National governments across the world are scrambling to contain the novel coronavirus disease 2019 (COVID-19). The Caribbean region has been affected later than other regions including Asia, Europe and Africa. As at 21st March 2020, twenty-four countries/territories in the Caribbean region have reported a total of 384 confirmed COVID-19 infections. Most cases are imported from European countries and the United States of America.
Experts have emphasized the importance of collecting and analysing sex dis-aggregated data for understanding the risks of and gender effects of the pandemic. Similarly, the World Health Organization has also highlighted the value of good quality, disaggregated data for identifying and responding to gender inequalities in health, and for allocating resources to improve people’s health and well-being. Yet, few countries or regions of the world currently include sex-aggregated data in regular reports on the COVID-19 outbreak. To fill this gap in knowledge, we share some thoughts based on the gendered nature of COVID-19 in the Caribbean region.Table 1 shows six countries/territories in the Caribbean that reported the highest numbers of confirmed cases namely: The Dominican Republic (n=112), Guadeloupe (n=56), Trinidad & Tobago (n=49), Martinique (n=37), Cuba (n=21) and Puerto Rico (n=21).
Sex-disaggregated data reported by countries/territories on numbers of confirmed infections and of deaths from COVID-19 are often incomplete (see Table 1). Where data was available (in 173 of 384 confirmed cases), early indications are that 51.4% of cases (i.e. 89 of 173 confirmed infections) occurred in females whilst 48.6% of cases were in males. Country-level reports neither provided detailed information of the severity of the infection nor the recovery rates from COVID-19 for men or women. Only 8 of 10 COVID-19 related deaths reported by countries/territories were disaggregated by sex, with 75% of them (i.e. 6 of 8 deaths) occurring in women while the remaining 25% of occurred in men. However, all 10 reported deaths occurred in individuals over 60 years of age with underlying conditions such as uncontrolled diabetes and hypertension.This early data contradicts evidence from Europe and China that COVID-19 infects and kills more men. Data from Europe showed 57% of people infected and 71% of those who died were male. Evidence from Wuhan Province of China similarly revealed that 51.4% of individuals infected were male and the proportion of deaths among infected cases was higher in men (2.8% in men compared with 1.7% in women). However the Gansu Province of China later reported a slight predominance of females following the Chinese New Year festival. A possible reason provided for the sex difference between the two provinces of China is that the labour market in Wuhan was dominated by males, thus increasing their likelihood of coming in contact with the source of the outbreak (i.e. the seafood market), and by extension, the numbers of males with the infection in Wuhan. On the other hand, the outbreak reached Gansu two weeks later than Wuhan (i.e. during the Chinese New Year festival) when both sexes took part in the celebrations.
It is unclear why more females have been affected by COVID-19 at this early phase of the outbreak in the Caribbean region. However, it is important to highlight that the Dominican Republic contributed 75.3% of the 89 females infected by COVID-19 in the region. As this male:female ratio might yet change, our findings should be interpreted with caution as data analysis is based on a small sample of 384 confirmed infections and 10 deaths in the early stages of the pandemic in the Caribbean.
Table 1. Caribbean countries/territories by confirmed cases of and deaths from COVID-19 as of 21st March 2020.
|Country/Territory||№ of confirmed infections||Imported from||№ of deaths|
|Total||№ of Male||№ of Female||Total with sex data not available||Total||Male||Female|
|Antigua & Barbuda||1||0||1||0||The UK||0||0||0|
|Barbados||6||4||2||0||USA, and a cruise ship in the region||0||0||0|
|Cayman Islands||3||1||NA||2||Italy and from the index case||1||1||0|
|Cuba||21||7||3||11||Spain, France, Italy, Canada and from Guyana||1||0||0|
|Curacao||3||1||1||1||The Netherlands, from index case||1||1||0|
|Dominican Republic||112||45||67||0||Italy, Canada, and through local transmissions||3||0||1|
|French Guiana||18||2||NA||16||France, and a cruise ship in the region||0||0||0|
|Guadeloupe||56||2||3||51||France, and a cruise ship in the region||1||0||1|
|Guyana||5||1||1||3||USA, from the index case||1||0||1|
|Jamaica||19||7||4||8||Malaysia, Portugal, Spain, Trinidad & Tobago, UK, USA||1||0||1|
|Martinique||37||1||2||34||France, and from a cruise ship in the region||0||0||1|
|Puerto Rico||21||8||2||11||Not available||1||0||1|
|Saint Barthelemy||3||1||–||2||Under investigation||0||0||0|
|Saint Lucia||2||NA||NA||2||Under investigation||0||0||0|
|Saint Martin||5||1||1||3||From St. Barthelemy case||0||0||0|
|Saint Vincent & the Grenadines||1||0||1||0||From the UK||0||0||0|
|Sint Maarten||1||1||0||0||From the UK||0||0||0|
|Suriname||1||NA||NA||1||1 from The Netherlands||0||0||0|
|Trinidad & Tobago||49||2||0||47||From Switzerland, and from a cruise ship in Guadeloupe||0||0||0|
|US Virgin Islands||6||NA||NA||6||1 from local transmission||0||0||0|
|Grand Total||384||84 (22%)||89 (23%)||211 (55%)||10||2||6|
* NA= Not available.: Data collected from a variety of sources: situation reports disseminated by individual countries/ territories, social media reporting from Ministries of Health and websites of regional health institutions such as PAHO . See Appendix for additional sources of gender dis-aggregated data reported at country/territory level
EDITORIAL NOTE : BMJ Global Health Blogs is not peer-reviewed and should not be used for decision making. Two typographical errors were fixed post-publication.
