Author at the Margareta Church ruins, in the Maridalen valley north of Oslo, early March 2020
Blog post written March 16, updated March 22 and April 6, 2020
“There is no such thing as society” – ? The social profile of Covid19
A virus does not have any idea of social class, status, and other forms of ranking or hierarchy in human society. It just looks for bodies where it can survive and multiply.
The virus spreads to “somebody”, not just “anybody”, in our society. It doesn’t affect all groups in the population equally.
It spreads through people who create society through their practical lives.
The neoliberal idea that “there is no such thing as society” (Margareth Thatcher), that we are only individuals, is not very convincing in these times of trouble.
Epidemics have a social class profile, and this is an important perspective to keep in mind, as argued by Svenn-Erik Mamelund at Oslo Met, and other researchers. Mamelund warns that the effects of the pandemic will be worse, in lower income groups https://www.klassekampen.no/article/20200316/ARTICLE/200319974
The total cost of epidemics is usually higher among poor people and regions. This is why, as the WHO warns us, we need to worry about Africa and the poor world, in the current situation, not just the spread of the virus in Europe and the US. Poor countries will be even worse hit, and this will hit back on us, unless we can break the cycle.
The new corona virus is socially blind, it just jumps to the nearest somebody. Workers in high-contact jobs are more prone to get it, and people with more social contact. The transmission as well as the resulting Covid-19 disease has a social profile, with the death rate much higher among some population groups than others.
Although the patterns of disease transmission and development are partly cloudy, two facts emerge beyond doubt. 1) the disease selects by age, older people are more likely to get heavier symptoms and are more likely to die from the resulting worsening of the disease. 2) underlying health problems like heart problems and diabetes are also clear negative factors increasing the chance of dying from Covid-19.
Men go first
It is also clear that the death rate from the disease is higher among men than women. Yet the reasons for this are still in the dark. They are not well clarified.
It seems that, once again, “gender” is a topic that stands at the end of the queue, regarding research, even though, empirically, it is central.
I have looked for research on men’s larger death rate from Covid19 since late February. It is only in the last weeks that the issue has shown up more frequently, mainly in the media, citing recent and still rather fragmented research.
The numbers are only partly clear. I have not seen exact international statistics, regarding the gap between women and men’s chance of dying from the disease. My overall impression is that men stand a one and a half chance, to a double chance, of dying from the disease, compared to women. According to the Chinese evidence (based on the first 55 000 deaths), the chance of an infected man dying from the disease was 168 percent the chance of a woman dying from it (crude fatality rate). A more recent study (72 ooo deaths) shows a very similar pattern, 165 percent chance.
Why?
The first reports, from China, on the larger death rate among men, were tentatively explained by the much higher proportion of smokers among men compared to women in the country. Now, reports from Italy indicate that men are even more prone to die from the disease compared to women, than in China. The “extra male burden” of the new disease is maybe even larger in Italy than in China. Yet in Italy, smoking is more gender-balanced than in China. From age 60 upwards – the main part of the new disease death cases – the proportions of women smoking is circa 80 percent the proportions of men. The gender gap in smoking seems too small to explain the large fatality difference. See https://www.statista.com/statistics/501615/italy-smokers-by-age-and-gender/
I wrote about this in the original version of this post some weeks ago. Now (April 6) I see the same point picked up elsewhere also, e g in this informative text: https://www.wired.co.uk/article/coronavirus-death-men-women
There is recently more interest in gender issues, and I notice a move away from purely “external” explanations, like smoking, towards more integrated approaches. Even if damaged lungs doesn’t help, its not enough to explain the gender difference. The same goes for other biological or other disease factors. They are important, but they don’t explain all. Quoting from the above paper:
“Ultimately, biology, lifestyle and behaviour are all likely to play a role in the spread and impact of Covid-19. But it will only be possible to understand the exact differences between men and women once more countries produce and make available sex-disaggregated statistics on infection and mortality.”
