Tag Archive for: COVID-19

Violence Against Women Escalates as We Flatten the Curve for the COVID-19 Pandemic

Authors: Nisha Malhotra (PhD, School of Economics, UBC) & Karen Mason (Co-Founder, SOAR)

Every day, headlines of violence broadcast news from around the globe. The stories occur in different locations and different cultures, with different perpetrators, but many have one thing in common: women are the victims. Since much of the world went on lockdown in an effort to slow the spread and devastation of COVID-19, global reports indicate that women are increasingly being abused and killed and thus are bearing the brunt of this pandemic as they self-isolate in an effort to flatten the curve for us all.

Violence against women is not new. It’s already rampant in Canada—three in ten women have been sexually assaulted at least once since the age of 15, and a woman or girl is killed violently every two-and-a-half-days, most often by a male partner or a family member. The pandemic has shone a light on this global health crisis and brought the discussion of women’s rights to a safe environment to the forefront. Canada identified its first case of COVID-19 on January 25, 2020. By the end of March, all provinces had declared a state of emergency. Businesses, schools, offices, stores, and daycare facilities shut down, and measures to physically isolate people within their homes quickly became the norm. These measures forced individuals to stay in physically-bound spaces with their family members during these highly stressful conditions. Homes are unsafe for most victims of partner violence, and social distancing does not distance victims from their abusers, particularly when they already live together. In 2018, 50% of intimate partner violence reported to police occurred in homes occupied by both the victims and the abusers. A lockdown requiring victims to spend longer hours in proximity to their abuser is likely to increase the frequency and intensity of violent episodes. And since 80% of victims of intimate partner violence in Canada are women, they face a disproportionately higher impact of measures taken during a pandemic. 

Physical and social distancing disconnect  victims from their support networks such as friends and grassroots organizations, many of which are operating at reduced capacity. There is also a loss of community support that might have helped a potential perpetrator from committing a violent crime. A rise in incidents of intimate partner violence is not a surprise when these factors are coupled with stressors of financial insecurity and job loss caused by the pandemic. In fact, numerous studies have shown that natural disasters and pandemics lead to an increase of these risk factors.

“Pandemics and health emergencies, including SARS, Swine Flu, and influenza, have been associated with problematic coping behaviours, anxiety, suicide attempts and mental health disorders, including post-traumatic stress and depressive disorders, with quarantines, social isolation and limitations on freedom as possible contributing factors.” (Peterman et al., 2020, p 9)

While the COVID-19 pandemic is no excuse for such crimes, it is certainly providing the context in which existing violence can fester, worsen, and explode. 

 

 

Shutdowns and Economic Downturns

With non-essential services shut down during the pandemic many families have to take on the additional work of caring for children and other family members while concurrently working from home and fulfilling other regular household responsibilities. Others found themselves unemployed and dealing with the financial and emotional impacts of being laid off, while also trying to navigate the unknowns of this unprecedented situation. An economic and financial downturn is inevitable during a pandemic, as manufacturing and services shut down, supply-chains breakdown, international trade falls, and the economy contracts. The recession not only leads to salary cuts and unemployment, but also increases the likelihood that job losses will continue into the future. Uncertainty about the future, coupled with increased food insecurity and poverty, exacerbate stressors known to contribute to domestic violence. 

Essential Intoxication

The above stressors can also increase reliance on drugs and alcohol. This reality is particularly worrying given that a large body of research (as well as a wide array of anecdotal evidence) suggests that increased alcohol consumption leads to a higher likelihood of violence and abuse. The sale of alcohol was declared an essential service in much of Canada during the lockdown and a recent poll showed that 25% of Canadians between the ages of 35-54 and 21% of 18-34-year-olds reported drinking more alcohol at home. Similar results were reported from a crowd-sourced survey conducted in Ontario during the lockdown. This poll discovered that 70% of those that changed their drinking behaviour indicated they had increased drinking since the start of COVID-19.

