CORONAVIRUS UPDATE: As experts learn more about the novel coronavirus, news and information changes. For the latest on the COVID-19 pandemic, please visit the Centers for Disease Control and Prevention.

The COVID-19 pandemic has been going on for more than a year, and new studies continue to shed light into the risk factors and effects of the disease. One data point that is garnering attention involves the impact of this coronavirus on men vs. women. Since cases were first reported in China, a consistent trend is that men seem to be getting hit harder with COVID-19 than women, but the reasons behind the statistics are multifaceted.

While no apparent sex differences exist in the number of confirmed cases, there is a gendered difference in deaths, according to the CDC. More men have died of COVID-19 in 41 of 47 countries tracked—making the case-fatality ratio around 2.4 times higher among men than among women. What reasons could be behind the discrepancy? Biological factors may play a role, along with some psychological and behavioral influences.

Are males more vulnerable to COVID-19 than women?

Men and women are equally susceptible to contracting COVID-19, but there is some evidence that men could be at risk for more complications from the disease. A global COVID-19 health tracking project has found that infected men have more severe disease and higher mortality than women in most countries with available data. One review of the topic notes that lab and animal data show that men respond differently to the SARS-CoV-2 infection than women, and list possible reasons to be sex-related differences in angiotensin-converting enzyme 2 receptors, immune function, hormones, habits, and coinfection rates.

Men may be getting hit harder initially with COVID-19, but women may be having a harder time recovering from the infection as one clinical group’s experience from France has been that women were much more likely to suffer from long-haul symptoms; outnumbering men 4 to 1.

Immune system differences

There are several theories as to why men may be getting hit harder with COVID-19 than women, including immune response. “Ever since the first COVID-19 epidemic wave observed in Wuhan, it’s been often stated that the novel coronavirus affects male patients more than female patients; there is some truth to it, though the specifics are a bit complicated and not fully understood,” says J. Wes Ulm, MD, Ph.D., a physician-researcher with doctorates from Harvard Medical School and MIT.

Dr. Ulm explains that there could be differences in immune clearance with men. One cause for the discrepancy may be that “men have a higher clustering of the ACE-2 receptor (angiotensin-converting enzyme 2)—particularly on lung tissues—which the virus uses as a ‘docking site’ to enter cells.”

You may have heard that women have a stronger immune system than men. “Biologically, men and women have different types of immune responses,” says Beth Beatriz, Ph.D., epidemiologist and public health expert at ParentingPod.com. “It appears that men are more likely to have an immune response that inflames the lung and causes a severe course of disease,” says Beatriz.

One study found that women tend to have a greater immune response to flu vaccination than men but that this advantage disappears as they age, when estrogen levels decline. This immune response may help to explain why data from the CDC shows that women are reporting more side effects from the COVID-19 vaccine than men; with women reporting 70% of the side effects even though they received about 61% of the doses.

Comorbidities

In addition to immune differences, another cause for men getting hit harder with COVID-19 versus women could be that men tend to have more comorbidities that put them at greater risk. “Comorbidities are really important predictors of severe disease with COVID-19. In particular, men are more likely to have conditions such as cardiovascular disease, COPD, and [to] be current or former smokers,” Beatriz says.

Risk-taking behaviors

Along with biology, risk taking may also play a role in men getting hit harder with COVID-19.

“Men may be affected more simply due to behavioral differences,” says Dr. Ulm. Some of these behaviors may include working in high-exposure areas, and reduced willingness to exercise certain preventative measures such as frequent handwashing and wearing masks.

“[Men] may be less prone to engage in protective behaviors that lower the infectious viral load, which has been frequently associated with severity of an affected individual’s case,” Dr. Ulm says.

How men can avoid COVID-19

Men may be more at risk for complications from COVID-19, but can protect themselves by getting vaccinated and continuing to take precautions to avoid infection.

When it comes to preventing coronavirus infection, “frequent hand washing and sanitizing, wearing masks, maintaining 6 feet distance and staying in well-ventilated or outdoor spaces are all best bets,” Beatriz says.

“If the vaccine is available to you, vaccination is another important tool for preventing getting sick from the virus,” Beatriz explains. “Once you are vaccinated it is important to still engage in other prevention measures because even though the vaccine has been shown to be very effective in keeping you from getting sick, we do not know if it stops you from spreading the virus to other people.”

What should men do if they contract COVID-19?

There is much to feel hopeful for as COVID vaccination rates across the U.S. increase, and case counts continue to go down, but you should continue to exercise caution as COVID-19 remains a risk. So, what are the best options we know of so far for treatment?

“Once the illness commences and the virus replicates within a person’s cells, there is no cure for COVID-19 specifically,” says Dr. Ulm, who emphasizes that most people will recover from COVID-19 “through the standard immune clearance that transpires for viral infections” even those who are in high risk categories. Concerns remain, however, over chronic health issues that may stem from the disease; including long-haul COVID syndrome.

Monoclonal antibody treatments may help high-risk patients avoid hospitalization. If a patient’s symptoms become severe enough to warrant hospitalization, Dr. Ulm says there are a couple drugs “along with variations in positioning and ventilation” in hospitals that do seem to improve survival.

These drugs include:

Dexamethasone
Remdesivir

If COVID symptoms are not severe, the CDC recommends that patients stay home and contact their healthcare provider, rest, and stay well-hydrated. Over-the-counter medications like acetaminophen or ibuprofen can be taken to help alleviate symptoms.

While data shows that there may be some differences in how this coronavirus affects men and women, there is much that we still don’t know. What remains important is that we do all we can to avoid contracting COVID-19, even as the country opens up and life returns to more normalcy.