Puzzle in Covid-19 infections to the women in India

Puzzle in Covid-19 infections to the women in India
Researchers are wondering whether women in India are testing late. Source: Getty Images
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Daily US Times: Data shows more men are dying from Covid-19 than women across the world. In the US, China, Italy, for example, more men have been infected by the virus and a higher proportion of men have died. But when it come to women in India, something other is happening.

“Being male is as much a risk factor for the coronavirus as being old”, said Sabra Klein, a scientist who studies sex differences in viral infections at Johns Hopkins Bloomberg School of Public Health.

But something puzzling is happening in India.

New research by a group of scientists in US and India shows that although men make up the majority of infections, women face a higher risk of dying from the coronavirus than men.

The study is based on Covid-19 deaths in India until 20 May. It shows early estimates that 3.3% of all women in India contracting the infection were dying compared to 2.9% of all men. (India had a caseload of more than 110,000 with 3,433 deaths and a fatality rate of 3.1% when the study was conducted.)

In the 40-49 age group, 3.2% of the infected women have died, compared to 2.1% of men. Only females have died in the 5-19 age group.

SV Subramanian, one of the leader authors of the study and a professor of population health at Harvard University told that the narrative of calculating the Covid-19 fatality rate by groups has conflated two key metrics – mortality risk and mortality burden.

Mortality risk measures the probability of death in a specific group- in this case, total number of deaths of women divided by confirmed infections among women.

Mortality burden, on the other hand, gives you the number of deaths among women as a percentage share of the total deaths, both men and women.

For the large part, the statistics have looked at the latter – men having a greater share of total deaths (63% in India, hewing to international data) – but “inferred the former risk”, Prof Subramanian says.

He says: “Our overall conclusion is that, when infected, women do not seem to have any specific survival advantage [in India].”

More than 300,000 infections have been reported in India. Source: Getty Images

“How much of this can be attributable to biological factors and how much of this is associated with social factors is unclear. Gender can be a critical factor in Indian settings,” he added.

But the findings are certainly striking because they run counter to what has been observed other parts of the world.

For one, men are more likely to suffer from co-morbidities or underlying health conditions, like hypertension and cardio-vascular disease, says Kunihiro Matsushita, a professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health.

In many countries, men also smoke more than women, and some studies have shown that men wash their hands less frequently than women.

According to Prof Matsushita, male patients have a higher risk of contracting severe Covid-19 infection. He said this on the basis of that studies he had participated in.

Scientists from various countries also believe that women have a lower mortality risk because of sturdier immune defences.

And have hormones like oestrogen which has “beneficial effects on upper and lower airways and is associated with stimulation of the immune response to upper airway infections”.

Prof Matsushita said: “In that regard, a higher case fatality rate in women than men in this report is certainly unique.”

But he says the research data needs to be scrutinised in the context of how Covid-19 is diagnosed in India. “For example, is the opportunity to get a test same between men and women?” he wonders.

There could be more to this puzzle than what meets the eye.

More than 4,000 people have died of Covid-19 in India. Source: Getty Images

There are more older women than men in India and women outlive men in the country. Is this leading to more deaths among women, as elderly people are vulnerable to the Covid-19 infection?

Also, women in India are often self-medicate at home and more likely to delay going to doctors and women’s health is more likely to be ignored in a household.

So the question stands- are women arriving late for testing and treatment?

T Jacob John, a retired professor of virology at Christian Medical College, Vellore says: “We need to dissect the gender data to find out more about what’s going on.”

Prof Subramanian says that researchers agree to keep a close watch and keep updating the results.