Sex differences in COVID-19

Published

2 years ago

July 27, 2023

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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 Some information may be out of date.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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Sports

MLB playoff tracker: Tigers clinch postseason spot — what else is at stake?

Published

39 mins ago

September 28, 2025

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MLB playoff tracker: Tigers clinch postseason spot -- what else is at stake?

Sep 27, 2025, 06:57 PM ET

The final weekend of the MLB season is here — and there’s still plenty to play for!

In the National League, the Milwaukee Brewers and Chicago Cubs have both clinched postseason berths, with the Brewers also taking home the NL Central title. The Philadelphia Phillies have locked up the NL East title, and the Los Angeles Dodgers clinched their fifth straight NL West title on Thursday. The New York Mets beat the Marlins on Saturday and, with the Cincinnati Reds playing on the Brewers later Saturday night, they’re (momentarily, at least) back in the lead in the NL wild-card race.

In the American League, the Toronto Blue Jays became the first AL team to secure a playoff spot and the New York Yankees and Seattle Mariners joined them days later. While the Detroit Tigers clinched a postseason spot Saturday, in one the biggest twists of the 2025 season, the Cleveland Guardians have rocked the playoff picture with a September surge, emerging as a serious contender in the AL wild-card race and for the AL Central title.

Beyond division races, there are many storylines to watch as the regular season comes to an end and playoffs begin: Where do current playoff matchups stand? What games should you be paying attention to each day leading up to October? Who will be the next team to clinch a postseason berth? And what does the playoff schedule look like?

We have everything you need to know as the regular season hits the homestretch.

Key links: Full MLB standings | Wild-card standings

Who’s in?

Milwaukee Brewers

The Brewers clinched the season’s first playoff spot for a second consecutive year on Sept. 13 and followed up by securing their third straight NL Central title. They earned a bye in the first round and are playing for the NL’s overall No. 1 seed.

Philadelphia Phillies

The Phillies clinched a spot in the postseason on Sept. 14. With a win the following night, Philadelphia clinched the NL East title for the second straight year. On Wednesday, the Phils beat the Marlins to clinch a first-round bye and home-field advantage in the NLDS.

Chicago Cubs

The Cubs clinched their spot in the postseason on Sept. 17 and will be making their first playoff appearance in a full-length season since 2018. With a win on Saturday, they clinched home-field advantage in their wild-card series with the Padres.

Los Angeles Dodgers

With a win Thursday over the Diamondbacks, the Dodgers clinched the NL West title for the 12th time in the past 13 years. They will be the No. 3 seed in the NL and host the No. 6 seed in the wild-card series.

Toronto Blue Jays

The Blue Jays became the first AL team to secure a postseason berth with a with over the Royals on Sept. 21. They are currently tied with the Yankees for first place in the AL East — the division winner will earn a bye.

San Diego Padres

The Padres clinched their fourth postseason trip in six years with a walk-off win over the Brewers on Monday. They will travel to Chicago to meet the Cubs in the wild-card series.

New York Yankees

The Yankees became the second AL team to clinch a playoff spot with a walk-off win over the White Sox on Tuesday. They are currently tied with the Blue Jays for first place in the AL East — the division winner will earn a bye.

Seattle Mariners

The Mariners clinched their first postseason appearance since 2022 on Tuesday and, with a 9-2 win on Wednesday, won their first AL West crown since 2001. They earned a bye in the first round.

Boston Red Sox

With a win against the Tigers on Friday, Boston clinched an AL Wild Card berth. They will be the road team in one wild-card series.

Detroit Tigers

With a win in Boston on Saturday, Detroit clinched at least an AL Wild Card berth. They are still in play to win the AL Central.

Who can clinch a playoff spot next?

Upcoming clinch possibilities:

The Guardians can clinch today with a win OR a loss by the Astros
The Brewers can clinch the NL’s No. 1 seed and home-field advantage throughout the postseason today with a win OR a loss by the Phillies
The Blue Jays can clinch the AL East and the AL’s #1 seed Sunday with a win OR a loss by the Yankees
The Yankees can clinch the AL East and the AL’s #1 seed Sunday with a win AND a loss by the Blue Jays

What are this October’s MLB playoff matchups as it stands now?

American League

Wild-card round: (6) Tigers at (3) Guardians, (5) Red Sox at (4) Yankees

ALDS: Tigers/Guardians vs. (2) Mariners, Red Sox/Yankees vs. (1) Blue Jays

National League

Wild-card round: (6) Reds at (3) Dodgers, (5) Padres at (4) Cubs

NLDS: Reds/Dodgers vs. (2) Phillies, Padres/Cubs vs. (1) Brewers

Tiebreaker scenarios

AL East teams

Toronto Blue Jays

Win tiebreaker: Mariners, Red Sox, Yankees
Lose tiebreaker: Guardians

New York Yankees

Win tiebreaker: Mariners
Lose tiebreaker: Blue Jays, Guardians, Red Sox

Boston Red Sox

Win tiebreaker: Astros, Guardians, Yankees
Lose tiebreaker: Blue Jays, Mariners, Tigers