Possibly, fatal cardiovascular disease, more common among men than women, is a more important factor behind the different fatality rates, than smoking. Studies point to a higher fatality among men at this point, maybe twice as high as women, and cardiovascular disease is the number one factor increasing the complications of the new disease, ahead of diabetes, and others, according to Chinese studies. However, this is probably also only part of the picture. The fatality from cardiovascular disease becomes more gender-balanced, among older people.
There are other medical or biological explanatory factors too, including better immune systems among women, and maybe hormone and chromosome differences, but the picture is still far from clear (as far as I can see).
Patterns of behaviour – our old friend “society” – most probably plays a large role.
Men and health
According to men and masculinities research, men are in situations that may work against good health, and often adapt to patterns of action and practice that increase the health problems. Men’s health behaviour is more often in the high risk zone, than women’s behaviour.
A dramatic example of this rule comes from studies of suicide. These show an almost universal global pattern – men suicide more often than women. Recent studies have also mapped suicide attempts, not just suicides. Here, the situation is the opposite. Women, not men, are most prone to attempt suicide. These studies show that when people consider suicide, men tend to do it, while women more often stay on the brink, they may attempt it, but they don’t go through with it.
Similar patterns can be found in other health-related behaviors. Compared to women, men typically take less (and later) contact with the health system, and are less open about problems. Even in gender-equal Norway, if a couple has a problem, it is typically the wife contacting the family councelling or therapist, dragging the husband along.
Greater fatality among men compared to women in different age groups and for different diseases and causes has been reported e g by the UK researcher Alan White (https://alan-keith-white.blogspot.com/2019/07/mens-health-and-womens-health-emerging.html).
These are relevant factors, even if they may not play the main role for the Covid19 deaths today. The health and social evidence are important parts of the whole. Another important data source on men and health is the International Men and Gender Equality Study (IMAGES, cf. https://promundoglobal.org/programs/international-men-and-gender-equality-survey-images/
It should be noted, that the idea of a “zero sum game” in terms of gender and health is rejected by most health researcher, even if it lives on in the media. Women’s health does not improve by men dying before them (or vice versa). Instead, women’s and men’s health problems should be seen in connection, and reduced in terms of better health behaviours from both (all) genders. Yet the idea stays on, in today’s media and debate.
According to the evidence regarding gender conceptions and bias, “fundamentalist” gender ideas may become stronger, in times of crisis or perceived danger. Crises may create “social panic”, a pattern mapped by researchers already in the 1960s. With more anxiety, studies show, there will be more of a backwards leaning on what is “safe”. Strict conservative gender rules are often considered “safe”. The evidence at this point is not conclusive (there may be gender innovative responses also), but it is clear that gender conservative fallback is a recurrent trend.
Generals planning for the last war?
Imagine what would happen, if women’s death rate from the new disease was almost the double of men’s. Would there have been an outcry? I think so. In gender-equal countries like Norway, at least.
I find it strange, based on the death rate evidence, that “male” is not included, and still not much highlighted and discussed, among the new disease risk factors.
Why not?
Is it mainly due to gender conservativism and a kind of automatic thinking? Men are more prone to die, this is part of the male role, with the man as protector and provider? We are “at war” with the virus, we are told. And men / soldiers are of course the ones most likely to pay their lives. So, the empirical red light warning, the much higher death rate among men, has mainly passed under the conceptual radar.
Class experts tell us that Covid19 will hit poor people worst. Gender experts tell us that women will be worse hit. This has been very visible in Norway, and internationally, as the media debate has taken up research issues, with more peope concerned about the “how” and “why” of the disease.
I think these experts, opinion leaders, or “generals”, are mostly quite correct, regarding strategy, or overall impact. Yet generals need to know about tactics too. Tactics is not about what happens some years ahead. It is about what happens today and tomorrow. The current empirical picture of transmission, hospital treatment and death from Covid19.
We need to untangle the overall long term effects of the disease, from the actual happenings here and now. Especially, we need to distinguish between the transmission group and the serious impact group (those who get seriously ill, and may die).
For a dramatic example, compare the Black Death. This also probably first started among poor people – we don’t know. It spread through tradesmen to Europe. A typical first stage is transmission through people with money and contacts.
