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COVID-19 affects people differently, in terms of infection with the virus SARS-CoV-2 and mortality rates. In this Special Feature, we focus on some of the sex differences that characterize this pandemic. Share on Pinterest The data that are available so far indicate that there are significant differences between how the sexes respond to the new coronavirus.

All data and statistics are based on publicly available data at the time of publication. Some information may be out of date. Visit our coronavirus hub for the most recent information on the COVID-19 pandemic.Was this helpful?

There are many ways in which the pandemic itself affects peoples day-to-day lives, and gender understood as the ensemble of social expectations, norms, and roles we associate with being a man, woman, trans- or nonbinary person plays a massive part.

On a societal level, COVID-19 has affected cis- and transwomen, for example, differently to how it has cismen, transmen, and nonbinary people. Reproductive rights, decision making around the pandemic, and domestic violence are just some key areas where the pandemic has negatively impacted women.

However, sex differences understood as the biological characteristics we associate with the sex that one is assigned at birth also play an undeniable role in an epidemic or pandemic.

While sex and gender are, arguably, inextricably linked in healthcare, as in every other area of our lives, in this Special Feature, we will focus primarily on the infection rates of SARS-CoV-2 and the mortality rates that COVID-19 causes, broken down by sex.

In specialized literature, these effects fall under the umbrella term of primary effects of the pandemic, while the secondary impact of the pandemic has deeper social and political implications.

Throughout this feature, we use the binary terms man and woman to accurately reflect the studies and the data they use. Sex-disaggregated data lacking

Before delving deeper into the subject of sex differences in COVID-19, it is worth noting that the picture is bound to be incomplete, as not all countries have released their sex-disaggregated data.

A report appearing on the blog of the journal BMJ Global Health on March 24, 2020, reviewed data from 20 countries that had the highest number of confirmed cases of COVID-19 at the time.

Of these 20 countries, Belgium, Malaysia, Netherlands, Portugal, Spain, United Kingdom, and the United States of America did not provide data that was disaggregated, or broken down, by sex.

At the time, the authors of the BMJ report appealed to these countries and others to provide sex specific data.

Anna Purdie, from the University College London, United Kingdom, and her colleagues, noted: We applaud the decision by the Italian government to publish data that are fully sex- and age-disaggregated. Other countries [] are still not publishing national data in this way. We understand but regret this oversight.
At a minimum, we urgently call on countries to publicly report the numbers of diagnosed infections and deaths by sex. Ideally, countries would also disaggregate their data on testing by sex.

Anna Purdie et al.

Since then, countries that include Belgium, the Netherlands, Portugal, and Spain have made their data available.

The U.K. have made only a part of the sex-disaggregated data available for England and Wales, without covering Scotland and Northern Ireland while Malaysia and the U.S. have not made their sex-disaggregated data available at all.

At the time of writing this article, the U.S. still have not released their sex-disaggregated data despite the country having the highest number of COVID-19 cases in the world.

For more research-backed information and resources for mens health, please visit our dedicated hub.Was this helpful? Men more than twice as likely to die

Global Health 5050, an organization that promotes gender equality in healthcare, has rounded up the total and partial data that is available from the countries with the highest numbers of confirmed COVID-19 cases.

According to their data gathering, the highest ratio of male to female deaths, as a result of COVID-19, is in Denmark and Greece: 2.1 to 1.

In these countries, men are more than twice as likely to die from COVID-19 as women. In Denmark, 5.7% of the total number of cases confirmed among men have resulted in death, whereas 2.7% of women with confirmed COVID-19 have died.

In the Republic of Ireland, the male to female mortality ratio is 2 to 1, while Italy and Switzerland have a 1.9 to 1 ratio each.

The greatest parity between the genders from countries that have submitted a full set of data are Iran, with 1.1 to 1, and Norway, with 1.2 to 1.

In Iran, 5.4% of the women patients have died, compared with 5.9% of the men. In Norway, these numbers stand at 1.3% and 1.1%, respectively.

China has a ratio of 1.7, with 2.8% of women having died, compared with 4.7% of men.
Infection rates in womenand men

A side-by-side comparison of infection rates between the sexes does not explain the higher death rates in men, nor is there enough data available to draw a conclusion about infection rates broken down by sexes.

However, it is worth noting that in Denmark, where men are more than twice as likely to die of COVID-19 as women, the proportion of women who contracted the virus was 54%, while that of men was 46%.

By contrast, in Iran, where the ratio of deaths between men and women is less different (1.1 to 1), just 43% of cases are female compared with 57% cases in men.

