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COVID-19 affects people differently, in terms of infection with the virus SARS-CoV-2 and mortality rates. In this Special Feature, we focus on some of the sex differences that characterize this pandemic. Share on Pinterest The data that are available so far indicate that there are significant differences between how the sexes respond to the new coronavirus.

All data and statistics are based on publicly available data at the time of publication. Some information may be out of date. Visit our coronavirus hub for the most recent information on the COVID-19 pandemic.Was this helpful?

There are many ways in which the pandemic itself affects peoples day-to-day lives, and gender understood as the ensemble of social expectations, norms, and roles we associate with being a man, woman, trans- or nonbinary person plays a massive part.

On a societal level, COVID-19 has affected cis- and transwomen, for example, differently to how it has cismen, transmen, and nonbinary people. Reproductive rights, decision making around the pandemic, and domestic violence are just some key areas where the pandemic has negatively impacted women.

However, sex differences understood as the biological characteristics we associate with the sex that one is assigned at birth also play an undeniable role in an epidemic or pandemic.

While sex and gender are, arguably, inextricably linked in healthcare, as in every other area of our lives, in this Special Feature, we will focus primarily on the infection rates of SARS-CoV-2 and the mortality rates that COVID-19 causes, broken down by sex.

In specialized literature, these effects fall under the umbrella term of primary effects of the pandemic, while the secondary impact of the pandemic has deeper social and political implications.

Throughout this feature, we use the binary terms man and woman to accurately reflect the studies and the data they use. Sex-disaggregated data lacking

Before delving deeper into the subject of sex differences in COVID-19, it is worth noting that the picture is bound to be incomplete, as not all countries have released their sex-disaggregated data.

A report appearing on the blog of the journal BMJ Global Health on March 24, 2020, reviewed data from 20 countries that had the highest number of confirmed cases of COVID-19 at the time.

Of these 20 countries, Belgium, Malaysia, Netherlands, Portugal, Spain, United Kingdom, and the United States of America did not provide data that was disaggregated, or broken down, by sex.

At the time, the authors of the BMJ report appealed to these countries and others to provide sex specific data.

Anna Purdie, from the University College London, United Kingdom, and her colleagues, noted: We applaud the decision by the Italian government to publish data that are fully sex- and age-disaggregated. Other countries [] are still not publishing national data in this way. We understand but regret this oversight.
At a minimum, we urgently call on countries to publicly report the numbers of diagnosed infections and deaths by sex. Ideally, countries would also disaggregate their data on testing by sex.

Anna Purdie et al.

Since then, countries that include Belgium, the Netherlands, Portugal, and Spain have made their data available.

The U.K. have made only a part of the sex-disaggregated data available for England and Wales, without covering Scotland and Northern Ireland while Malaysia and the U.S. have not made their sex-disaggregated data available at all.

At the time of writing this article, the U.S. still have not released their sex-disaggregated data despite the country having the highest number of COVID-19 cases in the world.

For more research-backed information and resources for mens health, please visit our dedicated hub.Was this helpful? Men more than twice as likely to die

Global Health 5050, an organization that promotes gender equality in healthcare, has rounded up the total and partial data that is available from the countries with the highest numbers of confirmed COVID-19 cases.

According to their data gathering, the highest ratio of male to female deaths, as a result of COVID-19, is in Denmark and Greece: 2.1 to 1.

In these countries, men are more than twice as likely to die from COVID-19 as women. In Denmark, 5.7% of the total number of cases confirmed among men have resulted in death, whereas 2.7% of women with confirmed COVID-19 have died.

In the Republic of Ireland, the male to female mortality ratio is 2 to 1, while Italy and Switzerland have a 1.9 to 1 ratio each.

The greatest parity between the genders from countries that have submitted a full set of data are Iran, with 1.1 to 1, and Norway, with 1.2 to 1.

In Iran, 5.4% of the women patients have died, compared with 5.9% of the men. In Norway, these numbers stand at 1.3% and 1.1%, respectively.

