Men are more vulnerable to Coronavirus

We realized that old age individuals are more defenseless against COVID-19, however, another factor has identified: being male.

Picture clicked at 2 pm May 30, 2020.

There is a gender distinction among deaths because of Coronavirus. Death records from 21 hospitals in Wuhan between 21 to 30 January 2020, discovered that 75% of people who died were men.

In Italy, one investigation of 1,591 cases of critically sick individuals who were conceded into ICU demonstrated that about 82% of them were men.

Furthermore, an investigation of individuals hospitalized in the U.S. for COVID-19 in March comparatively found that "Males might be more affected by COVID-19 then females."

General health data from the city of New York, which has one of the world's biggest outbreak, demonstrates that men are more likely to be hospitalized and are nearly twice as likely to die. Further, their department of health reports that around 39 female deaths for every 100,000 individuals while 71 males for every 100,000 individuals. The World Health Organization (WHO) has reported that 63 percent of deaths related to COVID-19 in Europe have been among men.

The Centers for Disease Control and Prevention (CDC) still has not reported COVID-19 deaths by gender.

Scientific Reasons:

1) ACE 2 Receptors:

One study published by the European Society of Cardiology on May 11, 2020, shows that men have higher concentrations of angiotensin-converting enzyme 2 (ACE2) in their blood than women. Since ACE2 enables the coronavirus to infect healthy cells, this may help to explain why men are more vulnerable to COVID-19 than women.

Dr. Adriaan Voors (MD-PhD), Professor of Cardiology at the University Medical Center Groningen (The Netherlands) said:

“ACE2 is a receptor on the surface of cells. It binds to the coronavirus and allows it to enter and infect healthy cells after it has been modified by another protein on the surface of the cell, called TMPRSS2. High levels of ACE2 are present in the lungs and, therefore, it is thought to play a crucial role in the progression of lung disorders related to COVID-19.”

Another author, Iziah Sama of UMC Groningen, said: "When we found that one of the strongest biomarkers, ACE2, was much

higher in men than in women, I realized that this had the potential to explain why men were more likely to die from COVID-19 than women."

The study, published in the European Heart Journal 11 May 2020, also found that heart failure patients taking drugs

targeting the renin-angiotensin-aldosterone system (RAAS), such as angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), did not have higher concentrations of ACE2 in their blood. Dr. Adriaan Voors (MD-PhD), Professor of Cardiology at the University Medical Center Groningen (The Netherlands), who

led the study, said: “Our findings do not support the discontinuation of these drugs in COVID-19 patients as has been

suggested by earlier reports.”

2) Immune System Differences: Dr. Stephen Berger, an infectious disease expert and co-founder of the Global Infectious Diseases and Epidemiology Network (GIDEON), told Healthline that "Women, because of their extra X chromosome, have a stronger immune system and response to infections than men."

Article published online at Elsevier Public Health Emergency Collection on Published 2020, Apr 24: One key difference is that

women have two X chromosomes per cell whereas men have one. “Some critical immune genes are located on the X chromosome,” says Goulder, in particular the gene for a protein called TLR7, which detects single-stranded RNA viruses like the coronavirus. “As a result, this protein is expressed at twice the dose on many immune cells in females compared with males, and the immune response to coronavirus is therefore amplified in females,” he says.

While one X chromosome is usually inactivated in each female cell, the TLR7 gene somehow escapes this in some immune cells, meaning women produce more of the protein.

There is also some evidence that female sex hormones such as estrogen and progesterone boost the immune system, but this hasn't been specifically investigated in COVID-19 yet. (Study)

The gender difference issue is not the same throughout the world- in South Korea, for instance, men are in the minority, while in New York they are in majority.

3) Other Factors:

Besides biological factors, there are other issues like hypertension or diabetes which increases the risk factor of COVID-19. Further, way of life decisions and practices have an impact, with men less likely to seek medical help at the first signs of disease or to follow public health advice,” said Dr. Balkis.

“In most cultures, men are more likely to be engaged in outdoor work, exposing them to conditions associated with extreme climate and pollution,” Berger said. “This could directly impact their response to an infection like COVID-19.”

Another possibility is that men are simply less hygienic. They are less likely to comply with basic sanitation measures such as hand washing, says Kunihiro Matsushita of Johns Hopkins University in Maryland. (Study)

References:

“Circulating plasma concentrations of angiotensin-converting enzyme 2 in men and women with heart failure and effects of renin-angiotensin-aldosterone inhibitors”, by Iziah E. Sama et al. European Heart Journal. DOI:10.1093/eurheartj/ehaa373

https://www.escardio.org/The-ESC/Press-Office/Press-releases/Men-s-blood-contains-greater-concentrations-of-enzyme-that-helps-COVID-19-infect-cells

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7195268/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7195268/