
But why are women more affected than men?
Generally, depression is about twice as common in women as in men, says Østergaard to Weekendavisen. However, part of the explanation may be the phrasing of the question in the survey. In late April 2020, his team conducts a separate study focused especially on men to determine whether they too are suffering, only with different manifestations.
‘There may be a tendency for men to act out, while women look inward,’ he says.
Regardless, the study suggests that there will be a greater number of patients struggling with poor mental health in the future. Both because more people refrain from seeking help during this time and because a pandemic imposes a heavy psychological burden.
Why there is a particular health risk for LGBTQIA+ persons
For LGBTQIA+ persons, the pandemic has a unique set of consequences related directly to their gender identity and sexuality.
In the United States, more than 100 LGBTQIA+ organisations have published a joint open letter outlining three reasons why LGBTQIA+ persons face increased risk factors in a pandemic, such as the coronavirus, particularly with regard to their access to healthcare.
First, the group points out that the LGBTQIA+ population uses tobacco at rates that are 50 per cent higher than the general population, which may lead to more severe complications if they are infected. Second, they point out that the LGBTQ+ population has higher rates of HIV and cancer and may thus be more vulnerable if they are infected. And third, many people who identify as LGBTQIA+ are more reluctant to seek medical care because they have had stigmatizing experiences at the doctor’s office, in hospitals or similar.
Moreover, two recent studies conducted in connection with the COVID-19 outbreak find that the coronavirus pandemic has particularly severe implications for LGBTQIA+ persons.
‘LGBTQ youth have been found to be at significant increased risk for depression, anxiety, substance use, and suicidality. These risks are even more pronounced among youth who are transgender and/or nonbinary. Thus, LGBTQ youth may be particularly vulnerable to negative mental health impacts associated with the COVID-19 pandemic,’ writes The Trevor Project, which did one of the studies.
Thus, the authors underscore that physical distancing does not equate with social isolation. They also call on governments and politicians to advocate actively for LGBTQIA+ persons, as this group is particularly at risk of additional stigmatisation in epidemics and pandemics – with HIV as the clearest example because it affected homosexual men particularly hard.
How governments use the coronavirus pandemic to limit the rights of LGBTQIA+ persons
There is nothing to indicate that LGBTQIA+ persons are at greater risk of being infected with COVID-19 than others. However, there are clear examples that governments with an agenda to undermine the rights of LGBTQIA+ persons use the coronavirus as an opportunity to carry out arbitrary arrests. One example is Uganda, which recently arrested 20 LGBTQIA+ persons and charged them with engaging in risk behaviour that could spread coronavirus infection.
According to Ugandan police, the 20 individuals were in violation of the rules on social distancing during the pandemic, when the police raided a shelter where they were staying. Advocacy organisations claim that the Ugandan authorities are using the restrictions to target LGBTQIA+ persons, as other group gatherings were not raided.
A similar picture is emerging from Hungary, where the government under cover of the coronavirus storm has proposed a bill that would make it illegal to change gender identity in official documents. In Poland – as in Tunisia and the United Kingdom – LGBTQIA+ organisations report that coronavirus lockdown restrictions are driving their members to stay home or even to move back in with their families, who do not approve of their gender identity or sexuality, which can lead to isolation, violence and bullying.
‘I would say that there is a huge group in our community that is more scared of their current home/work situation than the virus itself,’ says Julia Maciocha, chairperson of Volunteers of Equality Foundation, which organizes Warsaw’s annual Equality Parade, to TIME magazine.
Just as festivals and big events are cancelled the world over this summer, so are Pride events that celebrate LGBTQIA+ persons’ existence and rights. However, even if things do not go to plan, there is always a rainbow after the rain, and several organisations are currently working on an online version called Global Pride that participants can join, no matter where in the world they are.
‘Global Pride will be able to give others that beautiful moment of feeling: ”I am not alone, I am loved and I am with my fellow community”,’ says Matthew Van As, who is normally involved in organising the annual Pride in Cape Town, South Africa, to TIME.
How the coronavirus jeopardises women’s right to control their own bodies
Some countries are taking advantage of the situation to restrict other rights. For example in the United States, where the states of Ohio and Alabama have passed temporary abortion bans.
These states do not consider abortion an essential procedure and thus argue that abortions should be subject to the same rules as other non-essential procedures that are being postponed in order to economise on medical staff, protective gear, respirators and other resources.
In Poland, the government has taken this approach one step further. The country already has some of the strictest abortion legislation in Europe, which only permits abortion in case of rape, incest, a serious threat to the woman’s life, or severe foetal abnormalities. The Polish government tried to impose the new restrictions in 2018, but Polish supporters of freer access to legal abortion took to the street to protest. Now, under cover of the coronavirus crisis, the Polish government is redoubling its efforts to pass the new legislation. On 16 April 2020, the bill was debated in the Polish parliament, where the legislators could either pass or reject the bill. Instead, they chose the middle-road option, sending the bill back to the parliamentary committee that had prepared it. According to The Guardian, this has previously been a way to let legislation quietly die, although the ultimate outcome will not be clear until later.
Why the coronavirus crisis could lead to both setbacks and breakthroughs for gender equality
Even though most of the world has been affected by the coronavirus for more than two months by now, some few months longer, we still do not have a clear picture of all the consequences. Meanwhile, the situation continues to develop rapidly from day to day. However, as indicated by the reports, studies and statements quoted in this article, it seems clear that the coronavirus is affecting men, women and LGBTQIA+ persons in different ways. While more men become severely ill and die from the disease, so far, the wider consequences seem to affect women and LGBTQIA+ persons disproportionately.
In one response to this development, the United Nations is now underscoring that the coronavirus can cause setbacks for gender equality globally, as the situation exacerbates existing disparities. Situations for women and girls are deteriorating.
‘I urge governments to put women and girls at the centre of their efforts to recover from COVID-19,’ says António Guterres, Secreatary-General of the United Nations.
Among other initiatives he calls on governments to expand social safety nets, valuing and paying healthcare workers and to target measures to protect and stimulate the economy at women to prevent failing anyone who is already struggling to get by.
Some might argue that past crises have in fact led to a boost, not a setback, for gender equality. For example, many women entered the labour market during the Second World War because their husbands were not around to act as the breadwinner. So maybe this crisis, too, could help men and women move forward rather than going back to the gender roles of the 1950s.
In countries where women and men currently have almost equal opportunities some believe that the crisis may in the long term make it easier, for example, to work full-time while also being a mother of children living at home; roles many do not necessarily feel able to reconcile today.
In response to the pandemic, many companies now for the first time introduce work-from-home options. If these arrangements become permanent, they could arguably benefit working women, who will otherwise have to juggle a career and childcare needs. Previously, the lack of this sort of flexibility has been highlighted as an important cause of wide gender wage gaps in business and financial services.
Moreover, the crisis may lead to a shift in social norms. More fathers may be persuaded to deal with the laundry, and kids step in front of the camera during Zoom or Skype meetings. This may lead to everyday life being put into the same category as one’s career and make room for people to handle both – in their own and others’ assessment.