China has a ratio of 1.7, with 2.8% of women having died, compared with 4.7% of men.
Infection rates in womenand men

A side-by-side comparison of infection rates between the sexes does not explain the higher death rates in men, nor is there enough data available to draw a conclusion about infection rates broken down by sexes.

However, it is worth noting that in Denmark, where men are more than twice as likely to die of COVID-19 as women, the proportion of women who contracted the virus was 54%, while that of men was 46%.

By contrast, in Iran, where the ratio of deaths between men and women is less different (1.1 to 1), just 43% of cases are female compared with 57% cases in men.

Until we know the proportion of people from each sex that healthcare professionals are testing, it will be difficult to fully interpret these figures.

What we do know so far is that, overall, nine of the 18 countries that have provided complete sex-disaggregated data have more COVID-19 cases among women than they do among men. Six of the 18 countries have more cases among men than they do among women.

Norway, Sweden, and Germany have a 5050% case ratio.

Other countries where more women have developed COVID-19 include:
Switzerland (53% of women to 47% of men)Spain (51% to 49%)The Netherlands (53% to 47%)Belgium (55% to 45%)South Korea (60% to 40%)Portugal (57% to 43%)Canada (52% to 48%)Republic of Ireland (52% to 45%)

Greece, Italy, Peru, China, and Australia all have a higher number of confirmed cases among men than women.Why are men more likely to die?

Part of the explanation for why the new coronavirus seems to cause more severe illness in men is down to biological sex differences.

Womens innate immune response plays a role. Experts agree that there are sex differences, such as sex chromosomes and sex hormones, that influence how a persons immunity responds to a pathogen.

As a result, women are in general able to mount a more vigorous immune response to infections [and] vaccinations. With previous coronaviruses, specifically, some studies in mice have suggested that the hormone estrogen may have a protective role.

For instance, in the study above, the authors note that in male mice there was an exuberant but ineffective cytokine response. Cytokines are responsible for tissue damage within the lungs and leakage from pulmonary blood vessels.

Estrogens suppress the escalation phase of the immune response that leads to increased cytokine release. The authors showed that female mice treated with an estrogen receptor antagonist died at close to the same rate as the male mice.

As some researchers have noted, lifestyle factors, such as smoking and alcohol consumption, which tend to occur more among men, may also explain the overall higher mortality rates among men.

Science has long linked such behaviors with conditions that we now know are likely to negatively influence the outcome of patients with COVID-19 cardiovascular disease, hypertension, and chronic lung conditions. Why women might be more at risk

On the other hand, the fact that societies have traditionally placed women in the role of caregivers a role which they continue to fulfill predominantly and the fact that the vast majority of healthcare workers are women cold place them at a higher risk of contracting the virus and might explain the higher infection rates in some countries.

An analysis of 104 countries by the World Health Organization (WHO) found that Women represent around 70% of the health workforce. In China, women make up more than 90% of healthcare workers in Hubei province.

These data emphasize the gendered nature of the health workforce and the risk that predominantly female health workers incur, write the authors of a report on the gendered impacts of the pandemic that appears in The Lancet.

Although we cannot yet draw definitive conclusions because sex-disaggregated data is not yet available from all the countries affected, The Lancet report looks at previous epidemics for clues.

During the 201416 west African outbreak of Ebola virus disease, the authors write, gendered norms meant that women were more likely to be infected by the virus, given their predominant roles as caregivers within families and as frontline healthcare workers.

The authors also call out for governments and health institutions to offer and analyze data on sex and gender differences in the pandemic.
Why sex-disaggregated data are urgent

The report in The Lancet reads, Recognising the extent to which disease outbreaks affect women and men differently is a fundamental step to understanding the primary and secondary effects of a health emergency on different individuals and communities, and for creating effective, equitable policies and interventions.

For instance, identifying the key difference that makes women more resilient to the infection could help create drugs that also strengthen mens immune response to the virus.

