By Mary Hearty

While there are no differences in confirmed COVID-19 cases between men and women, men have a higher risk of severe disease and death.

This is linked to both biological sex-based differences such as immunological, hormonal and vascular systems, and gender-related factors like co-morbidities, risk and health seeking behaviours.

Asha George, Professor at the University of Western Cape, School of Public Health stated as she gave a presentation on Gender and COVID-19 elements of clinical trials, clinical characterization and mental health, during a virtual conference on COVID-19 in Africa, hosted by Africa Academy of Sciences (AAS).

She further noted that more complex findings continue to emerge indicating that specific groups of women such as postmenopausal women may have similar risks as men.

As with other viral infections, the professor said that biological differences in women and men’s immune system activity and its modulation by sex hormones are likely to play a role in disease severity.

She added: “This may as well explain early indications of a higher risk of post COVID-19 condition, also known as ‘long COVID’. Besides, there are indications that sex differences with regards to COVID-19 vaccines have adverse events with clinical implications, and differences in sensitivity to antibody tests.”

In clinical trials, she continued: “sex and gender contribute to dosing, safety, efficacy profiles, and the duration of protection. And this is defined by the different types of vaccines and strains of the virus. The virus is evolving and this means that we are still learning.”

Despite regulatory and journal reporting guidelines of nearly 2500 COVID-19 related studies, George noted that less than 5% of investigators had pre-planned for sex-disaggregated data analysis in their studies on clinical trials.

Another challenge, she said was including pregnant women in the clinical trial. “As we learn from Ebola crisis, there was disproportionate mortality among pregnant women. However, they were excluded from clinical trials for vaccines, thereby indirectly leading to many unavoidable deaths.”

On mental health, she noted that the pandemic brought a lot of stress. For instance, while gender based violence in men increased due to pressure from job insecurity and economic uncertainty, in women it was as a result of more domestic and unpaid work, combined with anxiety of financial insecurities and loss of livelihood.

Studies show that before COVID-19, one-third of women went through GBV. Nevertheless, this increased during the pandemic. Some finding indicate that women who undergo GBV are 97 % more likely to experience depressive symptoms.

Also, harmful use of alcohol and poor mental health in men leads to more GBV than women. Yet, mental health services and other social services were disrupted.

She emphasized that digital health interventions hold promise for mental health management, but they must consider sex and gender in their design and delivery.

She further called for the importance of considering mental health challenges for those most marginalized by multiple forms of inequality alongside gender inequalities such as LGBTQI+, sex workers and adolescents, among others.

Again, she mentioned ways on how to change research paradigm, like putting structural incentives and penalties, speaking to women to amplify demand, using subversive and tactical language, shifting the norm, and shaming the patriarchy.

Dr Richard Lessells, Infectious Diseases Specialist with the KwaZulu-Natal Research Innovation and Sequencing Platform at University of KwaZulu-Natal, also said that there is need for strong collaborative clinical networks.

“For instance, International Severe Acute Respiratory and Emerging Infection Consortia (ISARIC), a global federation of clinical research networks, providing a proficient, coordinated, and agile research response to outbreak-prone infectious diseases was established to prevent illness and deaths from infectious disease outbreaks,” Dr Lessells explained.

Dixon Chimanda, Director at the African Mental Health Research Initiative, and Program Manager of University of Zimbabwe, during the conference stated also the need for task shifting to address the treatment gap which has been worsened by COVID-19.

Chimanda also talked about the need to leverage digital platforms to deliver mental healthcare in Africa as use of phones has tremendously increased.

He added: “We need to integrate these interventions to existing services. For instance, when it comes to task shifting, we need to use non-professionals at community level because the strength we have in Africa is at the community level. This is by training these non-professionals to deliver mental health services.”

Also, Chimanda stated that adequate resource allocation towards mental health is vital, acknowledging that African countries allocate less than one percent towards mental health, and that allocation primarily goes towards strengthening institutions.

“We need to move away from institutionalization at the concept of treating mental health, and really shift towards treating it within the communities,” he said.