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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 Some information may be out of date.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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US talk show titans come out fighting after Kimmel cancellation

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US talk show titans come out fighting after Kimmel cancellation

US talk show host Stephen Colbert has condemned the cancellation of fellow late-night star Jimmy Kimmel as a “blatant assault on freedom of speech”, as America’s top late night presenters came out fighting.

He used the opening of Thursday night’s edition of his Late Show to address the pulling of Jimmy Kimmel Live over comments made about the assassination of the right-wing influencer Charlie Kirk.

Kimmel used his show earlier this week to accuse the Trump administration and its allies of “working very hard to capitalise on the murder of Charlie Kirk”, with the president among those to pin it on left-wing extremism.

The move by Disney-owned ABC has been widely criticised, with the network accused of kowtowing to President Donald Trump, who celebrated the decision.

Also airing on Thursday night, Jon Stewart, host of Comedy Central’s Daily Show, appeared in a garish gold set, in parody of Mr Trump’s redesign of the White House, to tell viewers the episode would be “another fun, hilarious, administration-compliant show”.

Stewart, playing the role of an over-the-top, politically obsequious TV host under authoritarian rule, lavished praise on the president and satirised his criticism of US cities and his deployment of the National Guard to fight crime.

“Coming to you tonight from the real […] crime-ridden cesspool that is New York City. It is a tremendous disaster like no-one’s ever seen before. Someone’s National Guard should invade this place, am I right?” he said.

He then introduced his guest – Maria Ressa, a journalist and author of the book How To Stand Up To A Dictator.

Jon Stewart. Pic: Associated Press
Image:
Jon Stewart. Pic: Associated Press

Over at The Tonight Show, Jimmy Fallon told his audience he was “not sure what was going on” but that Kimmel is “a decent funny and loving guy and I hope he comes back”.

Fallon then promised viewers that in spite of people being “worried that we won’t keep saying what we want to say or that we will be censored”, he was going to cover the president’s recent trip to the UK “just like I normally would”.

He was then replaced by a voiceover describing Mr Trump as “incredibly handsome” and “making America great again”.

Jimmy Fallon on Thursday's Tonight Show. Pic: The Tonight Show X
Image:
Jimmy Fallon on Thursday’s Tonight Show. Pic: The Tonight Show X

Seth Meyers also joined the fray.

“Donald Trump is on his way back from a trip to the UK,” he said at the top of his show Late Night, “while back here at home, his administration is pursuing a crackdown on free speech… and completely unrelated, I just wanted to say that I have always admired and respected Mr Trump.

“I have always believed he was a visionary, an innovator, a great president, and an even better golfer.”

Kimmel’s removal from the show he has hosted for two decades led to criticism that free speech was under attack.

But speaking on his visit to Britain, Donald Trump claimed he was suspended “because he had bad ratings”.

It came after fellow late-night host Colbert saw his programme cancelled earlier this year, which fans claimed was also down to his criticism of Mr Trump, who has since railed against Kimmel, Meyers, and Fallon.

He has posted on Truth Social that they should all be cancelled.

Jimmy Kimmel hosting last year's Oscars. Pic: AP
Image:
Jimmy Kimmel hosting last year’s Oscars. Pic: AP

Figures from both the worlds of entertainment and politics lined up to lament ABC’s removal of Kimmel.

Chat show doyenne David Letterman said people should not be fired just because they don’t “suck up” to what he called “an authoritarian” president.

During an appearance at The Atlantic Festival 2025 in New York on Thursday night, he added: “It’s no good. It’s silly. It’s ridiculous.

“I feel bad about this, because we all see where see this is going, correct? It’s managed media.”

Barack Obama on Jimmy Kimmel Live in 2016. Pic: Susan Walsh/AP
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Barack Obama on Jimmy Kimmel Live in 2016. Pic: Susan Walsh/AP

Former US president Barack Obama wrote on X: “After years of complaining about cancel culture, the current administration has taken it to a new and dangerous level by routinely threatening regulatory action against media companies unless they muzzle or fire reporters and commentators it doesn’t like.

“This is precisely the kind of government coercion that the First Amendment was designed to prevent, and media companies need to start standing up rather than capitulating it.”

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Trump and Starmer quizzed on Epstein

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Trump and Starmer quizzed on Epstein

👉 Follow Trump100 on your podcast app 👈

Starmer and Trump meet at Chequers. A news conference with enormous consequences, not just for the US and UK, but for the global world order.

To match the occasion – a special mashup episode of Electoral Dysfunction and Trump100. Mark Stone is joined by Beth Rigby, Harriet Harman and Ruth Davidson.

As Team Trump leaves British soil… is Starmer better off now than he was at the start of the week?

Or is he still on the ropes?

You can also watch all episodes on our YouTube channel.

Email us on trump100@sky.uk with your comments and questions.

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Canada’s TradeOgre seizure slammed as ‘theft from many innocent users’

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Canada’s TradeOgre seizure slammed as ‘theft from many innocent users’

Canada’s TradeOgre seizure slammed as ‘theft from many innocent users’

Canadian police have seized $40 million in crypto from TradeOgre, which the exchange’s supporters have criticized as heavy-handed.

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