COVID-19 diagnostic testing underestimated cases amongst females in Pakistan

ObjectivesUnderstanding the impact of COVID-19 largely depended on information from PCR based diagnostic testing of SARS-CoV-2. It was recognized early in the pandemic that testing rates varied greatly between high and low income countries. Whilst total numbers of tests conducted are noted, little attention has been made to differences that may be due to gender and we examined this in the context of Pakistan. MethodsWe conducted a retrospective cross-sectional analysis of respiratory specimens received for SARS-CoV-2 by PCR at Aga Khan University Hospital, Karachi, Pakistan between February 2020 and February 2022. Data was analysed in six monthly intervals; P-I, February to July 2020; P-II, August 2020 to January 2021; P-III, February to July 2021 and August 2021 until February 2022. ResultsA total of 470,047 PCR tests were conducted. The proportion of tests conducted for females was, 35% in P-I; 40% in P-II; 44% in P-III and 46% in P-III. 21% of specimens were positive for SARS-CoV-2, only 9% of these specimens were from females. The greatest numbers of tests were conducted in males aged 31 to 45 years followed by those aged 16-30 years. The fewest tests were conducted in children aged under 15 years. The highest percentage of PCR positive tests was found in those ages 60 years and above. Compared for gender SARS-CoV-2 positivity rates were comparable across the study period. ConclusionsCOVID-19 data from Pakistan indicates that there are larger numbers of males as compared with females who were affected by this disease. Our results show that this may be due to a gender bias in the demographics of testing. This was especially true in the early pandemic period, leading to under-surveillance and -reporting of COVID-19 cases in females especially, in those of younger and older age groups. Strengths and limitations of this studyO_LIwe stratified PCR testing based on gender and provide information on diagnostic trends C_LIO_LIwe found COVID-19 rates were comparable between females and males C_LIO_LIFewer samples from females were received particularly, in 2020 with an increase by 2022 C_LIO_LIit proposes the importance of examine the total samples tested in any case before drawing conclusions based on results of laboratory reports. C_LI LimitationsThis study was from one private healthcare system and cannot completely reflect nationwide trends to limited access to testing and also stigma related to the COVID-19.