Devising policies and intervention strategies that consider the needs of women who work as frontline healthcare workers could help prevent the higher infection rates that we see among women.

Finally, men and women tend to react differently to potential vaccines and treatments, so having access to sex-disaggregated data is crucial for conducting safe clinical trials.

As Anna Purdie who also works for Global Health 5050 and her colleagues summarize in their article, Sex-disaggregated data are essential for understanding the distributions of risk, infection, and disease in the population, and the extent to which sex and gender affect clinical outcomes.
Understanding sex and gender in relation to global health should not be seen as an optional add-on but as a core component of ensuring effective and equitable national and global health systems that work for everyone. National governments and global health organizations must urgently face up to this reality.

Anna Purdie et al

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Business

Reeves seeks outsider to run Britain’s banking watchdog

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Reeves seeks outsider to run Britain's banking watchdog

Rachel Reeves, the chancellor, is seeking a heavyweight outsider to run Britain’s main banking watchdog, with a senior Barclays executive expected to be among the top contenders for the job.

Sky News has learnt that the Treasury is to advertise the post of chief executive of the Prudential Regulation Authority (PRA), which oversees financial services firms such as banks and insurers, within days.

One source said the recruitment process could kick off as early as next week.

The process, which will run for several months, will lead to the appointment of a successor to Sam Woods, a long-serving official who has served two terms in the role.

This weekend, it emerged that Katharine Braddick, a former senior Treasury civil servant who joined Barclays in 2022, is expected to be among the applicants for the role.

Whitehall insiders said Ms Braddick would be a strong contender for the post if she decided to apply.

Read more:
Baroness Mone: I have no wish to rejoin Lords as Conservative peer

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A former director-general, financial services at the Treasury, Ms Braddick has been Barclays’ group head of strategic policy and advisor to the bank’s chief executive for three-and-a-half years.

Prior to the Treasury, she worked at the Financial Services Authority and was heavily involved in political negotiations on financial services legislation relating to Brexit.

Barclays declined to comment on Ms Braddick’s behalf on Saturday.

In response to an enquiry from Sky News, a Treasury spokesperson said: “Growing the economy is the Chancellor’s number one mission.

“Every regulator has a part to play by regulating for growth not just risk.”

The chancellor is said to be keen to identify candidates from outside Britain’s existing regulatory set-up to head the PRA.

A small number of internal candidates is thought to include David Bailey, the Bank of England’s executive director for prudential policy.

Ms Reeves’s apparent desire for an outsider comes amid a wider push for Britain’s economic watchdogs to remove red tape and reorient themselves towards growth-focused policies.

Earlier this year, Nikhil Rathi, chief executive of the Financial Conduct Authority, was appointed to a second term in charge following intensive discussions about the body’s five-year strategy.

Since then, both the FCA and PRA have removed rules relating to diversity and inclusion in the financial sector, while the former abandoned a plan to ‘name and shame’ companies which were the subject of enforcement investigations.

The Payment Systems Regulator (PSR) was abolished earlier this year as part of the government’s drive to reduce unnecessary regulation.

The search for the next PRA boss will get underway less than two months before the chancellor delivers an autumn Budget in which she is expected to have to raise tens of billions of pounds through additional tax rises.

Mr Woods’ next move will be closely watched in the City.

He has been seen as a potential candidate to succeed Andrew Bailey when the Bank of England governor’s term runs out in 2028, although it is unclear whether he covets the job.

As CEO of the PRA, Mr Woods is also a deputy governor of the Bank of England, a member of the Bank’s Court of Directors, and a director of the FCA.

The chancellor has shown a willingness to recruit from outside the Treasury, appointing Bank of America investment banking veteran Jim O’Neil as second permanent secretary to the Treasury earlier this year.

Mr O’Neil had also served as the head of UK Financial Investments, the agency set up to manage taxpayers’ stakes in Britain’s bailed-out banks.

