Why More Men Than Women Die of COVID-19

Why More Men Than Women Die of COVID-19

by | Apr 7, 2020 | Biological Difference, Men's Issues, Women's Issues

“There are profound sex differences in immune systems and this pandemic is revealing them.”
Marcia Stefanick, Stanford University School of Medicine.

More men than women have died of the COVID-19 virus. In China, Italy, South Korea, Germany, France, Iran, the U.S – everywhere around the world, the death rate of men to women is disproportionate. In New York City, men have died at nearly twice the rate.

Death rates from COVID-19 are more evidence of the biological differences between men and women. What are the components of these differences related to the pandemic?

Habits and Comorbidity

Questions about the sex discrepancy in death rates have focused (heretofore) mostly on male behavior: higher rates of tobacco assumption, reluctance to seek medical care, and even lower rates of handwashing.

Smoking is associated with negative progression and adverse outcomes of COVID-19. Smokers are more likely to have lung disease, which is a risk factor for severe infection. Also, smokers are more likely to touch their mouths and face.

But, Sabra Klein, Professor of Molecular Microbiology and Immunology at John Hopkins* suggests that smoking is not the leading factor. “There is a growing observation of increased mortality in men across very diverse countries and cultures. When I see that, it makes me think that there must be something universal that is contributing to this.” Klein’s prior research revealed that men have lower innate antiviral immune responses to a range of infections including hepatitis C and HIV. “Their immune system may not initiate an appropriate response when it initially sees the virus.”

Men also have other “comorbidities”: higher rates of pre-existing conditions such as heart disease, high blood pressure, and diabetes. These conditions increase the risk of death from the virus.

Kathryn Sandberg, Director of the Center for the Study of Sex Differences in Health, Aging and Disease at Georgetown University, says one explanation for the disparity in COVID-19 deaths may have to do with angiotensin-converting enzyme 2 (ACE2), a protein on the surface of the cells in the lungs and other organs. ACE2 is key in regulating blood pressure and it works differently and more favorably for women. COVID-19 binds to ACE2. A study of COVID-19 patients in China found hypertension as the most common risk factor.

Overall Differences in Male and Female Lifespan and Risk of Death

We did not need a pandemic to know men live (on average) 4 years less than women; male suicide rates are much higher; significantly more men die at work and in war. We know men aged 15-25 have a vastly greater risk of injury and death. Evolutionary psychology speaks volumes about the reasons for the risky behavior of men vs. women. (It is related to androgens and mating behavior.)

In the context of a pandemic, it makes sense to remember those markers of health and longevity, but also to look deeper for underlying biological causes.

When it Comes to Survival, Men are the Weaker Sex.

Men are the weaker sex independent of a pandemic; the innate biological advantage of women is apparent at every age and stage of human life. Baby girls are more likely to make it to their first birthday. Eighty percent of all centenarians today are women; ninety-five percent of those who reach the age of 110 are women.

Female survival advantage holds regardless of education, economic factors, and alcohol, drug, or tobacco consumption.

Sandberg underscores the bottom-line: “It doesn’t matter what the infectious agent is, women tend to be better at knocking it down because they have a more robust immune system.”

Genetic Disadvantage for Males and Female Immunity

Female genetic superiority starts at the chromosomal level. The cells of genetic females have two X chromosomes. Having the use of a spare X chromosome gives females an advantage against a virus.

There are more than 2,000 genes on the two X chromosomes that interact and cooperate within a women’s body. Each cell predominantly uses one X chromosome over the other. According to physician and scientist, Sharon Moaelm*, if one X chromosome has genes that better recognize an invading virus like COVID-19, the other X chromosome that can do a different task – like killing cells infected with COVID -19. This makes the fight against the virus more efficient for women. An extra X brings extra immune functioning.

Males have to get by with just one X chromosome. If a male’s genes are not capable of recognizing or killing cells infected with the coronavirus, his ability to fight the infection will be limited. Historically, coronaviruses such as SARS and MERS tended to affect men disproportionately, according to Luis Ostrosky-Zeichner, infectious disease specialist at McGovern Medical School at UTHealth in Texas.

Since women have a greater immune response to the virus, they are quicker to reduce its viral load – the quantity of the virus. Women may also be able to launch an earlier attack on infections in general, saving the body from needing to use all of its virus-fighting capacity later.

It should be noted that women pay a cost for having a more aggressive immune system. Women are more prone to autoimmune diseases. The immune system of genetic females is more likely to attack themselves, which occurs in conditions like rheumatoid arthritis, multiple sclerosis, autoimmune thyroiditis, Sjogren’s syndrome, and lupus.

Hormonal Disadvantage for Males and Advantage for Females

Higher levels of testosterone appear to suppress the immune system. Estrogens have been found to stimulate a more vigorous immune response.

From an evolutionary perspective, some research suggests women have a stronger immune system against viral infections than men because they spend part of their lives with a “foreign body” inside of them; their baby grants them a survival advantage. Ostrosky-Zeichner believes that advantage may be related to hormonal changes.

Going Forward with Tests and Vaccine

A better understanding of men’s and women’s immune system response to the virus could be critical in developing a good vaccine. There are well-documented differences in vaccine effectiveness among men and women, with women tending to be better protected after vaccination. Therefore, it may be especially important to ensure that sex is taken into account when designing and analyzing vaccine trials.

