Unlike the rest of the world, Canada is seeing more COVID-19 deaths in women than in men. Here's why.

• While the rest of the world is witnessing more men dying of COVID-19 than women, Canada is one of the only countries where that statistic has been reversed.
• The Canadian province of Quebec is seeing the biggest gender disparity in coronavirus cases, with women making up 59.4% of confirmed coronavirus cases and 54.6% of deaths.
• Experts believe that the data could be skewed towards females because the province has seen the majority of its outbreak occur in long-term care homes, where the population of females is a lot higher.
• Another factor is that healthcare workers in the province — of which 80% are female — have also been largely affected.
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Early research into the novel coronavirus has shown an unusual pattern among COVID-19 patients: more men are dying than women.

But Canada seems to be bucking the global trend, with the latest data showing that it is one of the few countries where women have higher death and infection rates than men.

The virus has been particularly devastating for the eastern province of Quebec, which, to date, has more than 42,000 confirmed coronavirus cases and almost 3,500 deaths alone— the highest in the country, according to government statistics.

Quebec also sees the greatest gender disparity in COVID-19 cases out of all the provinces. As of May 14, women made up 59.4% of confirmed coronavirus cases and 54.6% of deaths, the Montreal Gazette reported.

But why?

While research is still underway and the lack of community sampling doesn't show the full picture, some experts believe that there are several explanations as to why the province — and Canada as a whole — is seeing a gender difference of infection and death rates, compared with the rest of the world.

Quebec has seen one of the worst outbreaks in its long-term care facilities

A large part of Quebec's battle against the coronavirus has been fought in its long-term care facilities, Dr Donald Sheppard, a professor and Chair of the Department of Microbiology and Immunology (MI4) at McGill University, told Business Insider.

"One factor is that the outbreak in Quebec is a very different outbreak than what has been seen in other provinces. It's being driven not by community spread, but by a spread in long-term care facilities," Sheppard said.

The virus was first brought into care homes by family members who had taken trips abroad during the province's early March break. A failure by authorities to respond quickly and effectively in the days and weeks that followed caused COVID-19 to spread rampantly in dozens of homes, according to the Canadian Broadcasting Corporation (CBC).

The situation was worsened by massive staff-shortages of personal protective equipment (PPE) as thousands of care home workers started getting infected with the virus.

According to provincial data, 82% of Quebec's dead lived in long-term care homes.

On top of that, women make up over 75% of residents aged 85 years and older in care homes, according to data cited in the Montreal Gazette.

"What we're seeing here is that a lot of the numbers are being skewed by the fact that we assume that we're taking 50/50 men and women, exposing them to the virus, and what's coming out of the other end is the numbers that you're getting now," Sheppard said.

"I actually think what we're doing is taking a population that is around 75% female, exposing them to the virus, and that female portion of that population is older than the male fraction so they're more at risk for bad outcomes and shockingly, this is what you're seeing."

"And to make matters worse, the average age of the women in the long-term care facility is older than the average age of the male. And we know there is a direct correlation between age and severity of this illness and its mortality," Sheppard added.

Philip Goulder, a pediatrician and research immunologist at the University of Oxford, agrees that when you look only at the population of older people in the country, the numbers change.

"People haven't taken into account when they look at the male and female statistics, the fact that it shouldn't be just 50/50. It should be 60/40, for example, because women live older than men," Goulder told Business Insider

"Even in Canada, the number of males dying is still far more than you expect because you got fewer men who are over 70 than females," he added.

The problem of outbreaks in long-term care facilities has been witnessed in other parts of Canada too. In April, Canada's chief public health officer Theresa Tam said that nearly half of the known coronavirus deaths in the country were linked to outbreaks in elderly care homes, according to the BBC.

Healthcare workers in the province have also been affected badly

Another explanation for the different gender disparity in Canada could be that the virus has affected frontline healthcare workers in the country.

Women form 70% of workers in the health and social sector worldwide, according to a report by the World Health Organisation (WHO)

In Quebec, this number is much higher, with an estimated to be 80% of the workforce comprised of women, according to the Fédération de la santé et des services sociaux (FSSS-CSN), which is the largest union representing the province's healthcare workers.

"So the healthcare worker population is estimated to be 80% women already, and if you think about what it is in long-term care, it's skewed even further —it's probably closer to 90% of healthcare workers in this setting are female," Sheppard said.

According to CBC, at least 4,000 healthcare workers have tested positive for COVID-19 in Quebec, making up the second-largest portion of infections outside nursing homes.

"It's such a massive part of the outbreak. If you think about the fact that 20% of all the cases in the province are healthcare workers," said Sheppard.

"We're seeing the dramatic difference between the community outbreak which is smaller, and then the hospital associate outbreak with healthcare workers and with patients in the outbreak," he added.

Sheppard believes that it is the combination of the virus breaking out in long-term care facilities and affecting predominantly healthcare workers in the province that are skewing the numbers that show more women are dying.

"If we can split off just the community data in Quebec, people that are not healthcare workers and are not long-term care facility patients, I really think we would see that the balance would be the same as what we have seen in other countries," Dr Speppard said.

"In the community, we might have a 50/50 mix, but in long-term care facilities and healthcare workers it's absolutely skewed towards females," he added.

Most countries in the world are witnessing a different trend

Meanwhile, researchers in other countries have been trying to understand why men seem to be dying at a higher rate than women.

One of the first studies that looked into the gender differences in COVID-19 cases was conducted by the Chinese Center for Disease Control and Prevention at the beginning of the year. The study found that out of more than 44,000 patients, 2.8% of men diagnosed with the coronavirus ultimately died as of February 11. For women, the fatality was 1.7%.

Researchers quickly realized that the trend wasn't exclusive to China and that countries, including Italy, Germany, and South Korea, also started reporting a higher death toll among male patients, according to academic research group Global Health 50/50.

Several possible explanations behind this trend have since been discussed. One factor could be that men smoke cigarettes more than women do. Other researchers have pointed to behavioral factors as another possible explanation — surveys suggest US men are less likely to wash their hands.

Another possibility could be that those with preexisting health conditions like high blood pressure or heart disease are more likely to die from the virus. In many countries, men usually have higher rates of these underlying health issues.

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