AL Central teams

Cleveland Guardians

Win tiebreaker: Astros, Tigers, Yankees, Blue Jays
Lose tiebreaker: Mariners, Red Sox

Detroit Tigers

Win tiebreaker: Red Sox, Astros
Lose tiebreaker: Guardians, Mariners

AL West teams

Seattle Mariners

Win tiebreaker: Tigers, Guardians, Red Sox
Lose tiebreaker: Blue Jays, Yankees

Houston Astros

Win tiebreaker: N/A
Lose tiebreaker: Guardians, Red Sox, Tigers

NL East teams

Philadelphia Phillies

Win tiebreaker: Dodgers
Lose tiebreaker: Brewers

New York Mets

Win tiebreaker: N/A
Lose tiebreaker: Reds

NL Central teams

Milwaukee Brewers

Win tiebreaker: Phillies
Lose tiebreaker: N/A

Chicago Cubs

Win tiebreaker: Dodgers
Lose tiebreaker: N/A
(Padres and Cubs tied season series, division record tiebreaker TBD)

Cincinnati Reds

Win tiebreaker: Mets
Lose tiebreaker: N/A

NL West teams

Los Angeles Dodgers

Win tiebreaker: Padres
Lose tiebreaker: Brewers, Cubs, Phillies

San Diego Padres

Win tiebreaker: N/A
Lose tiebreaker: Dodgers
(Padres and Cubs tied season series, division record tiebreaker TBD)

Breaking down the AL race

The Blue Jays are trying to hold for the AL’s No. 1 seed and division title. While Toronto has the tiebreaker in the AL East, the Boston Red Sox and New York Yankees are both headed to the postseason regardless. And the Seattle Mariners separated themselves from the Houston Astros in a two-team AL West race to win their first division crown since 2001. Meanwhile, the Cleveland Guardians are going toe-to-toe with the Detroit Tigers in the AL Central while also playing themselves into a tight race for the final wild-card spot.

And what about when these teams get to the postseason? Here’s what their chances are for every round:

Breaking down the NL race

The Brewers were the first MLB team to seal its spot in October, and the Phillies — who then sealed an NL East title — clinched next. A group of contenders have separated themselves atop the NL standings with the New York Mets and Cincinnati Reds battling for the final playoff spot, with the Dodgers (who won the division) and Padres headed to the postseason from the NL West.

And what about when these teams get to the postseason? Here’s what their chances are for every round:

Game of the day

Looking for something to watch today? Here’s the baseball game with the biggest playoff implications:

Playoff schedule

Wild-card series
Best of three, all games at better seed’s stadium

Game 1: Tuesday, Sept. 30
Game 2: Wednesday, Oct. 1
Game 3: Thursday, Oct. 2*

Division series
Best of five

ALDS
Game 1: Saturday, Oct. 4
Game 2: Sunday, Oct. 5
Game 3: Tuesday, Oct. 7
Game 4: Wednesday, Oct. 8*
Game 5: Friday, Oct. 10*

NLDS
Game 1: Saturday, Oct. 4
Game 2: Monday, Oct. 6
Game 3: Wednesday, Oct. 8
Game 4: Thursday, Oct. 9*
Game 5: Saturday, Oct. 11*

League championship series
Best of seven

ALCS
Game 1: Sunday, Oct. 12
Game 2: Monday, Oct. 13
Game 3: Wednesday, Oct. 15
Game 4: Thursday, Oct. 16
Game 5: Friday, Oct. 17*
Game 6: Sunday, Oct. 19*
Game 7: Monday, Oct. 20*

NLCS
Game 1: Monday, Oct. 13
Game 2: Tuesday, Oct. 14
Game 3: Thursday, Oct. 16
Game 4: Friday, Oct. 17
Game 5: Saturday, Oct. 18*
Game 6: Monday, Oct. 20*
Game 7: Tuesday, Oct. 21*

World Series
Best of seven

Game 1: Friday, Oct. 24
Game 2: Saturday, Oct. 25
Game 3: Monday, Oct. 27
Game 4: Tuesday, Oct. 28
Game 5: Wednesday, Oct. 29*
Game 6: Friday, Oct. 31*
Game 7: Saturday, Nov. 1*

* If necessary

World

Sergei Lavrov warns NATO and EU countries over ‘aggression’ towards Russia

Published

39 mins ago

September 28, 2025

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Sergei Lavrov warns NATO and EU countries over 'aggression' towards Russia

Vladimir Putin’s top diplomat says Russia has no intention of attacking any NATO or EU member state but warned of a “decisive response” if any “aggression” was directed towards Moscow.

Sergei Lavrov, Russia‘s foreign minister of 21 years, was speaking in New York at the 80th UN General Assembly, where he said threats against his country by Western nations were becoming “increasingly common”.

He was expected to address allegations made against Moscow that it has violated the airspace of several of its neighbours in recent weeks, heightening tensions across Europe.

