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Why do more men die from CoVid-19 then women?
In China men were more than twice as likely to die from CoVid related disease as women, whereas in other countries, including the US, the statistics are more in the range of 60% of deaths being men, although in select regions such as NYC this can be substantially higher, reaching the same disproportionate death rate for men as in China. There are likely two different variables at play. The first is cultural. More men smoke worldwide. The gender bias is particularly egregious in China where less than 3% of women smoke and over half of men do. Men are also more likely to have workplace exposures to heavy metals, pollutants etc that can weaken the lungs. Since many CoVid deaths are respiratory based this contributes to the higher vulnerability of men. Some suggest men are less likely to wash their hands and this may be a factor.
But there is also the potential for a biological basis for the sex difference. Women on average have stronger immune systems then men, sometimes to their detriment as women are at significantly higher risk of autoimmune disorders. Nonetheless this may help women fight off the virus more effectively given that initial rates of infection appear to be the same in men and women. Men are also more likely to have the co-morbidities that contribute to death rates, such as hypertension, diabetes and obesity.
Lastly, there is some evidence hormones may play a role. Cancer patients with CoVid-19 infection are at very high risk but men with prostate cancer who are deprived of androgens were found to have a particularly low death rate, suggesting that testosterone is a risk factor. This may be due to regulation of the Ace-2 receptor which is how the SARS-CoV2 virus enters cells. Androgens appear to up regulate the receptor in some tissues, thereby increasing the ability of the virus to get into cells.
There is mixed evidence for the role of estrogens, are they protective in women? Perhaps, since the death rate among premenopausal women is much lower than age matched men. But postmenopausal women also die at lower rates then men. We still have much to learn about why men are vulnerable and women are resilient. Discovering the biological basis of each will help in the prevention and treatment of viral infections in both sexes.
