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CanCOVID Speaker Series: The Impact of Sex and Gender on COVID-19:

Drs Pilote and Norris contributed as presenters at the CanCOVID Speaker Series on March 16, 2021. Their talk, 'The Impact of Sex and Gender on COVID-19,' was very well received.

A recorded version of the talk is posted here: https://www.youtube.com/watch?v=wryK2ynhRzA

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CanCOVID Speaker Series: The Impact of Sex and Gender on COVID-19 Among the many unknowns regarding coronavirus disease 2019 (COVID-19) is the way in which sex and gender affect the risk of acquiring the virus, illness presentation, disease management and outcomes. Sex, a biological attribute, and gender, a social construct, may both influence an individual’s susceptibility, vulnerability and exposure to ... www.youtube.com

Listen to Dr. Louise Pilote talk about Sexe et genre: les differences en matiere de risque et de gestion de la Covid-19. Webinar was hosted by Heart and Stroke. [ Video here: Sexe et genre: les differences en matiere de risque et de gestion de la Covid-19.  Read here: presentation_differences_de_sexe_et_de_genre_1er_mai_2020_finallpilote_only.pdf ]

Listen to Dr. Colleen Norris talk about Sex & Gender Differences in the Risk Management of Covid-19. Webinar was hosted by Heart and Stroke. [ Video here: Sex & Gender Differences in the Risk Management of Covid-19. Read here:  sex_and_gender_and_covid_19_c._norris.pdf ]

EU: Understanding gender dimension for MSCA projects

Gender-Net: Integrating the Gender Analysis into Research (IGAR)

Plotina project: Contrasting gender biases in the evaluation and recruitment of professors and researchers