And, as we develop antibody testing, what are the differences in the antibodies produced in men vs. women? Should the test be gender-specific? Sex differences in the immune response to COVID-19 are likely to show up in antibody surveys currently underway across the world.

Conclusion

Knowing more about how the virus differently impacts men and women could help determine the most effective treatment for individual patients. Nearly 20 years ago, the Institute of Medicine of the National Academy of Sciences published a report that claimed: “Being male or female is an important variable that should be considered.”

Moalem claims there has been little tangible progress on this insight in the practice of medicine. “We must now apprehend the real biological strength that each genetic female possesses and how men differ in this regard. The future of medicine depends upon it.”

*Sabra Klein is also President of the Organization for the Study of Sex Differences (OSSD).

**Sharon Moalem is a scientist, physician, and author. His most recent book is The Better Half: On the Genetic Superiority of Women. Moalem is an expert in the fields of rare diseases, sex differentiation, neurogenetics, and biotechnology.

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Can We Be Honest About Women?

Can We Be Honest About Women?

by | Mar 24, 2020 | Gender Politics, Men's Issues, Women's Issues

In 2017, David French of the National Review wrote an article stating that men enter high-status professions and achieve wealth in part, or even primarily, to gain access to beautiful women. D.C. McAllister responded to French with her own analysis, “Can We Be Honest About Women?” in The Federalist (Dec.12, 2017).  She countered French by saying many men enter high-status professions in order to best other men in their field of expertise, not just to get beautiful women.  McAllister said competition can fuel men even more than sex.  Here, McAllister misunderstands cause and effect, ends, and means.  She misunderstands the underlying reason for male status aspiration and male competition.  At the most primal level of evolutionary adaptation, male competition is only about sex.

Woman Collude For Their Own Benefit

Most importantly, McAllister’s piece in The Federalist took issue with the assumption that women are passive and innocent in this situation. She spelled out basic truths about women that created ire among her feminist detractors.  David French asked what is wrong with men.   Rather than posit that men are wrong, McAllister correctly asserted that women “naturally” collude with men for their own benefit. Further, McAllister courageously proffered “we can’t always assume women are hapless damsels in distress horrified by how they’re objectified.   Women love the sexual interplay they experience with men, and they relish men desiring their beauty.  Why?   Because it is part of their nature.”

Citing a Pews Research study entitled, “On Gender Differences, No Consensus on Nature vs. Nurture,” McAllister noted that Americans valued physical attractiveness in women more than other traits.  Nurturing and empathy were second.  The traits most valued in men were morality and professional success.   Men want women who are attractive and emotionally sensitive, and women want good men who are financially successful.  (Zsa Zsa Gabor famously asked: “I want a man who’s kind and understanding.  Is that too much to ask of a millionaire?”)

Men are Drawn to Beauty Like Moths to a Flame

This is human nature.  McAllister aptly opined, “men are drawn to beauty like moths to a flame, and women want to be the flame.”  Beauty is a source of power, a woman’s “erotic” or sexual power.

“When men are being their sexual selves, drawn to a woman’s beauty, they’re not exploiting women, they are responding to them.”   McAllister continued, “let men love a woman’s beauty and let a woman delight in a man’s competence and success.  This is part of the dance between the masculine and the feminine, and we would be miserable if we stopped it.”  McAllister quoted James Joyce in “Portrait of the Artist as a Young Man” and cited an earlier analog in the Bible’s, “Song of Solomon.”  Adoration of female beauty is archetypal and mythic.  Most heterosexual women want to be desired and acknowledged for their physical beauty.   Can we be honest about that?   This is McAllister’s central point.  The fact that women want to be (and should be) acknowledged for their character and skills is entirely beside the point to this biological truth.

Women are Attracted to Economic Power and Men Will Produce It

McAllister inadvertently identified insights from evolutionary psychology and mate selection science.  She revealed the perennial erotic-economic bargain: the provision of resources (providing and protecting) for sexual access given in return — granting access to female beauty with its inherent signaling of fertility.   Thus, women are inextricably attracted to “economic” power, and men will compete and even conspire to produce it.   That is a fundamental biological and evolutionary truth.  It has been a successful adaptation for thousands of years.

All Male Behavior is a Response to Female Choice

All male behavior is etiologically a response to female choice in mate selection. Erotic power is “first cause” and reigns supreme because it is the power that sustains and populates the human race.  Male status aspiration and power displays are a result of adaptive success in attracting women.  So-called “trophy wives,” or “a beautiful woman on a man’s arm,” are mostly for the sheer pleasure of being next to “the flame” of female radiance.   They are the reward, the raison d’etre.   Men want a beautiful woman on their arm in the spirit of Lord Byron (She Walks in Beauty) and James Joyce.  To the degree this is a status display, it is meant (mostly below awareness) to elicit the response of the next woman.  The goal is more sexual access.  Status is the means.   The current woman and the next woman demonstrate the result of male status.

Power acquisition is an evolutionary adaptation for sexual access to women, but this power can be abused.   David French wrote derisively about men, lamenting sexual harassment in media, politics, and entertainment.   McAllister, to her credit, admitted that this male power, while sometimes off the rails, is also desired by women.   And a women’s beauty is part of the ancient agreement.  As Mae West once said, “it is better to be looked over, than over-looked.”

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