As more data is gathered from an unfortunate and dramatic rise in the number of COVID-19 cases around the world caused by the coronavirus, SARS-CoV-2 (there have now been over 328,000 confirmed cases, 14,366 deaths, and 95,656 recoveries), we are learning more about the impacts of the infection. Researchers have noticed that men are worse off than women when they get sick from the pandemic virus and are dying at higher rates. This information, which says that boys and men are more likely to get seriously sick, and men are more likely to die, comes from countries like Italy that are being hit hard by the pathogen.
Reports from authorities in Italy last week stated that of 13,882 COVID-19 cases and 803 deaths that occurred from February 12 to March 12, 58 percent of the patients were men, who were 75 percent more likely to die than women who had been hospitalized from the infection. Men accounted for 72 percent of deaths during that one-month period.
Patient profiles from China have not been as stratified, but the trends are the same. From December 2019 to February 2020, roughly 60 percent of COVID-19 patients there were men, and the fatality rate was about 65 percent higher for men than women. Clinicians also noted that of 171 adolescents treated in Wuhan for the viral infection, 61 percent were male.
Similar gender disparities are seen in South Korea as well, where men make up almost 62 percent of cases, and once an infection takes hold, it is 89 percent more likely to be fatal in men.
Men are also more likely to be smokers, which can help explain why they are more vulnerable to an illness that affects the respiratory system. But, pediatric infectious disease specialist Dr. Stanley Perlman told the LA Times that it's not the whole story.
Perlman has studied other coronaviruses (that cause SARS and MERS) in his lab at the University of Iowa. His work showed that in a mouse model of any age, males were more susceptible to coronavirus infection than females. However, when the ovaries were removed from the female mice or they were exposed to drugs eliminating estrogen activity, their infection rates spiked. That strongly suggested that estrogen is exerting a protective effect, and may be shielding females from coronaviruses.
“Why does estrogen protect the woman, and how?” Perlman said. “We’d like to know.” Estrogen is a critical hormone with many functions in the body, so there's a lot more to learn before we can answer that question.
It may be that the hormone is affecting how the immune system responds to the infection. Immunologists had to rely on male models in their research for many years because hormones confounded their results. However, some scientists have theorized that a woman's immune system may have a more robust response to coronavirus than men, which means the more powerful soldiers of the immune system don't have to come out for a full-scale battle.
If viral loads get high and immune T cells and B cells need to respond to the infection, not only does the infection damage the lungs, the immune response itself, which involves inflammation, can cause even more problems for the delicate tissue, and potentially, death. In women, most infections may never get to this point, Susan Kovats, an immunologist at the Oklahoma Medical Research Foundation in Oklahoma City, told the LA Times.