In 1994, The Supreme Court of Canada acquitted a man who sexually assaulted a disabled woman. Drunkenness was used to excuse his actions. The Charter of Rights was invoked to justify intoxication as a defence for the abuser in a majority ruling (6-3). Sadly, the Henri Daviault case was not an exception. In light of other such cases, the government passed a law disallowing extreme intoxication as a defence for violent crimes. Yet on June 3, 2020 Ontario’s Court of Appeal allowed an individual accused of sexual assault to use extreme intoxication in their defence, declaring it a constitutional right. When courts refuse to convict people who violently attack people after willingly and knowingly intoxicating themselves, violence is even more likely to rise—especially when alcohol is deemed a necessity during a stressful pandemic. Sadly, the majority of people accused of domestic violence are male and the majority of victims are female. Furthermore, according to the 2018 Canadian Health survey, males are more likely to report heavy drinking (23.5%) compared to females (14.8%). If intoxication is allowed as a defence for violent crimes, it undermines a woman’s rights to safety and justice.  

Collateral Damage

Violence against women doesn’t just affect its direct victims. According to the federal Department of Justice, Canadians collectively spend $7.4 billion every year dealing with the repercussions of intimate partner violence. Costs include everything from health care, loss of income, therapy and funerals. Then there’s the intergenerational cost. In a typical year, as many as 362,000 children in Canada are exposed to family violence (Unicef, 2006). Research indicates that children who witness at least 10 violent episodes between their parents before they’re 16-years-old are twice as likely to attempt suicide, and children who witness intimate partner violence have twice the rate of psychiatric disorders as children from non-violent homes (Fuller-Thomson, Baird, Dhrodia, & Brennenstuhl, 2016; .

Shelter and Relief

The frequency of calls to crisis lines and stays at shelters have either increased substantially or, surprisingly, decreased across Canada. Professionals indicate that decreases could be the result of increased monitoring by the abuser at home, thus diminishing a woman’s opportunity to seek support or leave. Many experts predict that shelters, which are already under-resourced and under-funded, will see a surge in people requiring beds as the easing of restrictions continues around the world. Researchers investigating the intersection of intimate partner violence and brain injury also fear that the number of women suffering brain injuries due to violence will increase as well. 

 

 

 

 
What now?

On March 18, 2020 the federal government announced $50 million to support the sector working to end violence against women. Of this, up to $26 million was dedicated as emergency funding to support eligible shelters and transition houses. These are important, and necessary, steps. However, more is needed to address the existing epidemic of violence against women and prepare for the challenges still to come. Women’s groups and advocates, such as NUPGE, have been calling for a national action plan on violence against women and gender-based violence since 2015—yet it still does not exist. And our legal system makes it harder for survivors of sexual assault and violent crimes to get justice by allowing extreme intoxication to be considered a legitimate defense against such violent crimes. 

In its report “COVID-19 and Ending Violence Against Women and Girls” the United Nations urges countries across the world to form national responses. They encourage nations to include plans for increasing and adapting funding programs and support for essential services such as shelters, hotlines and online counselling services. This may include the provision of psychosocial support for women and girls directly affected by intimate partner violence and for frontline staff who often suffer vicarious trauma. Furthermore, they highlight the need for governments to prioritize training for front line workers about intimate partner violence and to ensure strong, timely action is taken by law enforcement on cases of violence against women and girls. 

And there’s still more that can be done. Canada needs to ensure that there are pandemic-safe housing options in place as alternatives to already-overburdened shelters. A financial aid program needs to be formalized to reduce victims’ dependence on their abuser. And more resources relating to family courts during and after a health crisis need to be provided. The experts agree a second wave of the COVID-19 pandemic IS coming. While on that it seems there is no question, one question remains: when it comes to keeping women and girls safe, will we be ready?

*If you feel unsafe in your home or relationship and need support, visit www.sheltersafe.ca for resources across Canada. If you are in immediate danger, call 911*

References

Abramsky, T., Watts, C.H., Garcia-Moreno, C. et al. (2011). What factors are associated with recent intimate partner violence? findings from the WHO multi-country study on women’s health and domestic violence. BMC Public Health 11, 109.

Canadian Department of Justice. (2009). An estimation of the economic impact of spousal violence in Canada. Available: http://www.justice.gc.ca/eng/rp-pr/cj-jp/fv-vf/rr12_7/p0.html – sum

Devries, K. M., Mak, J. Y., Garcia-Moreno, C. Petzold, M., Child, J.C., Falder, G. et al. (2013). The global prevalence of intimate partner violence against women. Science 340(6140): 1527–8.

Eckhardt, Christopher I., et al. (2015). Mechanisms of alcohol-facilitated intimate partner violence. Violence Against Women 21(8).

