Women fear COVID-19 more than men,
But men have more to fear
Why the coronavirus kills more men than women
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A March 25 Abacus poll of over one thousand Canadians found that 41 percent of women are “extremely” or “a lot” worried about COVID-19. Only 25 percent of men reported feeling the same way. Paradoxically, men are far more likely to die of the disease.
Statistics released by the New York City Health Department reveal that men account for 61.8 percent of deaths attributed to COVID-19 in that city — a city that has seen nearly 140 thousand confirmed cases of the virus as of mid-April. In Italy, where the virus has claimed over 25 thousand lives, 71 percent of the victims were male. Other countries that have been hardest hit by the global pandemic like Spain and China have also reported significantly higher rates of deaths among males.
Women, however, are just as likely to contract the novel coronavirus in the first place. The gender split in Italy is 50–50, whereas in Spain women account for more than half (54 percent) of all confirmed COVID-19 cases. Men represent only slightly more than half (51 percent) of all confirmed cases in China and 54 percent in New York City.
So why are men dying at a significantly higher rate than women? Is there something unique about this version of the coronavirus that makes men more susceptible to death?
It turns out, COVID-19’s disproportionate impact on men follows suit with two other deadly coronaviruses that made international headlines. Severe Acute Respiratory Disorder (SARS) was first discovered in southern China in November of 2002, becoming a threat of global significance in March 2003. It infected just shy of 8,100 people worldwide, causing 774 deaths. Ten years later, Middle East Respiratory Syndrome (MERS) would go on to cause 858 deaths.
In one study, SARS was found to pose a significantly higher risk of mortality to men when compared to women (21.9 percent versus 13.2). A similar result rang true regarding MERS deaths by gender (23.4 percent men versus 16.0 percent women).
But what explains this reality? Why are men more likely to die from coronavirus related illnesses than women?
Biological differences between men and women are one important factor to consider when understanding why men are faring worse against COVID-19. The sex hormone estrogen, levels of which are higher in women than men, appears to play a role in activating women’s antiviral responses. A 2016 study published in the American Journal of Physiology showed that estrogen can limit the ability of the flu virus to replicate. The study’s authors also cite previous research that demonstrated estrogen’s antiviral properties against HIV, Ebola and hepatitis viruses.
Another variable unique to biological males is the presence of only one X chromosome. This particular DNA molecule happens to contain the highest number of immune-related genes within the entire human genome. Human males express just one X chromosome (XY); women have two (XX), thereby possessing twice the aforementioned immune-related genes as men.
While biological factors will be hard to escape, another prominent factor that could explain why more men than women succumb to COVID-19 and other coronaviruses is more easily controlled.
Smoking and drinking are two lifestyle behaviours in which men indulge more than women. Chinese and Italian men, for instance, are far more likely to smoke tobacco than their female compatriots. Given smoking’s detrimental effects on the respiratory system, and COVID-19 and other coronavirus’ negative impacts on the lungs, this puts men at higher risk of developing life-threatening complications. For its part, heavy drinking — a behaviour which, again, is more common among men than women in virtually every country — has a wide range of deleterious effects on the immune system.
Another aspect pertaining more to men’s health than women’s is men’s reluctance to seek medical help. Men appear to have more trouble expressing their medical concerns and address them with a professional later in the progression of the ailment. Delayed medical interventions can serve to aggravate the condition whereas early recognition and treatment of COVID-19 has been shown to decrease mortality rates.
For the thousands of men and women who have already died as a result of the novel coronavirus, this information offers no comfort. But with an effective vaccine still 12–18 months away, and the potential for second and third waves of infections, factors contributing to men’s higher mortality rate ought to be widely-known.
Because while biological factors play an important role, so too do lifestyle choices. Less smoking and more moderate alcohol consumption could be a key in lowering instances of COVID related deaths among men — not to mention improve men’s health in general.
