Sex differences in COVID-19

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2 years ago

September 29, 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 Some information may be out of date.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 COVID-19.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 could place the 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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Politics

‘Shameful’ that black boys in London more likely to die than white boys, says Met Police chief

Published

23 mins ago

July 13, 2025

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'Shameful' that black boys in London more likely to die than white boys, says Met Police chief

It is “shameful” that black boys growing up in London are “far more likely” to die than white boys, Metropolitan Police chief Sir Mark Rowley has told Sky News.

In a wide-ranging interview with Sunday Morning with Trevor Phillips, the commissioner said that relations with minority communities are “difficult for us”, while also speaking about the state of the justice system and the size of the police force.

Sir Mark, who came out of retirement to become head of the UK’s largest police force in 2022, said: “We can’t pretend otherwise that we’ve got a history between policing and black communities where policing has got a lot wrong.

“And we get a lot more right today, but we do still make mistakes. That’s not in doubt. I’m being as relentless in that as it can be.”

He said the “vast majority” of the force are “good people”.

However, he added: “But that legacy, combined with the tragedy that some of this crime falls most heavily in black communities, that creates a real problem because the legacy creates concern.”

Sir Mark, who also leads the UK’s counter-terrorism policing, said black boys growing up in London “are far more likely to be dead by the time they’re 18” than white boys.

“That’s, I think, shameful for the city,” he admitted.

“The challenge for us is, as we reach in to tackle those issues, that confrontation that comes from that reaching in, whether it’s stop and search on the streets or the sort of operations you seek.

“The danger is that’s landing in an environment with less trust.

“And that makes it even harder. But the people who win out of that [are] all of the criminals.”

The commissioner added: “I’m so determined to find a way to get past this because if policing in black communities can find a way to confront these issues, together we can give black boys growing up in London equal life chances to white boys, which is not what we’re seeing at the moment.

“And it’s not simply about policing, is it?”

Sir Mark said: “I think black boys are several times more likely to be excluded from school, for example, than white boys.

“And there are multiple issues layered on top of each other that feed into disproportionality.”

‘We’re stretched, but there’s hope and determination’

Sir Mark said the Met is a “stretched service” but people who call 999 can expect an officer to attend.

“If you are in the middle of the crisis and something awful is happening and you dial 999, officers will get there really quickly,” Sir Mark said.

“I don’t pretend we’re not a stretched service.

“We are smaller than I think we ought to be, but I don’t want to give a sort of message of a lack of hope or a lack of determination.”

“I’ve seen the mayor and the home secretary fighting hard for police resourcing,” he added.

“It’s not what I’d want it to be, but it’s better than it might be without their efforts.”

‘Close to broken’ justice system ‘frustrating’ and ‘stressed’

Sir Mark said the criminal justice system was “close to broken” and can be “frustrating” for others.

“The thing that is frustrating is that the system – and no system can be perfect – but when the system hasn’t managed to turn that person’s life around and get them on the straight and narrow, and it just becomes a revolving door,” he said.

“When that happens, of course that’s frustrating for officers.

“So the more successful prisons and probation can be in terms of getting people onto a law-abiding life from the path they’re on, the better.

“But that is a real challenge. I mean, we’re talking just after Sir Brian Leveson put his report out about the close-to-broken criminal justice system.

“And it’s absolutely vital that those repairs and reforms that he’s talking about happen really quickly, because the system is now so stressed.”

Challenge to reform the Met

The Met chief’s comments come two years after an official report found the force is institutionally racist, misogynistic and homophobic.

Baroness Casey was commissioned in 2021 to look into the Met Police after serving police officer Wayne Couzens abducted, raped and murdered Sarah Everard.

She pinned the primary blame for the Met’s culture on its past leadership and found stop and search and the use of force against black people was excessive.

At the time, Sir Mark, who had been commissioner for six months when the report was published, said he would not use the labels of institutionally racist, institutionally misogynistic and institutionally homophobic, which Baroness Casey insisted the Met deserved.

However, London Mayor Sadiq Khan, who helped hire Sir Mark – and could fire him – made it clear the commissioner agreed with Baroness Casey’s verdict.

A few months after the report, Sir Mark launched a two-year £366m plan to overhaul the Met, including increased emphasis on neighbourhood policing to rebuild public trust and plans to recruit 500 more community support officers and an extra 565 people to work with teams investigating domestic violence, sexual offences and child sexual abuse and exploitation.

Watch the full interview on Sunday Morning with Trevor Phillips from 8.30am on Sunday.

Politics

Unite votes to suspend Angela Rayner over Birmingham bin strike

Published

23 mins ago

July 13, 2025

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Unite votes to suspend Angela Rayner over Birmingham bin strike

Labour’s largest union donor, Unite, has voted to suspend Deputy Prime Minister Angela Rayner over her role in the Birmingham bin strike row.

Members of the trade union, one of the UK’s largest, also “overwhelmingly” voted to “re-examine its relationship” with Labour over the issue.

