The statistical data was collected from the official fact finding documents of Government of Pakistan to analyses the gender based infection rate and mortality count. It was found that among the men population of Pakistan the mortality rate is very high. The study was design to factories the major cause of gender inequality of infection. This is study focused on regional and behavioral and biological issues of men that leads to high mortality rate.Pakistan is struggling hard with the present prevailing pandemic of COVID-19 since 26th February, 20201. According to World Health Organization’s situation reports before the March. 15th 2020, all the cases reported in Pakistan was imported through the returned working class and Pilgrimages from Europe, USA, Saudi Arabia and Iran respectively2. Ministry of Health Pakistan now confirmed the total 80,494 confirmed cases of COVID-19 in Pakistan. The epidemiological studies are more threatening because the mostly population which is under real panic are men. The recent briefing of Ministry of Health Pakistan has declared that 78% confirmed cases are found in men1. The claim is very shocking but it still has some grounds. Being a developing country where the health sector is not privileged as compare to the developed countries; Pakistan’s Government is struggling hard for its people.
I. Overseas Returner and PilgrimagesPakistani people are present in 35 different countries in the world. Most of them belong to working class men who went in different countries for their livelihood. The total overseas Pakistani population is 7.6 million3. During the outbreak of COVID-19 in different countries mostly Pakistani return to homeland and thought to be were the carriers of the virus. A total of 58,000 people returned from different countries of the world. Including 20, 000 pilgrimages from Iran and Saudi Arabia. A total of 4, 637 prisoners repatriated from different countries4. Most of the returning and repatriated were men. Figure 1 indicates the age distribution among the gender and reported cases among men and women.II. Tobacco UsersThe second biggest reason of more active cases in men is compromised immunity. A total of 36% male are active smokers in Pakistan while 9% of females are also tobacco user5. Smoking harms the immune system and can make the body less successful at fighting disease. The immune system is the body’s way of protecting itself from infection and disease; it works to fight everything from cold and flu viruses to serious conditions such as cancer. Additionally, smoking is known to compromise the equilibrium, or balance, of the immune system. This increases the risk for several immune and autoimmune disorders (conditions caused when the immune system mistakenly attacks the body’s healthy cells and tissues). New evidence finds that smoking is a cause of rheumatoid arthritis, an autoimmune disease in which the immune system attacks the joints and causes swelling and pain6. The Figure 1 clearly indicates the reported cases among youth. This might be reason as many young men and women are using tobacco and involved in smoking so, the reported ratio among them is high despite of their age group.III. Sex HormonesThe reason why sex-bias immunity exists may lie in the evolution and preservation of mankind. Evolutionarily, during reproductive years, an enhanced response to infections should help maintain health for reproduction. In aged women, reproductive function is not required, enhanced immune reactivity along with changes in immune cells during aging causes sex-specific differences in immunity. The sex-specific expression of genes may explain why women with a similar genetic background show higher immune reactivity or develop autoimmunity at a higher rate than men. Also, the circadian rhythm of sex-hormone-dependent immune system and microbiome could control metabolic profile of an individual. Microbial-metabolites are involved in various signaling pathways as well as immune pathways like differentiation of T cells via binding to receptors of gut immune cells and epithelium. Similar functions also occur in other tissues. Thus, combined with variable X inactivation in cells and pleiotropic nature of many genes, it is likely that sex-hormones impact immune system and its ability to break tolerance to pathogens 7.Age Distribution and Mortality Rate among Men Population The above mentioned factors can be the one which are causing high fatality among older age males.The most important factor is psychological and social stress among men. Despite from younger men in Pakistan, old age men are considered high risk under COVID-19 due to their effete immune system and are often associated with chronic underlying diseases. And the seniors are more severe after infection, so deaths are more common among the men and those with chronic underlying diseases. Therefore, this factor can accumulate stress and fear among the older men Faced with the sudden outbreak of Coronavirus, distinct from younger generations in Pakistan, the men not only face the disadvantages caused by relatively low immunity systems, but also need to overcome the challenges brought by the complex psychological environment in the special period of life.In conclusion I must add that Pakistan is still expecting the higher number of cases but the gender disequilibrium can case many psychological and social problems among the general population. The most dependency of household is on men in Pakistan. One of the most important Post-Infection challenge will be counter the level of unemployment and work force in Pakistan.References;1- Ministry of Health, Government of Pakistan [http://covid.gov.pk/stats/pakistan]2- World Health Organization [https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports]3- Population of Overseas Pakistanis [https://pakiholic.com/population-overseas-pakistanis-different-countries-world/]4- Ministry Of Overseas Pakistanis and Human Resource Development, Government of Pakistan [http://www.ophrd.gov.pk/TopStoryDetail]5- Rashid Ahmed, Rizwan-ur-Rashid, Paul W. McDonald, Wajid Ahmed. Prevalence of cigarette smoking among young adults in Pakistan. Journal of Pakistan Medical Association, 2008; 58:5976- Smoking and Overall Health [https://www.cdc.gov/tobacco/data_statistics/sgr/50th-anniversary/pdfs/fs_smoking_overall_health_508.pdf]7- Taneja V. Sex Hormones Determine Immune Response. Front Immunol. 2018. 27;9:1931. doi: 10.3389/fimmu.2018.01931. PMID: 30210492; PMCI