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Politics

Kemi Badenoch says Tories will quit ECHR if they win next election

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Kemi Badenoch says Tories will quit ECHR if they win next election

The Conservative Party will leave a key human rights treaty if it wins the election, its leader Kemi Badenoch has said.

Ms Badenoch announced the policy to leave the European Convention on Human Rights (ECHR) ahead of the Conservative Party’s conference next week.

Despite many Tory MPs having expressed displeasure with the treaty, and the court that upholds treaty rights in recent years, it had not been party policy for the UK to exit it.

The move follows a review on the impact of the UK’s ECHR membership conducted by shadow attorney general Baron Wolfson.

Lord Wolfson’s nearly 200-page report said the ECHR had impacted government policy in numerous areas.

The report said this includes limiting government’s ability to address immigration issues, potentially hampering restrictions on climate change policy, and impacting government ability to prioritise British citizens for social housing and public services.

Read more:
Baroness Mone: I have no wish to rejoin Lords as Conservative peer

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But leaving the ECHR would “not be a panacea to all the issues that have arisen in recent years”, Lord Wolfson said.

It comes after the Reform Party in August said they would take the UK out of the ECHR if elected.

The Conservatives have increasingly come under threat from Reform and are being trailed in the polls by them.

What is the ECHR?

The ECHR was established in the 1950s, drafted in the aftermath of the Second World War and the Holocaust, to protect people from serious human rights violations, with Sir Winston Churchill as a driving force.

It’s 18 sections guarantee rights such as the right to life, the prohibition of torture, the right to a fair trial, the right to private and family life and the right to freedom of expression.

It has been used to halt the deportation of migrants in 13 out of 29 UK cases since 1980.

Conservative Party leader Kemi Badenoch. Pic: PA
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Conservative Party leader Kemi Badenoch. Pic: PA

A political issue

Leaving the ECHR would breach the 1998 Good Friday Agreement, the peace settlement deal between the British and Irish governments on how Northern Ireland should be governed.

Labour has in recent days said it was considering how Article 3, the prohibition on torture, and Article 8,
the right to respect for private and family life, are interpreted. The sections have been used to halt deportation attempts.

The Liberal Democrats and Greens are in favour of the ECHR.

A general election is not expected until 2029.

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US

Trump tells Israel ‘stop bombing Gaza’ – as Hamas agrees to release Israeli hostages, and to parts of peace deal

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Hamas agrees to release all remaining Israeli hostages - but seeks further talks on rest of Trump's peace deal

Donald Trump has said Hamas is ready for a “lasting peace” after the Palestinian militants agreed to release all remaining hostages, as he called on Israel to stop bombing Gaza.

The US leader was responding to a statement by Hamas on Friday in which the group committed to returning all remaining hostages in Gaza, dead and alive.

Hamas also said it wants to engage in negotiations to discuss further details of the president’s peace plan, including handing over “administration of the enclave to a Palestinian body of independent technocrats”.

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‘This is a very special day’

However, other aspects of the 20-point document, it warned, would require further consultation among Palestinians.

The Hamas statement came after Mr Trump warned he would unleash “all hell” if they did not respond to his peace plan, announced earlier this week, by Sunday.

Following the group’s response, the president said there was now a real chance of peace.

“I believe they are ready for a lasting PEACE,” Mr Trump posted on Truth Social. “Israel must immediately stop the bombing of Gaza, so that we can get the Hostages out safely and quickly!

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“Right now, it’s far too dangerous to do that. We are already in discussions on details to be worked out. This is not about Gaza alone, this is about long sought PEACE in the Middle East.”

In a video later posted on his social media platform, Mr Trump called it a “very special day” and said the end of the war was “very close”.

Prime Minister Benjamin Netanyahu said Israel was prepared for the implementation of the “first stage” of Mr Trump’s plan, apparently in reference to the release of hostages.

Moshe Emilio Lavi, brother-in-law of Israeli hostage Omri Miran, told Sky News he “can’t wait” to see his family reunited.

