Nepal | July 05, 2020

COVID-19: The gender conundrum

Due to lack of mass testing, Nepal is clueless as to how gender is playing in the middle of this pandemic

Shaurya Kshatri
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As the national tally from the novel coronavirus mounts, evidence is growing that men are more susceptible to the virus than females. COVID-19 has affected a higher share of men in China, India, the USA, and the pattern seems to be largely repeating itself country after country and Nepal is no exception.

According to the record provided by the Ministry of Health and Population, until June 4 (5:00 pm), out of the 2,634 confirmed cases, 2,450 were males and 184 females. So far the number of discharged male patients amounts to 234 as compared to 56 women, which goes on to show only around 9.5 per cent rate of recovery in the former and 30 .4 per cent in the latter.

Similarly, at the time of this publication, the Nepal government has recorded the death of 10 individuals, consisting of seven men, a 29-year-old woman and an infant girl.

As of yet, there is no general consensus among researchers explaining this phenomenon, but nonetheless, a few intriguing clues have begun surfacing.

A recent research published in the European Heart Journal suggests that men have a higher amount of angiotensin-converting enzyme 2 (ACE2) in their plasma. It is said that SARS-CoV-2, the causative agent of COVID-19, uses this ACE2 receptor to enter cells.

Another study links the presence of two X chromosomes in women as contributing to their immune system. Many studies loosely correlate the higher prevalence of smoking in men as a contributing factor to a fragile respiratory system. This can’t be true here, because in Nepal, the prevalence of smoking among adult females is one of the highest in the WHO South-East Asia Region.

In fact, none of the aforementioned factors can be assumed as reasons to explain the gender-based discrepancy simply because local researchers have not yet begun to analyse the male to female correlation.

Finding the underlying reason

Despite the lack of a concrete answer, local medical professionals unanimously agree on one underlying factor as being the prime reason for the discrepancy.

“The number of migrant workers who have returned, mostly from India and Gulf countries, are predominantly male,” purports Dr Shravan Kumar Mishra, Consultant Virologist, Ministry of Health and Population (MoHP).

Backing Dr Mishra’s argument is Dr Sher Bahadur Pun, Virologist at the Sukraraj Tropical and Infectious Disease Hospital, Teku.

Be it the 2012 ban on women under the age of 30 years from migrating to the Arab states for domestic work, or the 2014 ban stopping women of all ages from migrating for low-skilled work, the government has time and again adopted labour migration policies restricting women migration, which explains the lack of female migrant workers. Hence, lesser number of female COVID-19 infections.

If this migrant worker theory is to be believed, then why haven’t these returning male workers transmitted the virus to their wives, children and parents and their community? And if they had indeed transferred the virus, shouldn’t the number of infected females be higher too?

This, however, doesn’t seem to be the case, because in Nepal, as per Dr Pun’s observation, COVID-19 hasn’t been as communicable as had been anticipated.

“After testing the families of those who returned from abroad and those who tested positive, we have mostly found that the virus hasn’t spread from the host to the family members or at the community level,” he elucidates.

This has prompted Dr Pun to refer to COVID-19 in Nepal as ‘silent corona’ — a term used to describe the asymptomatic nature of the virus.

But that’s not to say the nature of virus has been non communicable Dr Pun asserts.

The two-year-old infant girl from Bajura, the eighth recorded death from COVID-19 in Nepal, is said to have contracted the virus from her father, a migrant worker from India.

Dr Mishra informs, “Out of all the tests in Nepal, almost 80 per cent has been carried out among returning migrant workers and people with a travel history.”

And migrant workers are mostly males.

This suggests that male-to-female discrepancy is as a result of a lack of testing among those with no travel history. If such people (those with no travel history) were to be accounted for, then probably, as Dr Mishra points out, the male-to-female ratio might be different.

Tests are what is lacking among people with no travel history to give concrete information.

Differences not perfectly consistent

According to a joint study by the MoHP and Nepal Health Research Council called ‘Nepal Burden of Disease 2017’, the life expectancy rate of females (73.3 years) was seen higher than in males (68.7 years).

Although, the report doesn’t explain the reason for a higher rate of life expectancy among women, it does, however, provide a rather contradictory argument, which says that Chronic Obstructive Pulmonary Disease (COPD) and respiratory disease were more apparent in females.

The danger of respiratory illness ranking higher among women of Nepal may be explained by the fact that they are more likely to be exposed to indoor air pollutants, suggests Dr Mishra, resulting from the use of solid biomass fuels for cooking.

It is widely agreed that COVID-19 affects those with a weak respiratory system the most, and if Nepali women are seen as being more susceptible to respiratory ailments, why has the number of female COVID-19 infected patients been so drastically lower than men?

“Despite general susceptibility of women to respiratory illness, the coronavirus isn’t as apparent in them because most of the time in Nepali culture it’s the men who go outside and work, especially in the villages, while women are confined to their homes.”

And it is those who go out of homes who get infected easily. However, this assumption is merely based on conjecture.

Understanding how the virus impacts the genders could help determine the most effective treatment for individual patients. Perhaps it is high time health professionals in Nepal considered this issue seriously.

A version of this article appears in e-paper on June 5, 2020, of The Himalayan Times.

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