Estonia said Russian fighter jets flew into its airspace last week and remained there for 12 minutes, while a NATO air defence mission was recently carried out over Poland in response to “unprecedented” Russian drone incursions above the country.

Romania and Latvia also reported that single Russian drones had violated their airspace this month.

“Threats of force against Russia, accused of practically planning an attack on the North Atlantic Alliance and the European Union, are becoming increasingly common,” Mr Lavrov said in New York.

“President Putin has repeatedly debunked such provocations. Russia has never had and does not have such intentions, but any aggression against my country will be met with a decisive response.”

At the start of the week, US President Donald Trump told the UN that NATO nations should shoot down Russian planes in their airspace.

‘They will regret it’

After his UN address, Mr Lavrov held a news conference, where he insisted again that Moscow “has nothing to hide” over the allegations against it.

He was then asked by US correspondent Mark Stone what the Kremlin’s response would be if a nation shot down a Russian drone or plane in Russian airspace.

“Try to understand that a drone, when it is flying not over our territory, but if it crosses someone’s border but has left our airspace, probably everyone has the right to do with that drone whatever they consider necessary to ensure their security.

“But if there are attempts to shoot down any flying object, or indeed any object at all, on our territory, in our airspace, then I think people will seriously regret it, undertaking such a gross violation of our territorial integrity, our sovereignty.”

‘Hypocrisy’ over Gaza comments

At the start of his UN speech, Mr Lavrov took time to criticise Israel’s actions in the Middle East, accusing it of trying to “blow up” the region and saying it had “no justification” for the “brutal killings” of Palestinians in Gaza.

“The illegal use of force against the Palestinians and aggressive actions against Iran, Qatar, Yemen, Lebanon, Syria and Iraq today threaten to blow up the entire Middle East.”

He also hit out at Israeli plans to annex the West Bank: “There is no justification for plans to annex the West Bank. This is essentially a coup d’etat in diplomatic terms.”

Israel has repeatedly claimed that it does not target civilians in Gaza and says its military actions across the Middle East are strategically vital for its self-defence.

Mark Stone said Mr Lavrov’s comments on Israel’s actions will be seen as highly hypocritical given Russia’s war in Ukraine which began in February 2022.

“Lavrov said Israel is bombing schools, it is bombing hospitals in Gaza,” Stone said.

“Well, remember Mariupol and the rest of those cities in Ukraine, where Russia has and continues to do just the same thing? There’s a certain hypocrisy there, for sure.”

US

Donald Trump orders deployment of US troops to ‘war-ravaged’ Portland

Published

39 mins ago

September 28, 2025

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Donald Trump orders deployment of US troops to 'war-ravaged' Portland

Donald Trump has ordered the deployment of US troops to “war-ravaged Portland” in the state of Oregon, authorising the use of “full force” if needed.

The US president said he was directing US defence secretary Pete Hegseth to make the move in order to protect the city “and any of our ICE facilities under siege from attack by Antifa and other domestic terrorists”.

Mr Trump did not specify whether he would send in National Guard troops or the US military.

The move comes after a gunman opened fire on an Immigration and Customs Enforcement (ICE) field office in Dallas on Wednesday, wounding two detainees and killing another.

The ICE facility in Portland has been targeted by protesters since June, sometimes leading to violent clashes.

On Friday, the Department of Homeland Security (DHS) said demonstrators had “repeatedly attacked and laid siege to an ICE processing centre” there, adding that several arrests were made.

“Rose City Antifa, a recently designated domestic terrorist organization, illegally doxed ICE officers. They published their home address online and on public flyers. Individuals associated with Antifa also sent death threats to DHS personnel,” DHS wrote on X.

Speaking in the Oval Office on Thursday, Mr Trump said “anarchy” was taking place in Portland.

He said: “You go out to Portland, people die out there. Many people have died over the years in Portland. Portland is, I don’t know how anybody lives there. It’s amazing, but it’s, it’s anarchy out there. That’s what they want. They want anarchy.”

In separate comments, Mr Trump said people were “out of control” in Portland and pledged to “stop that very soon”.

After Mr Trump’s announcement, Oregon’s Democratic governor Tina Kotek said she was reaching out to the White House for more information.

“We have been provided no information on the reason or purpose of any military mission. There is no national security threat in Portland. Our communities are safe and calm,” she said.

Portland’s mayor Keith Wilson said in a statement that the “number of necessary troops is zero, in Portland and any other American city”.

But Republicans supported the move. US labour secretary Lori Chavez-DeRemer, who previously served as a Republican house representative for an Oregon district, said she had seen how “lawlessness” had turned Portland into a “crime-ridden war zone”.

In a post on X, she thanked Mr Trump “for taking action to keep our ICE facilities protected and Make America Great Again”.

Trump has sent military troops to the Democratic-controlled cities of Los Angeles and Washington DC so far in his second presidency. He has also discussed doing the same in Memphis and New Orleans, which are also Democratic strongholds.