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Long-term care homes – Eatonville Care Centre seen here in Toronto on April 14, 2020 – are hotbeds of infection in Canada.Nathan Denette/The Canadian Press

Women account for more than half the COVID-19 cases and deaths in Canada, making the country an outlier running counter to the overwhelming trend that sees the disease killing more men than women in most of the world.

Women represent 53 per cent of Canadian deaths linked to the disease, the highest proportion in any country, according to numbers compiled by a research initiative at the University College London’s Centre for Gender and Global Health. The nearest among countries that report gender data are Portugal and Finland, at 51 per cent. In the United States, Sweden, France and England, the proportion of female deaths is between 40 and 44 per cent.

Quebec and Ontario are driving the trend in Canada. In Quebec, 54.9 per cent of novel coronavirus deaths have been among women, 54.4 per cent in Ontario. Women account for 59.3 per cent of infections in Quebec and 56.9 per cent in Ontario, according to numbers compiled by the provinces as of Friday.

Experts say the trend in infection and death rates among men and women has important implications for how the disease is managed, particularly because the people who care for the sick are also mostly women.

“The response needs to be gendered,” said Kirsten Fiest, an epidemiologist at the University of Calgary. “We have these socially constructed and prescribed roles where women are both the sick and the caregivers. This has to inform the response.”

Likely explanations for why more women are contracting the disease and dying from it in Canada are relatively clear. Long-term care homes are the hotbeds of infection in this country. The illness is particularly hard on people over the age of 70, and Canadian women outlive men by an average of four years. More than 70 per cent of Ontario and Quebec long-term care residents are women, and more than 80 per cent of personal support workers and nurses working at high risk of infection in long-term care homes are also women.

However, it is too early to reach any final conclusions: The course of the pandemic so far is that it moves among vulnerable populations while testing lags and methods shift for counting cases and deaths.

Cara Tannenbaum, the scientific director of the Institute of Gender and Health for the Canadian Institutes of Health Research, noted that the coronavirus has spread into poorer Montreal neighbourhoods through health care workers, with 20 per cent of the city’s infections among that group.

“Sex and gender-based analysis of work, home activities [and] travel patterns could be the key to new, tailored interventions for curbing the virus in Canada,” Dr. Tannenbaum said. “We’ve done a good job of limiting travel, isolating families. We need to put the spotlight on health care workers and the role they play in their families and community.”

The solutions start with frequent testing of long-term care residents and health care workers, better tracking of where the workers are dispatched and better infection-control protocols, said Dr. Tannenbaum, who is working in a Montreal long-term care home during the pandemic.

Other adjustments should literally be tailored: Pieces of personal protective equipment, which are ostensibly one-size-fits-all, are generally way too big for women, she said.

Dr. Fiest added that women need supports so they have reliable, stable child care and don’t have to travel between two or three jobs – identified as a key factor in the spread of the infection among long-term care homes and into the community.

Scientists believe men generally die more often because they are more likely to smoke, drink and have underlying conditions, such as diabetes and heart disease. “We know biological sex affects the severity of COVID-19 in terms of the immunological response to the disease,” Dr. Fiest said. “People born male are more likely to get sick, end up in ICU and die.”

In Alberta, which did a relatively good job limiting outbreaks in long-term care homes, men account for 52 per cent of cases and 54 per cent of deaths.

Michèle Charpentier, the research chair in aging at the University of Quebec at Montreal, noted that retirement-aged women have about a third less income than men, which affects the quality of care they can get.

She said some of the Quebec government’s response has run contrary to a gender-based analysis.

The government has offered bonuses to full-time health care workers, in part to encourage part-time workers to go full-time.

“Sixty per cent of workers in Quebec long-term care homes are part-time, and the vast majority of them are women,” Dr. Charpentier said. “Forcing them to move from part-time to full-time puts them at greater risk of infection, mental-health effects, fatigue.”

Nancy Guberman, a retired professor of social work and director of a social gerontology research center, pointed out that the language Premier François Legault uses to describe health care workers – “our guardian angels” – demonstrates how gender roles are baked into the pandemic. “I would call them foot soldiers. We are sending them in at considerable risk, and the work is devalued,” she said.

She said race also needs to be tracked, as lower-paid personal-care workers tend to be members of racialized minorities. “Without marginalized, racialized people and women being at the centre of these discussions, there will be blind spots in the decisions that are made.”

She said the disease trajectory is at the intersection of gender, class and race issues, but may yet transform again. “When this hits the wider community, many more men are going to be affected and may have even more drastic results,” she said.

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