27 September 2023

Viral gap: Why the male-centric response to COVID-19 threatens lives

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Alyson J. McGregor* says lack of knowledge about how COVID-19 may affect women and men differently prevents us from delivering appropriate care.

I’m coming to you from the front lines of the battle against the novel coronavirus.

As an Associate Professor of Emergency Medicine at Brown University, I spend dozens of hours a week in the emergency department.

While the worries at ground level are overwhelming, my greatest concerns are larger and more systemic — in particular, I’m concerned that our male-centric medical system is missing the opportunity to gather crucial information about COVID-19 patients that could potentially save lives and reduce pandemic severity in the future.

As the co-founder and Director for the Division of Sex and Gender in Emergency Medicine (SGEM) at Brown University and the co-founder of the US Sex and Gender Women’s Health Collaborative, I study sex differences in medicine — particularly in emergency medicine.

I research and teach about the ways in which women are biologically different than men, and how these differences impact everything from diagnoses to treatment protocols to pharmaceutical bioavailability.

My concerns around COVID-19 are many, but among them is our lack of understanding about how the virus may affect women and men differently, and how this may prevent us from delivering the most appropriate and personalised care for all patients.

Women are biologically different than men from the level of our DNA on up.

But because our modern medical system is male-centric — foundationally based on knowledge of, research on and observation of male bodies and male patterns of illness — women often don’t fit the textbook models by which we learn to diagnose and treat our patients.

Across every facet of our medical system, women have poorer outcomes than men.

They have delays in diagnosis for the most common and deadly conditions, and a greater likelihood of receiving a psychiatric diagnosis for physical symptoms.

Many pharmaceuticals are also metabolised differently by women, and therefore produce different outcomes and side effects than they do for men.

Women even experience pain through different biological mechanisms than men.

Why does any of this matter?

It matters because we know next to nothing about how the methods we’re using to treat COVID-19 patients affect women’s unique biology.

Nor do we know how and why the virus is affecting men and women differently on a biological level.

That lack of knowledge may result in poorer outcomes for everyone.

There have been many news stories about how COVID-19 seems to hit men harder than women.

It appears that men account for over 61 per cent of coronavirus deaths.

But it seems that, except for some references to men’s poor handwashing practices and higher rates of smoking, little is being done to investigate this.

Epidemiological data from the SARS and MERS outbreaks of recent decades suggest that there may be sex differences in coronavirus disease outcomes beyond what one would expect from gendered social and lifestyle habits.

Women also have different immune response pathways than men.

Their bodies treat “attackers” differently.

However, we don’t understand enough about these mechanisms to apply them to COVID-19.

If we have the ability to track COVID-19 cases and provide daily updates, we have the ability to gather sex-specific information on those infected as well.

Making these data available would allow researchers like me to start evaluating susceptibility trends and outcomes with greater focus and specificity, potentially allowing us to reduce the spread of the virus and suggest more effective preventive measures for future pandemics.

If in fact women do have some natural protection against these viruses, we can put it to work to create better outcomes for men and women alike.

My colleagues in the research field are working at a breakneck pace to try to find a drug — or a cocktail of drugs — that works reliably to cripple the virus.

But if they are following established standards for research protocols, their models and projections are likely based on past male-centric research, the behaviours of male cells in petri dishes, and test results in male animal subjects.

In the eyes of the medical community, this isn’t a failure or an oversight.

It’s simply the way things have always been done.

Researching on male cells, animals and study participants saves time and expenses, because we don’t have to test for pregnancy, or account for the hormonal differences at each phase of menstruation.

However, because women and men are biologically different, what works for men may not always work reliably (or safely) for women.

My concern isn’t that we lack the capacity to gather the information we need to understand sex differences in viral diseases.

Rather, I fear that in situations like the one we are now facing — where time is of the essence, and everyone is racing to find a cure — researchers will turn to the most understood and straightforward testing pathways: male-dominant, with the results of all test subjects lumped together in the final analysis.

While this may not sound like a big deal given what we’re facing, it is.

Because women more often experience adverse reactions to prescription drugs, it’s necessary to analyse the data from female test subjects separately to ensure that an accurate picture is attained.

Sex differences can and should be integrated into our understanding of susceptibility, illness severity, treatments, pharmaceuticals, and vaccine formulations.

We have more sophisticated surveillance and reporting at our disposal than ever before; let’s use this volume of data to gain a better understanding of not only how the coronavirus affects individuals based on biological sex, but how we can improve our capacities for response and treatment of all future health threats.

Lives are on the line.

We need to do this right.

* Alyson J. McGregor is an Associate Professor of Emergency Medicine at the Warren Alpert Medical School of Brown University and co-founder and Director of the Division of Sex and Gender in Emergency Medicine.

This article first appeared at blogs.scientificamerican.com.

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