Sex differences in COVID-19

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2 years ago

October 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 Some information may be out of date.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 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

For live updates on the latest developments regarding the novel coronavirus and COVID-19, click here.

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College Football Playoff impact: Players who stuck around

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2 hours ago

April 30, 2025

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College Football Playoff impact: Players who stuck around

Following two transfer portal windows and the NFL draft, college football fans might need Apple AirTags to track where their favorite players wound up.

This space is dedicated to those who decided to stay — commitments who boosted their teams’ College Football Playoff hopes. Penn State’s 2022 recruiting class could take up half the list: quarterback Drew Allar, running backs Nicholas Singleton and Kaytron Allen, defensive end Dani Dennis-Sutton and defensive tackle Zane Durant are all back from the Nittany Lions’ CFP semifinal run.

“When we all committed here coming out of our ’22 class, that was one of our goals coming in as Penn Staters, we wanted to compete for championships, both Big Ten and obviously national championships,” Allar said. “And obviously we had a taste of that last year, and we know how close you are, so it’s just building off that and trying to make another run at it.”

Here’s a look at 13 players from 11 schools and representing five different leagues whose decisions to either forgo the NFL draft or sidestep the portal have beefed up their respective teams’ playoff chances.

The decision: Forgo the 2025 NFL draft

What his return means: Nussmeier, a fifth-year senior, and offensive coordinator Joe Sloan are entering their second season together and aiming to improve upon a stellar debut, which will help the Tigers contend for the SEC title. Nussmeier threw for 4,052 passing yards last year, 29 touchdowns and 12 interceptions. Even if LSU can’t win the league, Nussmeier’s return can help the Tigers earn an at-large CFP bid — especially if he makes a similar jump to his predecessors, Joe Burrow and Jayden Daniels, who both won the Heisman Trophy in their second seasons in Baton Rouge. Nussmeier’s dad, Doug, will be nearby as the Saints’ offensive coordinator after winning a Super Bowl as the Eagles’ quarterbacks coach. With four new starters on the Tigers’ offensive line, there’s going to be an adjustment period, but if the “Nuss Bus” gets the time he needs, this should be a breakout season and his draft stock will rise with LSU’s playoff chances.

2. Drew Allar, QB, Penn State

The decision: Forgo the 2025 NFL draft

What his return means: Penn State has something Ohio State and Oregon don’t — a starting quarterback with playoff experience. The Nittany Lions might finally have the pieces in place to return to the top of the Big Ten and contend for a national title. Allar, who’s entering his third season as the starter, will be surrounded by NFL talent on the offensive line and in the running game, and could make a case to be Penn State’s first Heisman Trophy winner since John Cappelletti in 1973. Last season, he had 3,327 passing yards, the third most in a season in school history. With a second season under coordinator Andy Kotelnicki, and more options at wide receiver — plus a still-loaded tight end room — there will be no shortage of options for Allar to push the ball downfield more.

The decision: Forgo the 2025 NFL draft

What his return means: On paper, Clemson has enough offensive firepower returning to elevate the Tigers into a deeper CFP run than their first-round exit in 2024 and they should have the Heisman-contending quarterback the program has desperately missed. Klubnik leads a Clemson offense that is No. 1 in the FBS in returning production (81%), according to ESPN’s Bill Connelly. Klubnik reestablished himself as one of the top quarterbacks in the country following a down season in 2023. Last year, his 308 completions, 3,639 passing yards and 36 passing touchdowns all ranked among the best seasons in program history. As he enters his third season as a starter under offensive coordinator Garrett Riley, Klubnik’s understanding of the offense and his relationship with Riley has grown, positioning Klubnik for what should be his best season with the Tigers.

4. Nicholas Singleton/Kaytron Allen, RBs, Penn State

The decision: Forgo the 2025 NFL draft

What their return means: The nation’s best running back duo returns intact, and they’ve got playoff experience along with familiarity and knowledge of the offense in coordinator Andy Kotelnicki’s second season, all of which should boost the Nittany Lions’ hopes of winning the Big Ten and returning to the CFP. Singleton and Allen were projected by ESPN’s Mel Kiper Jr. to be the Nos. 5 and 6 running backs available in the 2025 draft after becoming the first combo in Penn State history to each have at least 1,000 rushing yards in the same season. Penn State ran for more than 200 yards in 10 games last season, and the Nittany Lions led all Power 4 teams and Notre Dame in rushing with 3,237 yards. Of course, it helps to have 6-foot-4, 350-pound offensive guard Olaivavega Ioane blocking.

