Is COVID-19 more deadly for men than women? The numbers so far
According to evidence that is growing, men — specifically older men — appear to have a higher likelihood of developing severe symptoms compared to women.
As coronavirus envelops more of the world, with over 6,07,000 confirmed cases at last count, some trends are becoming more apparent. The virus seems to be more deadly to those over 70 and above, with mortality rates increasing dramatically for older age groups. It does not seem to be as deadly in children, though some studies have shown that infants below the age of 1 have a higher chance of hospitalization than older children. Also, the majority of those infected will have mild symptoms and not require hospitalization.
Embedded within this data is a gender divide; according to evidence that is growing, men — specifically older men — appear to have a higher likelihood of developing severe symptoms compared to women. According to the latest data from a Spanish study that looked at over 20,000 cases, while the number of infections appears to be similar for men and women, men made up 59% of hospitalizations, 72% of ICU admissions and 65% of deaths. This data, while it is preliminary and needs to be validated by further investigation, seems to corroborate data from other countries. In France, Norway and Britain, older men also made up over 70% of ICU visits. According to the largest Chinese study conducted by the country’s CDC, men had a mortality rate of 2.8% compared to 1.7% in women.
What explains these findings?
For starters, the data presented so far is crude, and since this is a developing phenomenon, future studies will give the data more meaning. For example, researchers are working on antibody testing and serological profiles which will give more information on disease incidence.
Initially, the discrepancies were explained by differences in smoking behaviours. Since Chinese men are much more likely to smoke than their female counterparts (over 50% males, as opposed to 2% females), more of them were at risk of becoming severe cases. The difference between the percentage of men and women who smoke is not so pronounced in other countries but the trend of more men becoming severely sick remains the same.
So what gives? Studies have suggested that due to cultural and social reasons, men are less likely to heed public health advice and be less risk-averse; so, they are less likely to wash their hands regularly, practice social distancing or seek medical care when they feel sick, on average. These differences should explain some of the data we are seeing, at least in part.
Men are more likely to develop certain conditions such as cardiovascular disease and hypertension at a younger age - both of which are underlying conditions that can worsen the outcome of COVID-19. In fact, according to the Spanish government, 58% of fatal cases involved patients who had cardiovascular issues.
On a more fundamental level, many genes in the X chromosome are responsible for mounting an immune response. Since women have two X chromosomes, it appears that they have a more responsive and robust immune system. Studies have shown that men have a lower antiviral response to diseases like HIV, for example, and the mortality rate for men during the SARS epidemic was also double that of women. Interestingly, the rate of infection was more similar between the sexes then, too.
Further, the hormone estrogen has also been shown to play a key role in mounting an immune response, further mounting the evidence for the stronger female system.
A complicated question
Again, the data presented so far is crude and the explanations offered are generalized. This is a completely new virus that the world has not previously seen; a comprehensive understanding presently eludes us.
Even when we understand the virus better, the answer to the gender divide will be multipronged; there are behavioural, social, and biological factors at play here.
For more tips, read our article on COVID-19 prevention tips for older people and those living with chronic illnesses.
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