The battle of the sexes rages on.
If an alien were to visit the Earth, it might at first think that since men are generally larger and stronger than women, males must be the dominant sex. In fact, plenty of humans think that, too. But does the science of medicine back that up? Since our focus is on the novel coronavirus dubbed COVID-19, we want to take a look at why it seems to have a worse effect on men—whose physical prowess should give them more protection—than on women.

Do more men than women get COVID-19?

In a recent WHO report,²  the following statistics were cited:

• 79% of all ICU admissions were in persons aged 50-79 years of age, with 70% of all ICU admissions in men
• 94% of all deaths were in persons aged ≥60 years and 59% of all deaths were in men

This report shows only that more men than women were hospitalized. It doesn’t account for women whose symptoms were not troubling enough to admit to the hospital. That’s why we need to be careful about how statistics are used.

Why are men more severely affected than women?

In Italy, the number of COVID-19 deaths mirrors that of China, with significantly more men dying. Sabra Klein, a scientist who studies sex difference in viral infections at Johns Hopkins Bloomberg School of Public Health,³ says that gender plays as significant a role in deaths from the virus as does age. “People need to be aware that there is this pattern. Just like being old means you’re at higher risk, so does being male. It’s a risk factor.”

Dr. Hani Sbitany, a reconstructive surgeon at Mount Sinai Health Systems who has been treating COVID-19 patients in Brooklyn, noted that men died at nearly double the rate of women affected with the coronavirus in New York City. “I’m in the emergency room, and it’s remarkable—I’d estimate that 80 percent of the patients being brought in are men. It’s four out of five patients.”⁴ 

“Some of the underlying reasons why COVID-19 may be more deadly for men than women may include the fact that heart disease is more common in elderly men than in elderly women,” Dr. Stephen Berger, an infectious disease expert and co-founder of the Global Infectious Diseases and Epidemiology Network (GIDEON), said in an article published in Healthline. “Studies also find that high blood pressure and liver disease are more prevalent in men and these all contribute to more negative outcomes with COVID-19.”

So is it genetic?

That’s up for discussion. “Genetics may also play a big role,” Berger said. “Women, because of their extra X chromosome, have a stronger immune system and response to infections than men.” That’s why two studies in the United States have focused on what role sex hormones might play in increasing the survival rate of those with severe symptoms.

A report in the New York Times cautions that sex hormones may be useful in treating COVID-19 but since even post-menopausal women tend to outlive men with the virus, its usefulness may be limited. Men also have a higher rate (9 out of 10) of the leading causes of death. Women tend to have stronger immune systems than men, but that is only one factor. 

Since men lead the pack in the highest causes of death outside of COVID-19, they are bringing compromised health to the table when they contract the virus. These pre-existing conditions make them more likely to succumb from complications made worse by the coronavirus.

What about behavior as risk factors?

Although genetics may play a part, behavior is also a major factor. Men have traditionally seen themselves as the protectors of their loved ones and are much more likely to participate in risky behavior. This idea of invulnerability has been historically taught to the male sex down through many ages. Women tend to engage in fewer risky activities naturally.

We all know that heart disease is more prevalent in men than women, partly due to stress, eating poorly, and participating in activities like smoking or drinking. But pollution can be a factor, too.

“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.”

So what do we really know?

Statistically, men—especially those over 50— who contract COVID-19 are more likely to suffer more severe symptoms and die than women. Why? The jury’s still out.