Suggested Readings

• July 2020: Reflections: Women in Medicine: Dr. Louise Pilote. [Read here]
• July 2020:Variations between women and men in risk factors, treatments, cardiovascular disease incidence, and death in 27 high-income, middle-income, and low-income countries (PURE): a prospective cohort study. [ Read here ]
• July 2020: Women are most affected by pandemics — lessons from past outbreaks. [ Read here ]
• June 2020: Sex differences in immune responses to SARS-CoV-2 that underlie disease outcomes. MedRxiv BMJ Yale [ Read here ]
• June 2020: Considering how biological sex impacts immune responses and COVID-19 outcomes. Nature Reviews | Immunology. [ Read here: rdcu.be/b4ROB ]
• June 2020: Where are the women? Gender inequalities in COVID-19 research authorship.  [ Read here: https://gh.bmj.com/content/5/7/e002922]
• June 2020: Published in 'comment & response' section, in the JAMA Internal Medicine, co-authored by Going FWD's Dr. Valeria Raparelli & colleagues ""Sex, Gender, and Precision Medicine. [ jamainternal_biskup_2020_le_200017.pdf ]
• May 2020: Sex Differences in Symptom Presentation in Acute Coronary Syndromes: A Systematic Review and Meta‐analysis. [ Read here ]
• April 2020: Clinical Advances in Sex- and Gender-Informed Medicine to Improve the Health of All, A Review. Published in JAMA Internal Medicine. [ jamainternal_bartz_2020_rv_190005.pdf ]
• Health inequities during Covid19. Access to care has been an ongoing health care issue for socially and economically disadvantaged populations in the United States for many decades. The recent COVID-19 pandemic has highlighted these disparities as people of color suffer disparate mortality and face growing inequities in care. [ Read here: https://home.liebertpub.com/publications/health-equity/641]
• Health inequities during Covid19. COVID-19 does not affect everyone equally. In the US, it is exposing inequities in the health system. Aaron van Dorn, Rebecca E Cooney, and Miriam L Sabin report from New York.In the US, New York City has so far borne the brunt of the coronavirus disease 2019 (COVID-19) pandemic, with the highest reported number of cases and the highest death toll in the country. The first COVID-19 case in the city was reported on March 1, but community transmission was firmly established on March 7. As of April 14, New York State has tested nearly half a million people, among whom 195 031 have tested positive. In New York City alone, 106 763 people have tested positive and 7349 have died.[Read here: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30893-X/fulltext]
• A preprint for Lancet by South African researchers presents a meta-analysis of how differences in biological sex are linked to the risk of, among other things, mortality for COVID-19. They have analyzed 29 studies covering a total of 206,128 cases.They found no difference in how men versus women are affected by COVID-19 (52% men), but men were on average 150% more likely to end up in intensive care unit. They were on average 60% more likely to die. Some explanations are introduced like possible sex differences in expression of entry proteins for the virus (ACE2 and TMPRSS2): [ Read here: Sex-Bias in COVID-19: A Meta-Analysis and Review of Sex Differences in Disease and Immunity.]
• Understanding sexual dimorphism in COVID -19 in the article. New attention to sexual dimorphism in normal mammalian physiology and disease has uncovered a previously unappreciated breadth of mechanisms by which females and males differentially exhibit quantitative phenotypes [Read here: Sex drives dimorphic immune responses to viral infections ]
• The study showed sex differences: In the case series, however, male cases tended to be more serious than female (P = 0.035). In the public data set, the number of males who died from COVID-19 is 2.4 times that of females (70.3 vs. 29.7%, P = 0.016). In SARS patients, the gender role in mortality was also observed. The percentage of males were higher in the deceased group than in the survived group (P = 0.015). [ Read here: Gender Differences in Patients With COVID-19: Focus on Severity and Mortality ]
• The immune system is aging differently in men and women. The study in 172 healthy individuals  (ages 22-93) found that sex differences become more evident after age 65, including signs of poor adaptive / specific immune system in men. [ Read here: Sexual-dimorphism in human immune system aging ]
• There are marked differences between the sexes in their immune response to infections and vaccination, with females often having significantly higher responses.This study generates a number of hypotheses on the sex differences observed in the human immune system and their relationship to mechanisms involved in the antibody response to vaccination. [Read here: Systems analysis of sex differences reveals an immunosuppressive role for testosterone in the response to influenza vaccination ]
• Research has shown that among mice and rats that there is sex difference in ACE2 expression. [ Read here: Sex differences in renal angiotensin converting enzyme 2 (ACE2) activity are 17β-oestradiol-dependent and sex chromosome-independent]
• Epidemiologic data suggested that there was an obvious predominance of young adult patients with a slight female proneness in severe acute respiratory syndrome (SARS). The angiotensin-converting enzyme 2 (ACE2) was very recently identified as a functional receptor for SARS virus and is therefore a prime target for pathogenesis and pharmacological intervention. Rats of both genders at three distinct ages (young-adult, 3 months; middle-aged, 12 months; old, 24 months) were evaluated to determine the characteristic of ACE2 expression in lung and the effect of aging and gender on its expression. [ Read here: Age- and gender-related difference of ACE2 expression in rat lung] 
• The New Science of Sex and Gender. Why the new science of sex & gender matters for everyone.Sex is supposed to be simple—at least at the molecular level. The biological explanations that appear in textbooks amount to X + X = ♀ and X + Y = ♂. Venus or Mars, pink or blue. As science looks more closely, however, it becomes increasingly clear that a pair of chromosomes do not always suffice to distinguish girl/boy—either from the standpoint of sex (biological traits) or of gender (social identity). [ Read here ]
• Atherosclerosis is a chronic inflammatory vascular disease and the predominant cause of heart attack and ischemic stroke. Despite the well-known sexual dimorphism in the incidence and complications of atherosclerosis, there are relatively limited data in the clinical and preclinical literature to rigorously address mechanisms underlying sex as a biological variable in atherosclerosis. In multiple histological and imaging studies, overall plaque burden and markers of inflammation appear to be greater in men than women and are predictive of cardiovascular events. [ Read here: Sex as a Biological Variable in Atherosclerosis] 
• An article by Amber Dance on sex differences in pain. It’s interesting because it conceptualizes pain as multidimensional concept. [Read here: https://www.nature.com/articles/d41586-019-00895-3]
• Sex differences in the burden of type 2 diabetes and cardiovascular risk across the life course. [Read here:https://link.springer.com/article/10.1007/s00125-019-4939-5]
• Sex and Gender Considerations in Transplant Research: A Scoping Review. [Read here:https://www.ncbi.nlm.nih.gov/pubmed/31461744]
