Since the beginning of pandemic, it has been noted that men tend to be more susceptible to infection, and the severity of their disease is much more. Though many recent studies have shown that women are infected as frequently as men, but it is the severity of disease in men which is perplexing. 

It is commonly known that men have a higher incidence of co-morbidities like Hypertension, Diabetes and Heart disease. Also, there is an increase trend towards smoking, also, possibly, men seek medical attention much later as compared to women. While these common observations do help in understanding the incidence of infection, it does not explain the severity. The data from India also shows that there is almost 65%:35% ratio (Male: Female) death rate disparity due to COVID-19. 

Medically there are various theories which have been discussed to be the reason for this gender bias; the three top theories being (1) Angiotensin Converting Enzyme-2 (ACE-2) receptor, (2) Oestrogen &Testosterone which affects the immune system and (3) genetic predisposition. Let’s understand these better:

– ATTACHMENT TO ACE-2 RECEPTORS:  

It is now clearly understood that the ‘spike protein’ on the corona viruses like COVID, SARS (Severe Acute Respiratory Syndrome), MERS (Middle East Respiratory Syndrome) have an affinity for the ACE-2 receptors; it is almost like the ACE-2 receptor is the gateway for these viruses. The concentration of ACE-2 receptors is present in abundance in males as compared to females. They are found in high concentration in the Lungs, Heart, Intestine and Gonads.

– UNDERSTANDING THE OESTROGEN AND TESTOSTERONE CONNECTION:

Female is a stronger sex with respect to immune response and resilience. The female hormone Oestrogen stimulates the immune response rapidly and also supresses COVID-19 virus replication. Whereas the male hormone Testosterone inhibits the body’s own immune response, hence making males more prone to severe infection. This quality of Oestrogen is not only seen in COVID -19 cases, but also in other viral illnesses like Influenza.

– THE GENETIC PREDISPOSITION:

The possible third reason for this phenomenon is that the genes which are responsible for identifying a pathogen in body and mount a response to them, are present on the X chromosome. Since females have 2 X chromosomes, they are more likely to have a rapid immune response to a pathogen and offer better protection. On the other hand, because of Oestrogen and rapid response to immune system, women tend to have more auto immune problems as compared to men!

 

In a recent Sero survey conducted in city of Mumbai, it was found that more women had developed antibodies to COVID-19, which affirms the fact that women probably had a very minor illness which went un-noticed as compared to men, hence while more men went on to develop symptoms, women probably remained largely protected due to their immune response.

Globally, healthcare ecosystems have majorly shifted focus to primarily combating and focusing on the management of COVID19. Citizens all over the world are in pertinent fear of being infected by the unseen threat and continue to take precautionary steps to avoid infection, as guided by administrative protocols. Clinicians in the field have been working with newer diagnostic and treatment delivery tools to ensure better clinical care, along with the continuation of screening measures to adapt to any uneventful situation for those in need of advanced care. 

The 6-minute walk test (6MWT) was established as a clinical test to look for Cardio-Pulmonary exercise tolerance, is now commonly being used as a screening tool for patients with COVID19 who don’t have Hypoxia (low Oxygen Saturation <94%) at rest, or those at a high risk, including patients with comorbidities like existing Heart disease. It is proposed to be performed by the individual from the 5th – 12th day of the onset of symptoms. This will enable a clearer understanding on probability status of Oxygen level decreasing, and will be a huge bonus for those who have been homebound worrying about the infection, especially the elderly. The 6min Walk Test (6MWT) will help measure your Heart rate and blood oxygen levels; which are bound to fluctuate upon exertion. The test is entirely self-paced and you have to do as many laps during the 6mins as you can manage, at a comfortable walking pace within the confines of your room/ home. The test can be administered by a family member using a finger Pulse Oximeter, and does not mandate a doctor, nurse or paramedical to be present.

Here’s how it is to be done: 

1. The patient must wear a simple cloth or surgical mask
2. The pretest baseline Oxygen Saturation should be > 94%, the individual must not short of breath, be at rest and should be able to walk unsupported
3. The individual must walk in the confinement of his/ her room for 6mins non-stop, without any oxygen support
4. After the walk is complete, use a Pulse Oximeter to measure if the oxygen saturation of the individual has dropped below 93%, or if there is an absolute drop of more than 3%

It is important to note if the person is feeling unwell i.e. light headed or short of breath while performing the test, these significant findings need to be noted. This is called ‘unmasking hypoxia’, these patients may progress to be Hypoxic (absence of enough oxygen supply into the body), and hence early intervention in the form of admission to a hospital, or shifting to ICU with Oxygen support +/- steroids as per the admitting doctor. Oxygen concentration in the blood should stay between 94%-100%, a drop below 90% should be considered as an emergency and the patient must immediately be hospitalized. It is important to note that the 6min walk test may be cut short for 3mins in patients above 60yrs of age.

If the person is able to walk unsupported, and is not needing Oxygen to maintain base Line saturation of >94%, there is no need to rush the person to the hospital. You may connect with your doctor over a tele-consultation to share your 6MWT findings, and concern if any.