“We’ve received necessary guarantees from President Trump and the wider international community and now we have to keep pressuring Hamas to ensure that they abide by the Trump framework, that they disarm and release all the hostages within the 72 hours the framework outlines.

“There should be no buts and no delays, there should be only a yes to President Trump’s vision to end the conflict and bring home all the remaining hostages.”

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Trump’s Sunday deadline threat

Starmer calls for ‘agreement without delay’

Sir Keir Starmer said Hamas’s partial acceptance of the peace plan was a “significant step forwards” and called for an “agreement without delay”.

The prime minister said Mr Trump’s efforts “have brought us closer to peace than ever before” and added: “There is now an opportunity to end the fighting, for the hostages to return home, and for humanitarian aid to reach those who so desperately need it.

“We call on all sides to implement the agreement without delay.”

He went on to say the UK was ready to support further negotiations and work “towards sustainable peace for Israelis and Palestinians alike”.

Read more:
If Hamas and Israel agree on a peace deal, it will be Trump’s success

Investigation reveals Israel’s support for Gaza militia
Praise and fury for Trump’s Gaza peace deal

French President Emmanuel Macron said “the release of all hostages and a ceasefire in Gaza are within reach”, while a spokesperson for UN Secretary General Antonio Guterres urged “all parties to seize the opportunity”.

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Hamas agrees to release hostages

The breakthrough came just hours after Mr Trump had set the Sunday deadline to respond to his proposals, backed by the Arab nations.

The US president and the Israeli prime minister unveiled the peace plan at the White House on Monday.

Israel agreed to the terms, which include an immediate ceasefire; the release of all hostages; Hamas disarming; a guarantee no one will be forced to leave Gaza and a governing “peace panel” including Sir Tony Blair.

And on Friday, a statement from Hamas confirmed “its approval to release all prisoners of the occupation – whether alive or the remains of the deceased – according to the exchange framework included in President Trump’s proposal”.

Israel estimates 48 hostages remain in Gaza, 20 of whom are alive.

Hamas official says group will not disarm ‘before Israeli occupation ends’

The group also said it was ready to engage in negotiations through mediators and it appreciated “Arab, Islamic and international efforts, as well as the efforts of US President Donald Trump”.

But, Hamas official Mousa Abu Marzouk told Al Jazeera news the group would not disarm “before the Israeli occupation ends”.

Hamas acceptance – but with major caveats

By Celine Alkhaldi, Middle East producer

Hamas has issued a carefully worded response to Donald Trump’s Gaza proposal.

The group welcomed international efforts to end the fighting, agreed in principle to the release of all Israeli hostages, and said it is prepared to begin negotiations on the details of an agreement.

It also renewed its commitment to handing over administration of Gaza to a committee of Palestinian technocrats formed by national consensus and backed by Arab and Islamic states.

That position has been consistent for months and was not part of Mr Trump’s plan.

On wider questions, Hamas said decisions must be taken within a comprehensive Palestinian framework, leaving the most sensitive issues for future discussion.

The statement appears to accept parts of Mr Trump’s proposal, but in some areas it does not match its terms.

Hamas made no mention of disarmament, avoided any pledge to withdraw permanently from governing, and linked any hostage deal to a complete Israeli withdrawal.

Taken together, the response shows a willingness to engage on humanitarian and political steps already familiar from past proposals, while deferring the core disputes to a broader Palestinian process.

Hamas does not know where all hostages are

Sky News Middle East correspondent Adam Parsons said the “most important part” of the Hamas response was that it showed a willingness to do a deal.

“The peace plan could have died – Hamas could have rejected it – but it is still alive.”

He said there were still “huge obstacles” which would prevent outright acceptance though.

In spite of a pledge to release hostages, he said Hamas did not entirely know where all of them were – some were even being held by other groups.

Hamas’s support for a new government for Palestine was positive, he said, but the specification in the Hamas response that it should be purely Palestinian and not, as Mr Trump had proposed, a “panel” that included external representatives, would be problematic.

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