Fuller-Thomson, E., Baird, S. L., Dhrodia, R. & Brennenstuhl, S. (2016). The association between adverse childhood experiences (ACEs) and suicide attempts in a population-based study. Child: Care, Health and Development. DOI: 10.1111/cch.12351

ISPCAN. (2020). Behind closed doors measuring family violence in the context of COVID 19 in Canada. Retrived from: https://www.youtube.com/watch?v=5YVLFl8l0mM&feature=youtu.be 

Peterman A, Potts A, O’Donnell M, Thompson K, Shah N, Oertelt-Prigione S, van Gelder N. Pandemics and violence against women and children. Center for Global Development working paper. 2020, April 1:528.

Statistics Canada. (2018). Family violence in Canada: A statistical profile, 2018. Retrieved from: https://www150.statcan.gc.ca/n1/pub/85-002-x/2019001/article/00018-eng.htm

Unicef. (2006). Behind closed doors: The impact of domestic violence on children. Available: http://www.unicef.org/protection/files/BehindClosedDoors.pdf

Why Paying Attention to Sex and Gender Will Advance our Knowledge on COVID-19

Authors: Bonnie H. Lee (BSc, PhD student) and Liisa A.M. Galea (PhD, Graduate Program in Neuroscience, Department of Psychology. Djavad Mowafaghian Centre for Brain Health, University of British Columbia)

Every day we learn more about the novel coronavirus (severed acute respiratory syndrome coronavirus 2: SARS-CoV-2). During these early months of the worldwide outbreak, it has become apparent that although men and women may be similarly susceptible to the virus, males are more likely to become severely ill developing the disease, known as COVID-19 that comes from SARS-CoV-2, and worse, have a higher mortality rate. Both biological (sex) and environmental (let’s loosely think of this as gender) factors likely contribute to this sex bias, although most of our focus here will be on the biological contributions.

A research group from China analyzed data from 1099 early cases of COVID-19, including 37 of the first death cases from Wuhan city, and found that in addition to older age and higher number of underlying health conditions, male sex was associated with higher disease severity and mortality rate in patients with COVID-19. Of the 37 death cases, 70.3% were males. 

According to Italy’s National Health Institute, 58% of the confirmed novel coronavirus cases, and 70% of the reported deaths from COVID-19 were males. These numbers are consistent with those from China. To date, 25 countries have made data relating to COVID-19 publicly available, but only 6 of them provided the data about both confirmed cases and deaths, broken down by sex: China, France, Germany, Iran, Italy, and South Korea. Through a collaborative effort, CNN and Global Health 50/50 have created a live tracker of the sex-disaggregated data. In order to continue assessing the important differences between males and females regarding COVID-19, it is necessary for all countries to collect and publish their data broken down by sex. Only in this way can we leverage knowledge on sex differences to aid in the discovery of new treatments.

So why is disease severity and mortality rate worse in males than females?
 

Two ways to approach the sex differences seen with COVID-19 are to examine factors that may cause males to be at greater risk of becoming severely ill with COVID-19 and examine factors that may cause female to be more resilient to becoming severely ill with COVID-19. Both perspectives are needed to understand the differences in mortality rates. In addition, although biological factors like genetics and sex hormones are important to examine, environmental and gendered factors may also contribute to the difference in COVID-19 disease severity and mortality rate between males and females.

Note that the term “sex” is used as a biological variable, defined by the physiological characteristics that define males and females (such as chromosomes, reproductive organs, and sex hormone levels), which is distinct from gender, which involves what a given society may deem appropriate behaviours and activities and/or gender identity (see definitions). It is also important to be aware of the intersectionality between sex and gender.

Biological Factors

Males and females differ in their innate and adaptive immune responses. Typically, females present with stronger immunological responses and are more resistant to virus infections compared to males. Genetically, females possess two X chromosomes whereas males possess one X and one Y sex chromosome, and these chromosomes are present in every cell throughout the body. Interestingly, literature shows that the X chromosome contains many genes that regulate immune function, and it is suggested that because males have fewer of these genes, they are at greater risk of developing certain immune-related diseases. A recent analysis indicates that females had a greater (high range) antibody response when in the severe stage of COVID-19 compared to males. These early analyses suggest some biological component to the sex differences in COIVD-19 responses. Time will tell, with further data, whether this finding is replicated, and whether this effect is seen across age groups.