Until we know the proportion of people from each sex that healthcare professionals are testing, it will be difficult to fully interpret these figures.

What we do know so far is that, overall, nine of the 18 countries that have provided complete sex-disaggregated data have more COVID-19 cases among women than they do among men. Six of the 18 countries have more cases among men than they do among women.

Norway, Sweden, and Germany have a 5050% case ratio.

Other countries where more women have developed COVID-19 include:
Switzerland (53% of women to 47% of men)Spain (51% to 49%)The Netherlands (53% to 47%)Belgium (55% to 45%)South Korea (60% to 40%)Portugal (57% to 43%)Canada (52% to 48%)Republic of Ireland (52% to 45%)

Greece, Italy, Peru, China, and Australia all have a higher number of confirmed cases among men than women.Why are men more likely to die?

Part of the explanation for why the new coronavirus seems to cause more severe illness in men is down to biological sex differences.

Womens innate immune response plays a role. Experts agree that there are sex differences, such as sex chromosomes and sex hormones, that influence how a persons immunity responds to a pathogen.

As a result, women are in general able to mount a more vigorous immune response to infections [and] vaccinations. With previous coronaviruses, specifically, some studies in mice have suggested that the hormone estrogen may have a protective role.

For instance, in the study above, the authors note that in male mice there was an exuberant but ineffective cytokine response. Cytokines are responsible for tissue damage within the lungs and leakage from pulmonary blood vessels.

Estrogens suppress the escalation phase of the immune response that leads to increased cytokine release. The authors showed that female mice treated with an estrogen receptor antagonist died at close to the same rate as the male mice.

As some researchers have noted, lifestyle factors, such as smoking and alcohol consumption, which tend to occur more among men, may also explain the overall higher mortality rates among men.

Science has long linked such behaviors with conditions that we now know are likely to negatively influence the outcome of patients with COVID-19 cardiovascular disease, hypertension, and chronic lung conditions. Why women might be more at risk

On the other hand, the fact that societies have traditionally placed women in the role of caregivers a role which they continue to fulfill predominantly and the fact that the vast majority of healthcare workers are women cold place them at a higher risk of contracting the virus and might explain the higher infection rates in some countries.

An analysis of 104 countries by the World Health Organization (WHO) found that Women represent around 70% of the health workforce. In China, women make up more than 90% of healthcare workers in Hubei province.

These data emphasize the gendered nature of the health workforce and the risk that predominantly female health workers incur, write the authors of a report on the gendered impacts of the pandemic that appears in The Lancet.

Although we cannot yet draw definitive conclusions because sex-disaggregated data is not yet available from all the countries affected, The Lancet report looks at previous epidemics for clues.

During the 201416 west African outbreak of Ebola virus disease, the authors write, gendered norms meant that women were more likely to be infected by the virus, given their predominant roles as caregivers within families and as frontline healthcare workers.

The authors also call out for governments and health institutions to offer and analyze data on sex and gender differences in the pandemic.
Why sex-disaggregated data are urgent

The report in The Lancet reads, Recognising the extent to which disease outbreaks affect women and men differently is a fundamental step to understanding the primary and secondary effects of a health emergency on different individuals and communities, and for creating effective, equitable policies and interventions.

For instance, identifying the key difference that makes women more resilient to the infection could help create drugs that also strengthen mens immune response to the virus.

Devising policies and intervention strategies that consider the needs of women who work as frontline healthcare workers could help prevent the higher infection rates that we see among women.

Finally, men and women tend to react differently to potential vaccines and treatments, so having access to sex-disaggregated data is crucial for conducting safe clinical trials.

As Anna Purdie who also works for Global Health 5050 and her colleagues summarize in their article, Sex-disaggregated data are essential for understanding the distributions of risk, infection, and disease in the population, and the extent to which sex and gender affect clinical outcomes.
Understanding sex and gender in relation to global health should not be seen as an optional add-on but as a core component of ensuring effective and equitable national and global health systems that work for everyone. National governments and global health organizations must urgently face up to this reality.

Anna Purdie et al

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World

Why are airdrops on Gaza so dangerous?

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Why are airdrops on Gaza so dangerous?

The United Nations has condemned airdrops on Gaza, warning they risk killing the starving Palestinians they are intended to help.

Jordan, the United Arab Emirates, and Israel parachuted aid packages into the territory for the first time in months at the weekend amid claims a third of the population has not eaten for days.

But Philippe Lazzarini, commissioner-general for the UN Relief and Work Agency for Palestinian Refugees (UNRWA), has said they “will not reverse the deepening starvation” and often do more harm than good.

