News from the COVID-19 Front Line:
An ER Outside of New York, Part II

Published on April 24, 2020

By Won Chung, Carrot Health Chief Medical Officer (@WGCMD)

“COVID-19 just revealed a hidden gap in men’s healthcare. What’s next?”

It is now April, and we’re at peak volume for patients with COVID-19. Almost everyone who comes into our ED has a fever, cough, shortness of breath, or all of the above. In the first two hours of my evening shift, I have already admitted three patients with advanced conditions brought on by the novel coronavirus. As the nursing staff and I take a break, we comment on the patients we’ve seen over the last few weeks. Many are obese or have other chronic illnesses, while others happen to be older or just unlucky. We review the census of the hospital on a computer screen and see that on the “regular” floors, there is a typical mix of patients, but we stop when we come to the Intensive Care Unit (ICU) census. In the hospital computer system, patient gender is denoted as blue for men and boys and pink for women and girls. The screen for the ICU shows a field of blue with two dots of pink: of 20 beds dedicated to the critically ill COVID-19 patients in the ICU, men occupied 18.

Surprisingly, the pattern we have seen at our hospital is no anomaly. A quick journal search revealed some eye-opening worldwide statistics: 67.2% of severely ill COVID-19 patients in China were men. In Spain, 71% of their critical COVID-19 patients were men. In the UK (ex. Scotland), 72.5% of critically ill patients with COVID-19 were men, while the Italians report that a whopping 81% of patients in their ICUs are men. And in the US, the exact critical care numbers have yet to be released. But thus far, the NYC DOH is reporting 1.8x higher death rates for men with COVID-19 when compared to women.

Why is this happening? Is there a gender-based genetic difference that protects women from the most critical COVID-19 outcomes? Do more men suffer from the chronic diseases that make COVID-19 infections worse? Or, are men unable to take care of themselves once they start having COVID-19 symptoms?

It remains to be seen what might be causing this gap in outcomes between men and women. Still, thus far, studies have shown that chronic illnesses and conditions, such as high blood pressure, diabetes, high cholesterol, and obesity, are closely related to poor outcomes for COVID-19 patients. Since these underlying conditions are related to lifestyle, maybe gender-specific habits could be causing the differences we’re seeing. Perhaps men smoke and drink more alcohol than women, and women tend to be more active, eat more healthfully, and have a tighter social network than men. These disparities of habit, in part, give rise to asymmetric development of the chronic illnesses linked to COVID-19 complications.

Now, what?

At Carrot Health, using over 5,000 different social, economic, clinical, and other consumer variables from 80+ different sources, we have found strong correlations not only between chronic illness and men’s habits but also between these chronic illnesses and men’s interests, activities and locations. Rather than trying the same old approach to healthcare with men and expecting different results, maybe we should try something different. For example, we’ve found a high correlation between men who smoke and men who enjoy fishing and hunting. Is there a role for health engagement programs based on those sports? What might those programs look like? We’ve also found that men with chronic illnesses tend to be socially isolated and resistant to input from authority figures when it comes to their health. How can we address men’s socialization patterns to offer them more support? Is there a role for men’s health programs that encourage bonding over shared interests rather than shared illness?

COVID-19 has clarified some of the ways today’s healthcare system fails to meet the needs of men. It’s also demonstrated that we can do better for men by looking deeper into who they are and meeting them where they live.

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