Are males more at risk from COVID-19 compared to females? Why?


A: Yes. While whether men or women get infected more often is not yet clear, men are consistently over-represented among COVID-19 deaths.

In hard hit New York City for example, males make up 52% of confirmed cases, but 61% of COVID-19 deaths. In Italy, men currently make up 47% of the confirmed cases, and 62% of the deaths.

The most important reason is likely to be sex-specific differences in immune function, in which females typically have stronger immune responses at all ages.

While differences in immune function by biological sex are well-established, a stronger immune response can be detrimental in women from damage due to inflammation, which has been seen for flu. Women also suffer more autoimmune diseases which are over-reactions of the immune system.

For previous coronaviruses including SARS-CoV and MERS-CoV, males also showed increased infection incidence and severity (link in comments). Mice models of SARS-CoV showed increased accumulation of inflammatory monocytes in the lungs of male mice. This suggests that there is something important about the sex-specific about the immune response to coronaviruses that we are seeing in the mortality data.

In some countries, sex differences in health behaviors such as smoking may play a role—for example in China around 50% of men smoke compared to 3% of women. Men also have higher rates of cardiovascular disease and hypertension, underlying conditions which may also increase the risk of death from COVID-19.

It’s important to note that different social and cultural contexts also affect how often women or men might be exposed to the virus. Women are often a higher fraction of nurses and front-line health care workers with close physical contact with patients, while in certain countries men may be over-represented in occupations such as construction that are less compatible with working from home and strict social distancing.

Bottom line: While both males and females are at risk, pay some extra attention to protecting your older male loved ones!

FiveThirtyEight Article

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