‘Make or break’ as starvation looms; Middle East latest

“They are expensive, inefficient & can even kill starving civilians,” he wrote in a statement on X.

What is an airdrop – and why are they dangerous?

There are several ways humanitarian agencies and international allies can deliver aid to regions in need – by land, by sea, or by air.

While parachuting in supply packages from planes may look impressive, airdrops are “fraught with problems”, Sky correspondent in Jordan Sally Lockwood says, and often used as a “desperate last resort”.

“Foreign nations know airdrops are a deeply flawed way of delivering aid,” she says.

“Palestinian sources tell us the aid that’s been dropped so far is not reaching the most vulnerable. They are an attempt to get something to a few – often viewed as a desperate last resort. Gaza is at that point.”

A plane drops aid over Gaza City on Sunday. Pic: AP
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A plane drops aid over Gaza City on Sunday. Pic: AP

Air drops land over Gaza City on Sunday. Pic: AP
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Air drops land over Gaza City on Sunday. Pic: AP

Read more
Israel announces ‘tactical pause’ in fighting
Eyewitness: Aid is sitting idle in Gaza

Military analyst Sean Bell says that delivering aid by air is ideally done when planes can land on a runway – but Gaza’s only landing strip in Rafah was shut down in 2021.

The alternative is “very dangerous”, he warns. “Aircraft flying relatively low and slow over a warzone isn’t very clever. When these parcels hit the ground, there’s a significant danger of them hitting people.”

People in Gaza scramble for aid on Saturday. Pic: @ibrahim.st7 via Storyful
Image:
People in Gaza scramble for aid on Saturday. Pic: @ibrahim.st7 via Storyful

Crucially, they can only deliver a fraction of what lorries can.

“The really big issue is aircraft can only deliver one truckload of aid. Gaza needs 500 truckloads a day, so it’s 0.2% of the daily need,” Bell adds.

They also risk falling into the wrong hands and ending up on the black market.

“Some of it has been looted by gangs and is on the black market already,” Lockwood says.

Air drops land in northern Gaza on Sunday. Pic: AP
Image:
Air drops land in northern Gaza on Sunday. Pic: AP

Why are they happening now?

Israel cut off all supplies to Gaza at the beginning of March, reopening some aid centres in May, but with restrictions they said were designed to stop goods being stolen by Hamas militants.

Israeli authorities control the only three border crossings to the strip: Kerem Shalom in the south, Crossing 147 in the centre, and Erez to the north.

Since the current conflict with Hamas began in October 2023, humanitarian agencies and world leaders have repeatedly accused Israel of not allowing enough deliveries through.

Mr Lazzarini says the UN has “the equivalent of 6,000 trucks” in neighbouring Jordan and Egypt “waiting for the green light to get into Gaza”.

Israel says it has commissioned a “one-week scale-up of aid”, having conducted its own airdrops on Saturday.

In a statement over the weekend, the Israeli Defence Forces said it will work with the UN and other aid organisations to ensure aid is delivered but no more details were given.

Meanwhile on Sunday, it began daily 10-hour pauses in fighting in three areas of Gaza to address the deteriorating humanitarian situation.

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Baby Zainab starved to death in Gaza

According to the Hamas-run health ministry, 133 Palestinians had died of malnutrition by then, including 87 children.

Doctors Without Borders warned on Friday that 25% of young children and pregnant women in Gaza are malnourished.

Israel says there is no famine in Gaza.

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Sky’s Sally Lockwood on the runway in Jordan ahead of Gaza aid airdrop

What are in the airdrops and who is behind them?

Air packages are largely being delivered by C-130 planes. Jordan is reported to be using 10 and the UAE eight.

They can carry eight pallets of goods each, weighing around eight tonnes in total, according to Lockwood, who is on the runway at Jordan’s King Abdullah II airbase.

There are no medical supplies in the packages, she says, only dried food, rice, flour, and baby formula.

Prime Minister Sir Keir Starmer has said the UK will help with airdrops – but no British aircraft have been seen in Jordan so far.

He will discuss the matter with US President Donald Trump during talks in Scotland on Monday.

The RAF delivered 110 tonnes of aid across 10 drops last year as part of a Jordanian-led international coalition – but it is not clear what level of support will be offered this time.

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Technology

Huawei reclaims No. 1 smartphone spot in China — and Apple returns to growth

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Huawei reclaims No. 1 smartphone spot in China — and Apple returns to growth

The Huawei flagship store and the Apple flagship store at Nanjing Road Pedestrian Street in Shanghai, China, Sept. 2, 2024.