They said Ms Rayner, who is also housing, communities and local government secretary, Birmingham Council’s leader, John Cotton, and other Labour councillors had been suspended for “bringing the union into disrepute”.

There was confusion over Ms Rayner’s membership of Unite, with her office having said she was no longer a member and resigned months ago and therefore could not be suspended.

But Unite said she was registered as a member. Parliament’s latest register of interests had her down as a member in May.

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The union said an emergency motion was put to members at its policy conference in Brighton on Friday.

Unite is one of the Labour Party’s largest union donors, donating £414,610 in the first quarter of 2025 – the highest amount in that period by a union, company or individual.

The union condemned Birmingham’s Labour council and the government for “attacking the bin workers”.

Mountains of rubbish have been piling up in the city since January after workers first went on strike over changes to their pay, with all-out strike action starting in March. An agreement has still not been made.

Ms Rayner and the councillors had their membership suspended for “effectively firing and rehiring the workers, who are striking over pay cuts of up to £8,000”, the union added.

‘Missing in action’

General secretary Sharon Graham told Sky News on Saturday morning: “Angela Rayner, who has the power to solve this dispute, has been missing in action, has not been involved, is refusing to come to the table.”

She had earlier said: “Unite is crystal clear, it will call out bad employers regardless of the colour of their rosette.

“Angela Rayner has had every opportunity to intervene and resolve this dispute but has instead backed a rogue council that has peddled lies and smeared its workers fighting huge pay cuts.

“The disgraceful actions of the government and a so-called Labour council, is essentially fire and rehire and makes a joke of the Employment Relations Act promises.

“People up and down the country are asking whose side is the Labour government on and coming up with the answer not workers.”

Sir Keir Starmer’s spokesman said the government’s “priority is and always has been the residents of Birmingham”.

He said the decision by Unite workers to go on strike had “caused disruption” to the city.

“We’ve worked to clean up streets and remain in close contact with the council […] as we support its recovery,” he added.

A total of 800 Unite delegates voted on the motion.

Politics

Dozens of MPs call for UK government to recognise Palestine as state

Published

23 mins ago

July 13, 2025

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Dozens of MPs call for UK government to recognise Palestine as state

Nearly 60 Labour MPs have called on David Lammy and the Foreign Office to immediately recognise Palestine as a state.

A mix of centrist and left-wing MPs, including some committee chairs, wrote to the foreign secretary this week to say “by not recognising [Palestine] as a state, we undermine our own policy of a two-state solution and set an expectation that the status quo can continue and see the effective erasure and annexation of Palestinian territory”.

The 59 MPs suggest the government pursue five different measures to prevent the Israeli government from carrying out its Rafah plan, adding that they believed Gaza was being “ethnically cleansed” – a claim vehemently denied by Israel.

The letter was organised by Labour Friends of Palestine and the Middle East group.

It states that the Israeli plan, which would see the “population transfer to the southern tip of Gaza in preparation for deportation outside the strip”, is an accurate description, but that they believe a clearer way to describe it is the “ethnic cleansing of Gaza”.

Israeli officials have said they want to separate the civilian population from Hamas, which still controls parts of Gaza and holds dozens of hostages abducted in the October 7 attack that triggered the war 21 months ago.

Emmanuel Macron discussed recognising Palestine as a state at a joint news conference with Sir Keir Starmer on Thursday – the same day the letter was signed.

The French president said: “Today, working together in order to recognise the state of Palestine and to initiate this political momentum is the only path to peace.”

While France has not yet recognised a Palestinian state yet, Norway, Ireland and Spain coordinated their recognition last year.

The letter demands ministers take five different measures to:

• Recognise the state of Palestine
• Continue support for the UN Agency for Palestinian Refugees (UNRWA)
• Secure the release of hostages
• Press for the full and unhindered resumption of humanitarian aid
• Fully review and place restrictions on trade with and financial support of illegal Israeli settlements in the West Bank

The government says it is already providing funding for the UNRWA and working to secure the release of hostages held by Hamas, but immediate recognition of Palestinian statehood will be a much more controversial move.

Sky News understands this is the second time MPs have formally called on the government to immediately recognise the state of Palestine, with previous letters signed by some parliamentary aides and even junior ministers.

Ministers have indicated their plan to recognise Palestine would be “at a time that is most conducive to the peace process” without further clarity of when that might be.

They have also indicated that it would not be suitable to speculate about future sanctions, as this could reduce their impact.

A Foreign Office spokesperson said: “Since day one, this government has been clear that we need to see an immediate ceasefire, the release of all hostages cruelly detained by Hamas, better protection of civilians, much-needed food aid, medicines, shelter and other supplies immediately being allowed to enter Gaza, and a path to long-term peace and stability.

“The situation on the ground in Gaza is horrendous – for the hostages and for Palestinians – and we urgently want to see a deal done, to end the suffering on all sides.

“We are committed to recognising a Palestinian state and to doing so when will have most impact in support of a peace process. We continue to provide lifesaving aid to supporting Palestinians in Gaza and the West Bank, and to work closely in support of the Palestinian Authority.”