• Men Have a Stronger Monocyte-Derived Cytokine Production Response upon Stimulation with the Gram-Negative Stimulus Lipopolysaccharide than Women: A Pooled Analysis Including 15 Study Populations. [Read here:http://www.tweelingenregister.org/nederlands/verslaggeving/NTR-publicaties_2019/Beenakker_JII_2019_epub.pdf]
• Sex Differences in Kidney Replacement Therapy Initiation and Maintenance. [Read here: https://cjasn.asnjournals.org/content/14/11/1616]
• Health of Women Program Strategic Plan discusses the clinical findings that have been attibuted to sex differences in immune responses. [Read here: https://www.fda.gov/media/130971/download]
• Sex differences in cardiometabolic disorders. [Read here: Sex differences in cardiometabolic disorders
• The 7th Framework Programme strives to promote gender equality in scientific research, by facilitating the participation of women scientists and integrating the gender dimension into research content in all research areas. Yellow Windows: [ Read here: https://www.yellowwindow.com/genderinresearch] 
• Despite a global understanding that manifestations and outcomes of CVD are known to differ between men and women, uptake of the recognition of sex and gender influences on the clinical care of women has been slow or absent. To highlight the need for better research, diagnosis, treatment, awareness, and support of women with CVD in Canada, the Canadian Women's Heart Health Alliance (CWHHA), supported by the University of Ottawa Heart Institute, and in collaboration with the Heart and Stroke Foundation of Canada (HSFC), undertook a comprehensive review of the evidence on sex‐ and gender‐specific differences in comorbidities, risk factors, disease awareness, presentation, diagnosis, and treatment across the entire spectrum of CVD. [ Read here: State of the Science in Women’s Cardiovascular Disease: A Canadian Perspective on the Influence of Sex & Gender ]
• Women remain underrepresented on faculties of medicine and the life sciences more broadly. Whether gender differences in self presentation of clinical research exist and may contribute to this gender gap has been challenging to explore empirically. The objective of this study was to analyze whether men and women differ in how positively they frame their research findings and to analyze whether the positive framing of research is associated with higher downstream citations.. [Read here: Gender differences in how scientists present the importance of their research: observational study]
• Gender gap narrows in research and innovation but inequality persists, report shows [ Read here: https://www.elsevier.com/connect/gender-report]
• Clinical Advances in Sex- and Gender-Informed Medicine to Improve the Health of All. A Review [ Read here:  bartz-2020-clinical-advances-in-sex-and-gende.pdf]
• Past research has demonstrated the relationship between women's educational levels and other measures of social development with maternal and child health outcomes. This study examines the relationship between gender parity in education and work, achieved through greater female participation in both spheres, with survival in both women and men. [Read here: Gender parity at scale: Examining correlations of country-level female participation in education and work with measures of men's and women's survival]
• Sexual harassment and victims' fears of reprisals from naming it are older than the US and threaded through that country's, and most other's history. Women in medicine have reported sexual harassment for decades. It has likely existed forever. Most female physicians have a story to tell. There are some positive trends both outside medicine and within. Raj et al report a decrease in sexual harassment over time among female academic physicians and further, that experiencing more severe harassment aligned with reaching a higher academic rank. [Read here: When will it ever end? And how? Sexual harassment of female medical faculty]
• The papers in this collection well illustrate the critical importance of gender in health and well-being and in the development of societies across the world, all along the life course, and within families and sectors ranging from education to health and labour. [ Read here: Gender equality: Framing a special collection of evidence for all]
• Depression is approximately two-fold more prevalent among women than men. Social theories suggest that discrimination is a pathway through which gender inequalities affect women's lives, but data are lacking. This cohort study evaluates whether perceived gender discrimination is linked to depressive symptoms among child-bearing women. [Read here: https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(20)30041-9/fulltext]
• The United Nations’ 2030 Agenda for Sustainable Development is predicated on the interconnectedness of the 17 Sustainable Development Goals (SDGs) and 169 targets to achieve comprehensive global development. In this context, the study by Gadoth and Heymann provides robust evidence about the relationship between country-level female participation in education and work with measures of both men's and women's survival [ Read here: https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(20)30050-X/fulltext]
• Sex- and gender-sensitive medicine (SGSM) focuses on the role that biological differences (sex) and socio-cultural power structures (gender) play in healthcare. How both sex and gender affect health behavior, the development of diseases, their diagnosis, management and long-term effects. Furthermore, SGSM can focus on the structure of the healthcare system, on how traded traditions impact the make-up of the workforce and its opportunities. This, in turn, reflects on the care that is being provided and the research that is being conducted.[ Read here: https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(20)30049-3/fulltext]
• Adolescent participation in pro-social activities such as sport can promote identity formation, self-efficacy and social support, but its benefits in India remain unassessed. We examined longitudinal effects of adolescent sport participation on economic, social and political engagement, marital health and family planning among young adults in India.[ Read here: https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(20)30046-8/fulltext]
• Sexual harassment of women in academic medicine may impede advancement and productivity. This study analyzes the longitudinal effects of sexual harassment on academic advancement and productivity among women. [Read here: https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(20)30042-0/fulltext ]
• This year marks the 25th anniversary of Bejing Declaration and Platform for Action – which committed to the improvement of human rights for women and girls, as well as the 5th anniversary of the United Nations (UN) General Assembly ratifying the Sustainable Development Goals (SDGs), including SDG5- to achieve gender equality and empower all women and girls. Unfortunately, despite advancements made in some areas of gender equality and empowerment, such as reductions in child marriage and female genital mutilation, we have seen minimal improvements in either the health indicators related to women and girls’ empowerment or expansion of these indicators to better reflect the empowerment process. [Read here: https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(20)30031-6/fulltext]