People from all walks of life are falling seriously ill with COVID-19. However, growing evidence reveals that more men than women are being infected — and dying — from the virus. During the early weeks of the pandemic, countries didn’t provide data of coronavirus cases that were ‘disaggregated’ or broken down by sex. Researchers of a report published in the journal BMJ Global Health appealed to countries to provide sex-specific data. Since then, many governments have decided to publish data that are fully sex- and age-disaggregated.
Men More Than Twice As Likely to Die
The first signs that COVID-19 has more impacts on men than women in terms of infection and death rates emerged from hospital records in Wuhan, China. According to a report conducted by a team at Shanghai Jiaotong University School of Medicine, they found that among those admitted, men outnumbered women by more than two to one. Early mortality data from 21 hospitals in Wuhan also revealed that 75% of those who died were men.
Many countries have found similar findings. The World Health Organization reported that 68% of deaths related to COVID-19 in Europe have been among men. In New York City, men have been dying of coronavirus at almost twice the rate of women. For every 100,000 men, 43 are COVID-19 deaths, compared with 23 deaths for every 100,000 women. A study by the Higher Health Institute of Rome found 8% of Italian men hospitalized for the novel coronavirus died compared to 5% of women.
Another study by the Centers for Disease Control and Prevention covering 14 states and nearly 10% of the US population revealed that more than half of the COVID-19-associated hospitalizations happened in men. According to ABC News, an online site that covers breaking news, videos, and the latest top stories in world news, business, politics, health, and pop culture, the man-to-woman ratio for coronavirus deaths in Italy is 80% to 20%. In Denmark, 5.7% of the total number of cases confirmed among men has resulted in death, whereas 2.7% of women with confirmed COVID-19 have died.
Past epidemics showed that these findings aren’t new. “COVID-19 appears to follow the trend of previous infections with SARS and MERS [in that] men are affected more often than women," Veena Taneja, an associate professor of immunology at The Mayo Clinic, said.
As new data reveals dramatically stark sex disparities, researchers have proposed theories that could help explain why men appear to be more vulnerable to COVID-19. One of them shows that men are biologically weaker than women. Researchers think that women have a stronger immune response because most of them have two X chromosomes. The X chromosome contains most of the genes related to the immune system. Men, on the other hand, have only one – which is important when it comes to coronavirus.
Jay Bhatt, a practicing internist and chief clinical officer at Surgisphere, agrees. He said that having two copies of the X chromosome “may be helping bolster the immune response to coronavirus."
“In particular, the protein by which viruses such as coronavirus are sensed is encoded on the X chromosome. As a result, this protein is expressed at twice the dose on many immune cells in females compared to males, and the immune response to coronavirus is therefore amplified in females,” Philip Goulder, professor of immunology at the University of Oxford, said.
According to Vox, a liberal-leaning American news and opinion website owned by Vox Media, SARS killed more men than women during the outbreak in 2003. A study of mice in the Journal of Immunology found that male mice were more susceptible to the virus, validating recent findings that men are indeed more biologically vulnerable to COVID-19. Also, women might be more likely to launch an earlier attack on infections in general, saving the body from needing to use all of its virus-fighting might later.
Previous studies explained that there are many differences between men and women in immune response due to sex hormones (androgen and estrogen), regulatory genes (genes that tell the body what decisions to make), and the ability to produce antibodies (proteins that tell the body about the virus). Taneja said that androgen suppresses men’s immune response, while females can generate a higher immune response and make antibodies that can clear the infection due to estrogen.
Researchers said that these biological differences in men’s and women’s immune systems were forged over thousands of years of evolutionary history. “During evolution, nature, to preserve mankind, and for progeny, has selected women to be stronger during childbearing age. Women are less susceptible to get infections and can fight them by generating a robust response,” Taneja said.
Another factor that contributes to why men are susceptible to the virus than women is their lifestyle choices. According to BBC, an operational business division of the British Broadcasting Corporation responsible for the gathering and broadcasting of news and current affairs, Goulder said that there are important behavioral differences between the sexes which affect the level of pre-existing diseases such as heart disease, chronic lung disease, and cancer.
Lifestyle factors such as smoking and alcohol consumption, which tend to occur more among men, may also explain the overall higher mortality rates among men. Recent reports have shown that such behaviors are likely to negatively influence the outcome of patients with COVID-19, especially if they have preexisting conditions like cardiovascular disease, hypertension, and chronic lung conditions. In China, for instance, smoking is largely a male habit, resulting in many men suffering from chronic lung disease.
According to EcoWatch, a leading environmental news site engaging millions of concerned individuals every month, male behavior during the pandemic also could be increasing their exposure to the novel coronavirus. A recent poll by Gallup revealed that women were more concerned about COVID-19 than men were by a 62% to 58% margin.
"It's possible that men are more at risk because they tend to expose themselves more to larger crowds and social exchanges, including things like handshaking and sporting events," Dr. Stephen Berger, an infectious disease expert and co-founder of the Global Infectious Diseases and Epidemiology Network (GIDEON), said.
Pollution is also believed to have elevated COVID-19 mortality rates among men. Berger explained men in most cultures are more likely to be engaged in outdoor work, exposing them to conditions associated with extreme climate and pollution. "This could directly impact their response to an infection like COVID-19,” he said.