Cfoto | Future Publishing | Getty Images

Huawei reclaimed the top spot in China’s smartphone market in the second quarter of the year, while Apple returned to growth in the country — one of its most critical markets — data released by technology market analyst firm Canalys showed on Monday.

Huawei shipped 12.2 million smartphones in China in the three months ended June, a rise of 15% year on year — equating to 18% market share. It’s the first time Huawei has been the biggest player by market share in China since the first quarter of 2024, according to Canalys.

Apple, meanwhile, shipped 10.1 million smartphones in the quarter in China, up 4% year on year and ranking fifth. It is the first time Apple has recorded growth in China since the fourth quarter of 2023, Canalys said.

Shipments represent the number of devices sent to retailers. They do no equate directly to sales but are a gauge of demand.

The numbers come ahead of Apple’s quarterly earnings release this week, with investors watching the company’s performance in China, a market where the Cupertino giant has faced significant challenges, including intense competition from Huawei and other local players such as Xiaomi.

Huawei, which made a comeback at the end of 2023 after its smartphone business was crippled by U.S. sanctions, has eaten away at Apple’s share.

Apple’s return to growth in China will be a welcome sign for investors. The U.S. tech giant “strategically adjusted its pricing” for the iPhone 16 series in China, which helped it grow, Canalys said. Chinese e-commerce firms discounted Apple’s iPhone 16 models during the quarter. And Apple itself also increased trade-in prices for some iPhone models.

Canalys’ numbers back up figures released by Counterpoint Research earlier this month showing Apple’s return to growth in China.

Shares of Apple have fallen around 14.5% this year, partly on concerns over China and geopolitical headwinds.

Key questions for Apple ahead of earnings

U.S. President Donald Trump has threatened Apple with tariffs and urged CEO Tim Cook to manufacture iPhones in America, a move experts have said would be near impossible.

Meanwhile, competition in China has intensified. Huawei has aggressively launched various smartphones in the past year and has started to roll out HarmonyOS 5, its self-developed operating system, across various devices. It is a rival to Google’s Android and Apple’s iOS.

“This move is expected to accelerate the expansion of its independent ecosystem’s user base, while also placing greater demands on system compatibility and user experience,” Lucas Zhong, analyst at Canalys, said in a press release.

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Environment

More US cities are offering free or heavily discounted electric bikes to residents

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More US cities are offering free or heavily discounted electric bikes to residents

Electric bikes are booming in popularity across the US, and cities are starting to take notice. From famous programs like those in Denver to smaller initiatives around the country, local governments are rolling out rebate and incentive programs to make e-bikes more affordable, especially for lower-income residents. The goal? Get more people out of cars and onto two wheels.

E-bike incentives vary widely by city and state, but the overall trend is clear: public officials increasingly see e-bikes as a low-cost, low-emission transportation solution that checks a lot of boxes. E-bikes are cheaper than cars, don’t require gas, and are far more accessible than public transit in many neighborhoods. And with the ability to flatten hills and shrink long commutes, they’re attracting a much broader audience than traditional bikes.

Programs like Denver’s wildly popular e-bike rebate initiative have shown how effective these incentives can be. The city offers over $1,00 off an e-bike purchase depending on income level, and the demand has been enormous. Rhode Island recently launched its own statewide rebate program offering up to $750, and cities like Ann Arbor, Oakland, Providence, and dozens of others are following suit with their own variations. A Bend, Oregon program will offer free e-bikes to locals. Washington D.C. is piloting a rebate targeted at delivery workers, and even some utility companies, like Vermont’s Green Mountain Power, have gotten in on the action.

These programs especially benefit lower-income residents, who may rely on expensive or unreliable transportation options to get to work, school, or the grocery store. By offering higher rebates to income-qualified applicants, many programs aim to level the playing field and make car-free living more realistic.

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Of course, not every program has gone smoothly. California’s statewide e-bike incentive, much hyped before its launch, faced repeated delays and technical issues that left many applicants frustrated. While the program finally began distributing vouchers this year, the rollout highlights the challenges of scaling these efforts statewide without sufficient infrastructure or planning.

Still, the momentum is undeniable. As cities grapple with climate goals, traffic congestion, and rising transportation costs, e-bike rebates are a relatively cheap way to make a big impact. The biggest challenge now may be keeping up with demand.

Electrek’s Take:

This is one of those rare win-win policies: cleaner air, less traffic, more mobility for people who need it most – and it’s all powered by a single horsepower and some political will. Let’s hope even more cities plug into this trend.

Of course, funding is the biggest obstacle to keeping programs like these rolling. But with the benefits stacking up, from reduced road damage to improved air quality, hopefully the rewards outweigh the upfront cost.

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