Sex hormones play an important role in the regulation of the development and function of the immune system. Estrogens, which are produced at higher levels in females, can act by binding to estrogen receptors. Given that estrogen receptors are widely expressed in most cells of the immune system, it is not surprising that estradiol, the most potent form of the estrogens, modulates the functional activity of innate immune cells, and influences downstream adaptive immune responses. On the other hand, androgens, which are at higher levels in males suppress immune cell activity, resulting in inhibited immune reactivity and inflammation. Thus, it is possible that estrogens and androgens play a role in COVID-19 but given that the sex differences are seen in older age groups, which includes postmenopausal females, this suggests that levels of sex hormones can not be the only factor.

Research has identified the angiotensin-converting enzyme 2 (ACE2) as a receptor that is present in many areas of the body including the lungs and nose for the novel coronavirus (Hamming et al., 2004; Xu et al., 2020; Zhou et al., 2020). Data extracted from healthy human lung transplant donors revealed that male donors had higher ACE2-expressing cell ratio, more widespread distribution of ACE2, and a greater variety of different types of cells expressing ACE2, compared to female donors. This suggests that once in contact with the novel coronavirus, the virus has more opportunity to bind with receptors in males compared to females, thus making it easier for the virus to duplicate and potentially cause worse disease outcomes in males. However, we would like to caution that this study only included 8 donors, and only 2 of them were male, and that it will be important in future studies to replicate these intriguing findings. Other research has shown sex differences in ACE2 activity in kidneys, with greater activity in males compared to females that was not dependent on chromosomal sex, but rather 17β-estradiol. Further studies are beginning to bear fruit using gene by sex analyses to examine candidates to combat viral transfer – one such candidate is Muc4, in which expression gives an advantage to female mice but not male mice in viral loads following infection from SARVS-COV.

A study that analyzed lung tissue samples found that smokers (including current and former smokers) had higher ACE2 gene expression compared to non-smokers, even after adjusting for age, sex, and race. More males have reported a history of smoking compared to females according to the WHO, suggesting that males may be predisposed with a higher expression of ACE2 from smoking. In China, sex differences in smoking levels are very high (50% of males and 2% of females are smokers), but the sex difference in Italy is not as profound (28% of males and 19% of females are smokers). Given that both countries show sex differences in mortality from COVID-19 this suggests that sex differences in smoking may contribute but not completely account for the sex differences in mortality rates.

On a related note, it is known that preexisting health conditions confers greater risk for developing a severe case of COVID-19. A report recently released by the Centre for Disease Control and Prevention shows that approximately 80% of ICU and 70% of hospitalized COVID-19 patients in the United States of America reported having at least one underlying health condition. Commonly reported conditions include smoking, lung disease, heart disease, and diabetes. Some of these conditions (mainly lung and heart diseases) are found to be more prevalent among males compared to females. Sex differences in the prevalence of preexisting health conditions may also play a role in the findings that males have a greater morality risk than females from COVID-19.

Environmental Factors

Environmental factors play an impactful role in exposure and infection from viruses. For instance, practicing proper hand hygiene is a crucial for preventing contraction of the novel coronavirus. Curiously, an epidemiological investigation conducted in 2018 found that female participants had significantly greater hand hygiene knowledge compared to their male counterparts. In addition, research shows that females seem to wash their hands more often, use soap more often, and wash their hands for a longer period of time compared to males. And although anecdotal, a recent survey from February 2020 suggests that 65% of females were washing their hands (and keeping surfaces clean) compared to 52% of men surveyed due to coronavirus concerns.

The presence of these different risk and protective factors in males and females may, at least in part, explain the sex differences observed in the disease severity and mortality rate of COVID-19. Moving forward, it remains crucial for research to include and analyze both sexes in their data, so we can further understand the mechanisms driving these sex differences and to propel effective treatments forward for both sexes. It also emphases that the reasons for these sex differences span multiple disciplines and domains and that it will take a concerted effort among a number of different areas of research to fully understand all the factors that contribute to COVID-19 mortality (e.g. social, implementation science, compliance, inflammation, lifestyle choices).

 

Summary of risk and protective factors in males (blue) and females (pink relating to COVID-19 disease severity and mortality rate.

Lastly, it is important to remember that although mortality from COVID-19 affects men more than women, COVID-19 can affect anyone. Although some may feel as though our risk of becoming sick from the virus is low, there are many younger patients that can have COVID19, and even “mild” symptoms can be devastating. We all need to be doing our part to protect those around us and in the greater community. Let’s continue to wash our hands with soap, stay home, practice physical distancing, and be kind to one another in these trying times.

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