Why Do Men and Women React Differently to COVID-19?

JoAnn E. Manson, MD, DrPH


June 03, 2020

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This transcript has been edited for clarity.

Hello. This is Dr JoAnn Manson, professor of medicine at Harvard Medical School and Brigham and Women's Hospital.

What have we learned about sex and gender differences in COVID-19?

That there are many sex and gender differences in both health and disease is old news. For many conditions, rates differ markedly by sex. There are also important differences in the response to therapeutics, pharmacokinetics, and other factors.

But what about the sex and gender differences that are relevant to COVID-19? My colleagues and I recently published a summary of the evidence and a call to action on this subject.

Rates of COVID infection seem to be quite different between men and women. In many countries, reported case fatality rates are higher in men—in Italy, South Korea, China, and the United States. For example, in Italy, about 70% of the deaths from COVID were in men. In the approximately 60% of deaths from COVID-19.

There could be both biological and behavioral/sociocultural explanations for this.

On the biological side, there's evidence that women have better innate and adaptive immune responses. They have a more robust response to vaccination and more rapid clearance of viruses and other pathogens. There are genes for immune function that reside on the X chromosome.

There may be differences in the effects of sex hormones (estrogen, progesterone, testosterone) on immune modulation. Estrogen and progesterone have an immune-modulatory role and tend to tamp down inflammation more so than testosterone and androgens. Some current randomized clinical trials are studying the ability of transdermal estradiol and progesterone to reduce inflammatory response and improve clinical outcomes.

In terms of behavioral factors, there are major differences in some countries in rates of smoking between men and women. There may be handwashing and, therefore, the likelihood of transmitting the virus between men and women. There is also a higher prevalence of cardiovascular disease in men compared with women.

On the flip side, some effects of the pandemic may be more severe in women. For example, women may be more susceptible to stress, anxiety, depression, and post-traumatic stress disorder than men. The prolonged period of social isolation and the ongoing stress and anxiety may actually have more adverse repercussions in the long term on the emotional well-being of women compared with men. It's important to have efforts in place to monitor and mitigate this.

In our call to action, we encouraged researchers to account for sex and gender in their research. This goes beyond stratifying for sex to also take into account the design of studies to include sex and gender factors. We also encourage clinicians to take into account sex and gender in patient care to improve health for all.

Thank you so much for your attention. This is JoAnn Manson.

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