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Gender Dynamics of COVID-19

The COVID-19 pandemic is affecting everyone, but some populations are experiencing it differently than others. In this column, Professor Iyabo Obasanjo from W&M’s Department of Kinesiology and Health Sciences talks about the differences in the way men and women are experiencing COVID-19 and its fallout. Professor Obasanjo has a PhD in Epidemiology and her areas of specialization are Global Health, Health Policy, and the Social Determinants of Health.

Q.  I heard that more men are dying from COVID-19 than women. Is this true?

A.  From the initial outbreak in China and all the countries that have reported data, the case fatality rate is higher in men than in women. This means that of those infected with the disease, men tend to have more severe disease and die at higher rates than women. Getting the disease is gender neutral; it depends on getting exposed to the disease by contact with someone with the disease. Healthcare workers have high rates of exposure, especially those who have close contact with the sick to do their jobs. Because women tend to care for the sick at home and women predominate in nursing jobs, women would tend to have high rates of exposure. That said, the actual rate of exposure for each gender is hard to calculate since many get the disease and don’t show symptoms and we cannot tell they were exposed. 

Q.  How is COVID-19 affecting women?

A.  The majority of healthcare workers that care directly for patients are women, from CNAs to RNs, and they work in nursing homes and hospitals where the potential for exposure to the disease is high. But most of the general impact on women’s lives has been the impact of the shutdown to slow down transmission of the disease. Women predominate in service jobs that serve clients in face-to-face businesses, such as hair and nail salons, and during the shutdown these workplaces had to close completely and not do business.  People in professional jobs were able to work online since such jobs don’t involve face-to-face service to clients, so transmission of COVID-19 if either person is infected doesn’t take place.  Women are proportionally fewer in professional jobs where people can work from home.  Also, women tend to work more in the cash economy, and country-level stimulus packages tend not to focus on assisting people working predominately by receiving cash.  So, the shutdown has disproportionally affected women globally.  Finally, women are doing more of the at-home education of children and childcare during the shutdown. An interesting finding is that women are submitting less scientific articles during the shutdown compared to men. Other effects include increased reporting of domestic violence in many countries.

Q.  How can policy makers address these differential impacts on women?

A.  Economic stimulus packages must consider how women’s work and lives are impacted by COVID and caring for family. Policy initiatives such as paid family leave and universal health coverage are critical for improving women’s lives in response to COVID-19.  

Q.  You mentioned that men are more likely to die from the disease, conditional on becoming infected. Why is this?

A.  The reason men die at higher rates is still a highly researched area but the preliminary findings suggest that men’s immune systems react more vigorously to the virus causing COVID-19, and this creates an overwhelming reaction in the lungs that leads to a ‘cytokine storm.’ Cytokines are messenger proteins our immune system sends to fight foreign invasive organisms that enter the body. When coronaviruses invade the cells in the upper respiratory system and lungs, the cytokines directed at the virus kill the lung cells housing the virus as well. So in patients with the overactive immune system fighting the virus, the virus and the immune response are both killing lung cells, leading to more severe disease.  Women tend to have less severe immune response to COVID-19 and the pneumonia and other symptoms of the disease resolve over time with supportive care.

Q.  What courses can W&M students take to learn more about the health effects of COVID-19?

A.  In Introduction to Public Health and Introduction to Global Health, we cover various issues surrounding COVID-19, from its detection in Wuhan, China in November 2019, to the sequencing of its genome, to the initial spread in January, and then the more widespread pandemic that started in February. We study the population dynamics, including why a country like Italy (where grandparents tend to live at home in extended family units) has a different trajectory compared to countries where nursing homes exist for the elderly. The impact of population age distribution and rate of underlying diseases and other features of the pandemic are thoroughly examined.

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