The COVID-19 worldwide pandemic is getting closer and closer to legitimate comparisons with the 1918 pandemic! As a matter of fact, a research letter published by the Journal of American Medical Association this past summer noted that "the mortality associated with COVID-19 during the early phase of the New York City outbreak was comparable to the peak mortality observed during the 1918 H1N1 influenza pandemic." Just as important, similar to the 1918 influenza pandemic (see one analysis by the National Bureau of Economic Research here), COVID-19 has had a tremendous social and economic impact on the world today. As Frank Snowden wrote in a book called Epidemics and Society: From the Black Death to the Present released last year, pandemics like the 1918 Influenza Pandemic (and now, COVID-19) shape society in ways similar to wars, revolutions, and economic crises.
With all of that as context, it is clear that COVID-19 has had a disproportionate impact on women and minorities. Many of the gender and racial disparities already existed pre-COVID, but the pandemic has only worsened them. For example, a number of reports (see, for example, here and here), have highlighted the stark contrast in disease severity and mortality in Hispanics and Blacks compared to Whites. And, while men appear to be at higher risk of COVID-19-related morbidity and mortality, the social and economic impact of COVID-19 has largely fallen on women.
The United Nations Development Program and UN Women this past September gave most nations a failing grade on whether they were successful in shielding women from the adverse economic and social consequences of COVID-19. Similarly, the International Labor Organization has gone on record to say that any gains in gender equality (which they said represented "modest progress" at best) in the past several years will have been erased in the post-pandemic world. For example, this is the first recession in U.S. history that caused significantly more job losses for women compared to men. According to the most recent jobs report, employers cut 140,000 jobs in December - all of them were women (women lost 156,000 jobs while men gained 16,000 jobs)!
Balancing work and family obligations has always been challenging for women in the workforce. For example, women working full-time outside the home spend 50% more time each day caring for children compared to men working full-time outside the home. Early and throughout the pandemic, with schools shifting to remote learning and child care centers either closing temporarily or going out of business for good, childcare and home teaching responsibilities fell even more disproportionately on women. As a result, many women have left the workforce altogether (labor force participation from February to September fell by 3 percentage points for women versus only 1.2 percentage points for men).
COVID-19 has had an incredible (and when I say "incredible" I mean "incredibly bad") impact on women in academic medicine. I would kindly call your attention to a superb piece written by a few of my former colleagues in Cincinnati ("Collateral Damage: How COVID-19 is adversely impacting women physicians"). Drs. Jones, Durand, Morton, Ottolini, Shaughnessy, Spector, and O'Toole write, "The coronavirus disease of 2019 (COVID-19) pandemic has affected every facet of our work and personal lives. While many hope we will return to 'normal' with the pandemic's passing, there is reason to believe medicine, and society, will experience irrevocable changes."
These physicians cite some of the same statistics that I report above. Notably, during the pandemic, female physicians are spending more time on childcare activities compared to their male counterparts. As I have previously highlighted, more women are entering the pediatric workforce than men. While this is great news, there are still significant leadership gaps with fewer women in leadership positions in academic pediatrics (this is particularly true in my own specialty of pediatric critical care medicine). If women continue to leave the workforce in academic medicine, as they are currently doing, the leadership gap will only get worse. We simply can't afford that.
What should academic health centers do? I won't even begin to suggest that I speak for women physicians. Instead, I offer up six recommendations from Drs. Jones, Durand, Morton, Ottolini, Shaughnessy, Spector, and O'Toole:
1. Closely monitor the direct and indirect effects of COVID-19 on female physicians (they specifically state hospitalists in their article, but I think their recommendation universally applies to all female physicians).
2. Inquire about the needs of women in your organization and secure the support they need.
3. Provide a mechanism to account for lack of academic productivity during this time.
4. Recognize and reward increased efforts in the areas of clinical or administrative contribution.
5. Support diversity, inclusion, and equity efforts.
6. Advocate for fair compensation for providers caring for COVID-19 patients.
Now would be a great time to remind everyone that we will be celebrating National Women Physicians Day exactly one week from today (February 3, 2021). In addition to recognizing our female colleagues in medicine, wouldn't it be great if we sat down and had an honest conversation about the disproportionate impact of COVID-19 on women?
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