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Covid-19 is not a gender- or sex-neutral killer. Men are more likely than women to need intensive care for the disease or die of it. Among health care workers, however, the tables are turned: Women accounted for 73% of the more than 9,000 U.S. health care workers who had been infected with the novel coronavirus by early April.

This gender/sex difference has been seen in other countries, and it isn’t because more women than men are on the frontlines of Covid-19 care. The design of personal protective equipment might be to blame.


In late February, as the pandemic began to sweep across the U.S., the Centers for Disease Control and Prevention released an infographic on the use of protective masks for men with facial hair. It showed what kind of facial hair was acceptable for a proper fit for men using masks for infection control and prevention, and what kind wasn’t.

Reading these guidelines transported me back two decades when, as a senior medical advisor to the U.S. Department of Health and Human Services’ Office on Women’s Health, I read an internal report on the challenges that face masks and respirators posed for coal miners, especially men with facial hair — and women.

Rather than focusing solely on men with facial hair, the CDC guidelines should also have covered how women should be fit tested for their masks and respirators in a way that takes into account that the sizes, shapes, and geometries of their faces could affect the fit.


Heightened awareness about the lack of spacesuits fitting female astronauts generated significant discussion on the need for gender/sex-inclusive design. It is disheartening to see that this has not translated into awareness that the personal protective equipment women need to do their jobs as health professionals, caretakers, and essential employees may not be designed for them.

In August 2019, I had the opportunity to discuss the importance of gendered innovation for the space program during the National Space Council meeting chaired by Vice President Mike Pence, who is now leading the Covid-19 task force. I began my remarks with the following statement:

Saralyn Mark personal protective equipment

“Gender and sex impact every aspect of our lives on Earth and in space. It is more than spacesuits not fitting female astronauts. We see the impact from the shoes and clothing we wear, the electronic devices we use, the cars we drive in, and even the medications we take. Modifying appearances or the ‘pink it or shrink it’ approach for gendered innovation will never work in any environment including space, battlefields, hot zones, and in our homes.”

We are now facing a new hot zone. This time it isn’t in foreign countries. It is in our medical facilities, communities, and homes. With the outbreak of Covid-19, issues surrounding gender/sex-related design elements including products, policies, programs, and protocols need to be urgently addressed.

Size isn’t the only factor that affects proper fit for personal protective equipment. Anthropometric measurements like body proportion and movement that can be affected by sex can also have an impact and need to be considered.

I founded iGIANT — impact of Gender/Sex on Innovation and Novel Therapeutics — a nonprofit accelerator for gendered innovation, after I heard stories from female colleagues that they had to duct tape their gowns and gloves while caring for patients with Ebola because their protective gear did not fit properly. This put their lives at risk, especially when they tried to take off this equipment after potential exposure to the Ebola virus.

During iGIANT roundtable discussions around the world, I’ve heard numerous women report that their gowns, gloves, boots, and eye protection do not fit when they are working in laboratories and other environments. Female health care workers across the globe are sharing these same concerns while caring for patients with Covid-19.

In collaboration with the American Medical Women’s Association and the University of Indiana Center of Excellence in Women’s Health, iGIANT is hosting roundtables with representatives from the public and private sectors to raise awareness of these critical issues and catalyze partnerships to develop and manufacture personal protective equipment that fits women as well as it fits men.

This issue is both a professional and a personal one for me. As a physician who serves in the Medical Reserve Corps, I too want personal protective equipment that fits me.

Women across all sectors of the workforce on are on the frontlines of the Covid-19 pandemic. We need to ensure that they have the resources, opportunities, and tools to do their jobs well and safely. Seeing the world through the lens of gender and sex will advance new product designs to fit women, not just those working in the grandeur of space but in all environments.

All our lives are depending on it.

Saralyn Mark is a physician, founder and president of iGIANT, and a former senior medical and policy advisor to the U.S. Department of Health and Human Services, the National Aeronautics and Space Administration, and the White House Office of Science and Technology Policy.

  • The other end of this problem is equally important:

    Employers need to take responsibility for making certain that their employees are protected as well as is possible–not merely to the degree that equipment is currently available.

    This is an issue which should have been resolved in the 1920’s–that it is STILL an issue is insanely unethical, risks patients and caregivers alike, and undoubtedly would have saved many, many lives over the past century.

    Everyone with authority must have their responsibility tied irrefutably to their authority.

    The Trump order eliminating liability for a hazardous workplace is a horrible and unethical way to deal with ANYTHING!

    Everyone is responsible for their own actions, and there can be NO exceptions.

    Not for police, not for city council members, not for owner and managers of corporations and least of all not for Congress, the Judiciary and the President.

    Corporations should not be allowed to distribute funds gained from illegal or unethical operations to anyone without the public having a right to take back those unlawful earnings. We monitor and know every stockholder who receives such illegal gains–it is only just that those funds can be retrieved.

    AIG employees who received money which should have been retained to pay out insurance claims, should have been forced to return those illegal.

    Everyone in the healthcare field who has had to work during this pandemic, is entitled to hazard pay in additional to their normal pay, and their families should be paid additional death benefits for their heroic loss.

    We need desperately to return out government and economy to a functional state in which those with authority cannot escape the responsibility fo their actions.

    Only you are responsible for your actions. YOU. Not your boss, not your company, not the law. YOU and ONLY YOU can decide to do what is right or what is wrong. NO other entity is or can be responsible.

  • I’m both heartened and disheartened by your article. What you are doing is wonderful and much needed. As a woman who faced similar issues with gear in the late 1970‘S and the1980’s, I am disappointed that it is still an issue.

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