Sex differences in COVID-19

There are many ways in which the pandemic itself affects people’s day-to-day lives, and gender — understood as the ensemble of social expectations, norms, and roles we associate with being a man, woman, trans- or nonbinary person — plays a massive part. On a societal level, COVID-19 has affected cis- and transwomen, for example, differently to how it has cismen, transmen, and nonbinary people. Reproductive rights, decision making around the pandemic, and domestic violence are just some key areas where the pandemic has negatively impacted women. However, sex differences — understood as the biological characteristics we associate with the sex that one is assigned at birth — also play an undeniable role in an epidemic or pandemic. Sex-disaggregated data lacking Before delving deeper into the subject of sex differences in COVID-19, it is worth noting that the picture is bound to be incomplete, as not all countries have released their sex-disaggregated data. Men more than twice as likely to die Global Health 5050, an organization that promotes gender equality in healthcare, has rounded up the total and partial data that is available from the countries with the highest numbers of confirmed COVID-19 cases. According to their data gathering, the highest ratio of male to female deaths, as a result of COVID-19, is in Denmark and Greece: 2.1 to 1. In these countries, men are more than twice as likely to die from COVID-19 as women. In Denmark, 5.7% of the total number of cases confirmed among men have resulted in death, whereas 2.7% of women with confirmed COVID-19 have died. Infection rates in women and men A side-by-side comparison of infection rates between the sexes does not explain the higher death rates in men, nor is there enough data available to draw a conclusion about infection rates broken down by sexes. However, it is worth noting that in Denmark, where men are more than twice as likely to die of COVID-19 as women, the proportion of women who contracted the virus was 54%, while that of men was 46%. By contrast, in Iran, where the ratio of deaths between men and women is less different (1.1 to 1), just 43% of cases are female compared with 57% cases in men. Norway, Sweden, and Germany have a 50–50% case ratio. Other countries where more women have developed COVID-19 include: Switzerland (53% of women to 47% of men) Spain (51% to 49%) The Netherlands (53% to 47%) Belgium (55% to 45%) South Korea (60% to 40%) Portugal (57% to 43%) Canada (52% to 48%) Republic of Ireland (52% to 45%) Women’s innate immune response plays a role. Experts agree that there are sex differences, such as sex chromosomes and sex hormones, that influence how a person’s immunity responds to a pathogen. As a result, “women are in general able to mount a more vigorous immune response to infections [and] vaccinations.” With previous coronaviruses, specifically, some studies in mice have suggested that the hormone estrogen may have a protective role. To read more-


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