This is now replicated in the European evidence including Norway. Here, ski tourists from Italy and Austria brought home the virus. Likewise, with the so-called Spanish Flu after World War 1, the origin seems to have been in the US, spreading to Europe and the rest of the world mainly through the military. Poor people, and women, usually get the largest total costs from epidemics, but the transmission, especially in the early stage, is another story.
Top down transmission
Instead of the poorest and the lower classes, we obviously have a situation with a “top down” type of distribution of the virus, e g in Norway.
It started with people with money and contacts, mainly. And the fatality rate seems to be quite high, in these groups also. The lack of attention to the top down spread is evident in Europe and elsewhere with leaders in isolation, or infected.
Crying wolf regarding the working class, or women, is important in an overall perspective, but may be misleading, here and now. To understand and reduce pathways of infection and death from the disease we need to look at the upper/middle class, people in occupations with much contact – and men.
There are two different main groups involved, in reducing the total damage to society – the transmitters, and the seriously affected. Their social profiles started quite similar, but are now more diverse, as the disease spreads downwards in terms of social class, gender and ethnicity.
This is now quite clearly confirmed by local evidence from Oslo, capital of Norway. At first, the transmission was largest in the most affluent parts of the city. Recent evidence shows a shift towards the less affluent parts. Maybe, in some weeks time, these areas will be on the top of the list of infections per capita. The transmission will still be somewhat top-down, probably, but less so, than in the first phase.
This prediction fits the international Covid19 statistics (see e g Worldometers). Here, the numbers still read like a “rich world” club of transmission and deaths, with the rich world country deaths outnumbering the poor countries, and with the “epicentre” moving, with US rising fast, and Europe slowing down, while poorer countries – so far – have far lower rates.
This will most probably change, according to top down transmission class and gender analysis and historical epidemic evidence. We shall see. What is clear, here and now, is that top down transmition is shifting into wider transmition, going further out and downwards in terms of social status (class, gender, and others).
It seems that some of the bias and outmoded thinking in the first stage of the disease – where the gender death rate imbalance was almost totally overlooked (in February, early March, in my evidence), and the top down transmission evidence was mainly ignored (again, in my impression) – was due to the way expert researchers have conceptualized their work. They are into “gender”, for example, but in a quite restricted way, where gender mainly means “women”. Where men are assumed to be of less interest, and/or less gender-equal.
This gender-means-women bias is quite typical, in my experience, in international organizations, for example. Likewise, in terms of class, there is a common response, class means the lower class. Is this approach wrong? On the whole, no. But like I said, it is not the full picture. Tactics differs from strategy. Tactics involves the empirical material, here and now. At that point, experts have been slow to respond, in my view.
Since women generally live longer than men, and age is the number one factor increasing Covid19 fatality, we might have expected more women than men dying from it. Yet this is not the case. This underlines the need to investigate gender differences further.
Summing up
Clearly, better knowledge of the “hidden” gender dimension is needed. Researchers and experts need to cooperate, to create the best possible socio-medical-biological mapping of how Covid19 spreads, how it develops into serious illness, and takes lives – and how it can be reduced.
It is now clear that this will be a long-term pandemic. Gender is one of the central variables regarding the death rate from Covid19, and the reasons for this, still mostly unknown, are important for research and prevention.
The social part of the mapping of Covid19 should include social class, gender, ethnicity and other factors. This is vital and urgently needed. Gender may be a key factor, to reduce the disease and the social and economic cost of the pandemic.
Today (April 4), in Norway, there is really no telling how many have been infected by the virus. This is because testing equipment has become scarce and testing is not at all on the level of the WHO recommendation (“test, test, test”). So, experts and health workers are trying to trace transmission paths through a very limited number of test numbers. This is clearly far from optimal.
But at this stage, a social probability map – and guidelines – who, to test – is very important. Where to look, to find the transmitters. Social science cannot predict this exactly, of course, but it can help out, making it more likely that the tests that are actually done, find their target – the transmitters.
Author following Covid19 news on a mobile phone, April 6 (reading some good news, maybe light in the tunnel, now.)