About the authors :
Bassey Ebenso is a lecturer in International Public Health at the University of Leeds
Akaninyene Otu is an infectious diseases physician at the Department of Infection and Travel Medicine, Leeds Teaching Hospitals NHS Trust, Leeds UK
Francis Poitier is a doctoral researcher using the intersectionality approach to investigate the gendered nature of health in small Island States in the Caribbean Region
We have read and understood the BMJ Group policy on declaration of interests and declare no competing interests.
APPENDIX: Supplemental data sources for Table 1, organised by country
- Loop Jamaica. The latest on COVID-19 in the Caribbean Jamaica: Loop Jamaica; 2020 [13 March 2020]. Available from: http://www.loopjamaica.com/content/latest-covid-19-caribbean-3.
Antigua & Barbuda
- Deshong D. Antigua and Barbuda records first case of the novel coronavirus: Loop Barbados; 2020 [updated 13 March 202013 March 2020]. Available from: http://www.loopnewsbarbados.com/content/antigua-and-barbuda-records-first-case-coronavirus-4.
- Gilbert L. Updated: 61-Year-Old Woman Is The First Confirmed Case Of Covid-19 In The Bahamas Nassau, New Providence: The Tribune; 2020 [updated 15 March 202015 March 2020]. Available from: http://www.tribune242.com/news/2020/mar/15/breaking-news-first-confirmed-case-coronavirus-bah/.
- Curacao Chronicle. Updates coronavirus: Second person infected; several being monitored Willemstad, Curacao: Curacao Chronicle; 2020 [16 March 2020]. Available from: https://www.curacaochronicle.com/post/main/updates-coronavirus-second-person-infected-several-being-monitored/.
- Curacao Chronicle. Prime Minister confirms Curaçao’s first case of COVID-19; closes airspace with Europe Willemstad, Curacao: Curacao Chronicle; 2020 [16 March 2020]. Available from: https://www.curacaochronicle.com/post/main/prime-minister-confirms-curacaos-first-case-of-covid-19-closes-airspace-with-europe/.
- Cayman Compass. First confirmed case of COVID-19 in Cayman: Cayman Compass; 2020 [updated 13 March 2020; cited 2020 16 March 2020]. Available from: https://www.caymancompass.com/2020/03/12/breaking-1st-confirmed-case-of-covid-19-in-cayman/.
- US Embassy Santo Domingo. Coronavirus Information for the Dominican Republic 2020 [updated 15 March 2020]. Available from: https://do.usembassy.gov/covid-19-information/.
- Thébia M-C. Coronavirus : un septième cas en Guyane, le patient revient d’une croisière à bord du “Costa Magica” Guyane: Franceinfo; [updated 14 March 202016 March 2020]. Available from: https://la1ere.francetvinfo.fr/guyane/savanes/kourou/coronavirus-septieme-cas-guyane-patient-revient-croisiere-bord-du-costa-magica-810956.html.
- Angélique le Bouter DP. Coronavirus : combien de cas Outre-mer? : Franceinfo; [updated 16 March 2020]. Available from: https://la1ere.francetvinfo.fr/longs-formats-carte-coronavirus-combien-cas-outre-mer-807779.html.
- Préfecture de la Guyane. Les services de l’État en Guyane: Point de situation [16 March 2020]. Available from: http://www.guyane.gouv.fr/Politiques-publiques/Sante/Coronavirus-Covid-19/COVID-19-Points-de-situation/Point-de-situation-n-6-4-nouveaux-cas-averes-en-Guyane.
- Préfecture de la Guadeloupe. COVID-19 : informations, recommandations et points de situation [updated 16 March 202016 March 2020]. Available from: http://www.guadeloupe.gouv.fr/Politiques-publiques/Risques-naturels-technologiques-et-sanitaires/Securite-sanitaire/COVID-19-informations-recommandations-et-points-de-situation.
- Guyana Chronicle. COVID-19 poses threat to tourism sector, as country records four cases [updated 16 March 202016 March 2020]. Available from: http://guyanachronicle.com/2020/03/16/covid-19-poses-threat-to-tourism-sector-as-country-records-four-cases.