The decision: Avoid the transfer portal

What his return means: Sellers absolutely drew interest from other teams in November and December, but he re-signed quickly with the Gamecocks — and his commitment could be the difference between receiving or not receiving a CFP bid. The same can be said for edge rusher Dylan Stewart, who also attracted attention after 10.5 TFLs and 6.5 sacks last year. South Carolina made a playoff case with Sellers leading the offense last year, but the CFP selection committee didn’t rank the No. 15 Gamecocks high enough for inclusion. He improved throughout the season last fall, increasing his Total QBR from 52 in his first six games to 81 over the last six. This year, he’ll be working with Mike Shula, the son of Pro Football Hall of Fame coach Don Shula.

The decision: Avoid the transfer portal (twice)

What his return means: Illinois can be a CFP sleeper team by competing for the Big Ten title and earning an at-large bid if it doesn’t win the league. The importance of Illinois retaining its starting quarterback after a strong spring push from Tennessee can’t be understated. The Illini have a chance to be this year’s Indiana — a Big Ten contender with a manageable schedule that can play its way into the selection committee’s rankings with a standout quarterback and his supporting cast. After public speculation he might transfer for his final year of eligibility, Altmyer announced in December he would return to the team. He did it again in April, following the drama at Tennessee. Altmyer passed for 2,543 yards, 21 touchdowns and only five interceptions last year, leading Illinois to a 9-3 regular season and a top-20 ranking in the Associated Press poll.

The decision: Avoid the transfer portal

What his return means: K-State can win another wide-open Big 12 race and earn an automatic bid into the playoff as one of the five highest-ranked conference champions. Johnson never entered the transfer portal, but he attracted interest, especially after Tennessee lost Nico Iamaleava. “We got a damned wall built around him,” a K-State source told ESPN. “They better bring the Tennessee National Guard.” Expectations will be higher this year for Johnson, who threw for 2,712 passing yards, 25 touchdowns and 10 interceptions in his first full season as a starter last year. He also had 605 rushing yards and seven touchdowns. With the depth at wide receiver, K-State’s passing game could flourish this fall.

The decision: Forgo the NFL draft

What his return means: A veteran offensive line that includes four returning starters from a group that allowed the third-fewest sacks in the SEC last season (20). It also means better protection for quarterback DJ Lagway, who could be one of the best in the country if he can stay healthy — and Lagway’s health is the most critical component to Florida’s success this year. According to Pro Football Focus, Slaughter allowed one sack, one QB hit, six QB hurries and eight pressures — with only three penalties — in 728 snaps. The Gators again have one of the toughest schedules in the country, and Slaughter is the kind of veteran they need up front to help Lagway survive it.

The decision: Forgo the NFL draft

What his return means: That the Buckeyes didn’t lose everyone from their national championship defense. Styles had an outstanding 2024 season with 100 tackles, 11 tackles for loss, six sacks, a forced fumble, a fumble recovery and five passes defended. His draft stock rose as the Buckeyes ascended through the CFP bracket, but he told reporters at their national championship celebration that he “wasn’t ready to leave yet.” Styles still has room to improve and grow, and his draft stock will continue to rise. He’s now in a position of leadership as one of just three returning starters on defense and the most experienced player among the rising seniors.

The decision: Forgo the NFL draft

What his return means: The Ducks retained a 6-foot, 175-pound receiver who played a key role in advancing them to the top seed in the 2024 CFP, and they’ll need his help again — especially with the departure of Tez Johnson, who entered the NFL draft after leading Oregon with 83 receptions for 898 yards and 10 touchdowns his senior season. Stewart is Oregon’s only returning receiver who had more than 30 receptions in 2024. Stewart, who transferred to Oregon from Texas A&M, had 48 catches last season for 613 yards and tied for the team high with five receiving touchdowns. He was Oregon’s second-most targeted receiver in an offense that finished 13th nationally in passing yards. Stewart’s role will increase, and his decision to return will help the Ducks’ new starting quarterback, which could be former UCLA QB Dante Moore.

The decision: Forgo the NFL draft

What his decision means: The Longhorns have leadership, playoff experience, NFL talent and a familiar face returning to a defense that again has to replace multiple starters from the previous season. Taaffe, a rising senior who ascended from walk-on to All-American, had 71 tackles, 6 TFLs, 2 sacks, 2 interceptions, 10 passes defended, 1 forced fumble and 1 fumble recovery. His decision to return was driven in large part by the desire to win a national title at Texas and the devastation he said he felt following the loss to Ohio State. Taaffe will get another chance at the Buckeyes in the season opener.

