Sex- and Gender-Specific Observations and Implications for COVID-19

Lauren A. Walter, MD; Alyson J. McGregor, MD, MA


Western J Emerg Med. 2020;21(3):507-509. 

In This Article

Abstract and Introduction


This is a critical time for medicine. As we observe the exponential rise in the number of individuals in the United States (US) who are infected with COVID-19, we try to prepare. Those in the front lines are trying to protect themselves and their patients with the daily ration of personal protective equipment and ventilation assistive equipment. Many individuals are racing against time to develop the needed novel treatments and vaccines. Public health officials work with what little information is known in order to make effective recommendations for prevention. However, at this pivotal time in history where every detail obtained by US health officials could be lifesaving, we are leaving out vital information.

Descriptive and observational data from Wuhan, China, note that the majority (51%–66.7%) of affected patients have been male. In addition, male sex was an independent risk factor associated with refractory disease and death (2.8% death rate for men vs 1.7% for female).[1,2] Currently, men represent 58% of COVID-19 infected patients in Italy and 70% of COVID-related deaths.[3] As coronavirus cases and deaths in the US continue to soar, sex-specific, comprehensive data with regard to US patients is not yet available.

Sex- and gender-based medicine (SGBM) incorporates how biological sex and the sociocultural aspects of gender affect health and illness. It acknowledges the interrelationship between sex and gender on health outcomes and promotes consideration of this variable in both research and clinical practice. SGBM has demonstrated significant evidence-based impact on cardiovascular disease, stroke, sports medicine, and pain management, just to name a few

Sex and gender differences have been observed in infectious diseases previously. On a broad and critical scale, Nasir et al demonstrated that males with all-cause infectious sepsis have a 70% greater mortality than their female counterparts. Likewise, respiratory infection-specific epidemiological data from recent SARS (2003) and MERS (2012) outbreaks demonstrated a significantly higher case fatality rate in males as compared to females, 21.9% vs 13.2%.[4,5]