- Guyana Chronicle. UPDATE: Guyana confirms four coronavirus cases: St. Lucia News Online; [updated 14 March 202016 March 2020]. Available from: https://www.stlucianewsonline.com/update-guyana-confirms-four-coronavirus-cases/.
- Jamaica Observer. Child among 5 COVID-19 preliminary cases Kingston, Jamaica: Jamaica Observer; [updated 16 March 202016 March 2020]. Available from: http://www.jamaicaobserver.com/latestnews/Child_among_5_COVID-19_preliminary_cases_?profile=1228.
- Jamaica Ministry of Health & Wellness. 2 More COVID-19 Cases Confirmed; 17 test negative Kingston, Jamaica [updated 15 March 202016 March 2020]. Available from: https://www.moh.gov.jm/2-more-covid-19-cases-confirmed-17-test-negative/.
- Jamaica Ministry of Health & Wellness. Jamaica confirms 6 new COVID-19 cases Kingston, Jamaica [updated 13 March 202016 March 2020]. Available from: https://www.moh.gov.jm/jamaica-confirms-6-new-covid-19-cases/.
- Jamaica Ministry of Health & Wellness. Jamaica confirms first imported Coronavirus case Kingston, Jamaica [updated 10 March 202016 March 2020]. Available from: https://www.moh.gov.jm/jamaica-confirms-first-imported-coronavirus-case/.
- Brigitte Brault GE. Coronavirus Covid-19 : un premier décès lié au virus et 15 patients touchés en Martinique [updated 15 March 202016 March 2020]. Available from: https://la1ere.francetvinfo.fr/martinique/coronavirus-covid-19-premier-deces-lies-au-virus-15-patients-touches-martinique-811764.html.
- Santé Publique France. Infection au nouveau Coronavirus (SARS-CoV-2), COVID-19, France et Monde [updated 16 March 202016 March 2020]. Available from: https://www.santepubliquefrance.fr/maladies-et-traumatismes/maladies-et-infections-respiratoires/infection-a-coronavirus/articles/infection-au-nouveau-coronavirus-sars-cov-2-covid-19-france-et-monde.
- Brault B. Coronavirus : dix personnes déclarées positives au Covid-19 en Martinique: franceinfo; [updated 14 March 202016 March 2020]. Available from: https://la1ere.francetvinfo.fr/martinique/coronavirus-dix-personnes-declarees-positives-au-covid-19-martinique-811066.html.
- Agence régionale de santé Martinique. Coronavirus : point d’actualité [updated 15 March 202016 March 2020]. Available from: https://www.martinique.ars.sante.fr/coronavirus-point-dactualite.
- Martinique la 1ère. Coronavirus : 7 personnes sont actuellement placées en isolement au CHU de Martinique [updated 14 March 202016 March 2020]. Available from: https://la1ere.francetvinfo.fr/martinique/coronavirus-7-personnes-sont-actuellement-placees-isolement-au-chu-martinique-810794.html.
- Lucia News Online. BREAKING NEWS: Three cases of coronavirus confirmed in St. Barthélemy, Saint Martin [updated 1 March 202016 March 2020]. Available from: https://www.stlucianewsonline.com/breaking-news-three-cases-of-coronavirus-confirmed-in-st-barthelemy-saint-martin/.
- Agence de Santé. Bulletin n°2 Information « coronavirus » Point de situation au 02 mars 2020 [updated 2 March 202016 March 2020]. Available from: http://www.guadeloupe.gouv.fr/content/download/19004/120617/file/02032020%2520Point%2520de%2520situation%2520Coronavirus%2520n%25C2%25B02-.pdf&usg=ALkJrhgOB_JVGyWFL-cT0OFZOFetNjnrCA.
- The Government of Saint Vincent and the Grenadines. Ministry of Health WatE. Contact Tracing- LI737 – March 7th, 2020 [updated 16 March 202016 March 2020]. Available from: http://health.gov.vc/health/index.php/c/808-contact-tracing-li737-march-7th-2020.
Trinidad & Tobago
- Government of the Republic of Trinidad and Tobago. Trinidad and Tobago COVID-19 (Novel Coronavirus) Update # 25 [16 March 2020]. Available from: http://news.gov.tt/content/trinidad-and-tobago-covid-19-novel-coronavirus-update-25#.Xm_MpnL7RhF.
- Daily Express. T&T records 2nd case of COVID-19 [updated 14 March 202016 March 2020]. Available from: https://trinidadexpress.com/newsextra/t-t-records-nd-case-of-covid/article_dbd560e6-6592-11ea-adf9-9b60cb64b6db.html.
- Sorias L. Virus comes to T&T [updated 16 March 202016 March 2020]. Available from: https://trinidadexpress.com/news/local/virus-comes-to-t-t/article_f05e2740-64d0-11ea-a125-9f2cbd56ac80.html