The decision: Withdrew name from portal

What his return means: The Broncos were able to retain top talent from their 2024 CFP run, which featured one of the nation’s top defensive fronts, a huge boost for coach Spencer Danielson as he tries to own the Group of 5’s guaranteed spot as one of the nation’s five highest-ranked conference champions. Fely took visits to Miami and Cal before announcing on social media he planned to return to Boise. Fely, who spent the past three seasons at Boise State, started 28 games in the past two seasons. He had nine TFLs last year and 5.5 sacks.

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Boise State’s Danielson gets deal through 2029

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2 hours ago

April 30, 2025

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Boise State's Danielson gets deal through 2029

Boise State has finalized a new contract for coach Spencer Danielson, in the wake of leading the Broncos to the College Football Playoff in his first full season as their head coach, the school announced Tuesday.

Danielson has signed a five-year deal through the 2029 season, and sources said it will double his salary, as he’ll average $2.2 million over the course of the deal.

Danielson, 36, led Boise State to a 12-2 record in 2024, which included a Mountain West title and an appearance in the Fiesta Bowl against Penn State.

He has led Boise State to a pair of Mountain West titles, including one during his interim season after taking over in November 2023.

Danielson is 15-3 overall. He lost to UCLA in the LA Bowl, Oregon in the regular season in 2024 and Penn State in the CFP.

“Spencer has proven to be the right leader at the right time for Boise State football and our university as a whole,” director of athletics Jeramiah Dickey said in a statement.

“I truly believe it’s my calling to be the head coach at Boise State,” Danielson said in the statement.

Danielson’s deal will start at $2 million per year this season and increase by $100,000 over the course of the five years. The total deal will end up at nearly $11 million over the five years. He is expected to be the second-highest paid coach in the Mountain West behind UNLV’s Dan Mullen, who is set to make $3.5 million this year. Utah State’s Bronco Mendenhall is also set to make $2 million next year.

It’s a significant jump from Danielson’s original contract, which was a total of $6.5 million over five years after he earned the job with a strong run as the interim.

Danielson was promoted from defensive coordinator to Boise State’s interim coach in the wake of the firing of coach Andy Avalos. From there, Boise State won three games to emphatically to end the regular season, including a blowout of UNLV in the Mountain West title game.

Dickey saw how the team responded to Danielson and hired him as the full-time coach. Boise State parlayed that momentum to a run to the playoff, which included earning a No. 3 seed and a bye. Boise State logged wins over Washington State and twice beat UNLV to earn the Mountain West title last year.

Behind star tailback Ashton Jeanty, the No. 6 pick in the NFL draft, Boise State went undefeated in conference play. Jeanty staying in Boise for the 2024 season was Danielson’s biggest recruiting win, as Jeanty finished as a Heisman Trophy finalist.

Since the 2024 season ended, Boise State has done a strong job retaining players in the wake of its playoff run. The school has also shown significant commitment to both coordinator pay and staff salary pool.

Danielson was named the Mountain West Coach of the Year in 2024 and was a finalist for multiple national coaching honors. He began at Boise State as a graduate assistant in 2017.

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Pac-12 reaches TV deals for OSU, WSU games

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2 hours ago

April 30, 2025

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Pac-12 reaches TV deals for OSU, WSU games

Kyle BonaguraApr 29, 2025, 09:17 AM ET
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- Covers college football.
- Joined ESPN in 2014.
- Attended Washington State University.

The Pac-12 has finalized its television partnerships for the 2025 season, with The CW, ESPN and CBS combining to show the 13 home games involving Oregon State and Washington State.

“Having Pac-12 football featured across three leading broadcasters in CBS, The CW and ESPN in 2025 will provide tremendous exposure to showcase Oregon State, Washington State and our brand in the Pac-12’s final season before expansion,” Pac-12 commissioner Teresa Gould said in a statement. “We are thrilled to continue our partnership with The CW, to welcome a new partner in CBS Sports and to see a return of Pac-12 football on ESPN.”

The CW, which had the rights to all the home games for OSU and WSU last season, will retain most of the 13-game allotment with nine games on its air, with the other four split between CBS and ESPN.

ESPN will show Cal at Oregon State on Aug. 30 (7:30 p.m. PT) and Houston at Oregon State on Sept. 26 (7:30 p.m. PT), while CBS has the Apple Cup between the Cougars at Washington on Sept. 20 (4:30 or 5 p.m. PT) and the first of two matchups between OSU and WSU on Nov. 1 (4:30 or 5 p.m. PT).

The announcement did not include any details about anything 2026 season and beyond, when Boise State, Colorado State, Fresno State, Utah State and San Diego State will join the conference. However, Gould has made it clear over the past several months that the conference was looking for partners for the 2025 season that indicated they were not interested in only a short-term affiliation.

Before the 2026 season, the Pac-12 also needs to add at least one more football-playing member to fulfill NCAA requirements.