Sex differences in COVID-19

Published

3 years ago

April 17, 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 Some information may be out of date.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

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

Politics

Budget 2025: Hospitality pleads for ‘lifeline’ as Rachel Reeves accused of imposing ‘stealth tax’

Published

53 mins ago

November 29, 2025

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Budget 2025: Hospitality pleads for 'lifeline' as Rachel Reeves accused of imposing 'stealth tax'

Rachel Reeves has been accused of failing to “support the great British pub” as she promised in the budget, with owners facing skyrocketing business rates bills.

In her speech in the House of Commons on Wednesday, the chancellor said she was backing small businesses by introducing “permanently lower tax rates for over 750,000 retail, hospitality and leisure properties – the lowest tax rates since 1991”.

But while the government gave itself the powers to discount the business rates bills for high street businesses through legislation earlier this year, the chancellor only implemented a reduction of a quarter of what the government is able to, and she is being accused of imposing a “stealth tax”.

It has left small retail, hospitality, and leisure businesses questioning whether their businesses will be viable beyond April next year.

A Treasury spokesperson said: “We’re protecting pubs, restaurants and cafes with the budget’s £4.3bn support package – capping bill rises so a typical independent pub will pay around £4,800 less next year than they otherwise would have.

“This comes on top of cutting licensing costs to help more venues offer pavement drinks and al fresco dining, maintaining our cut to alcohol duty on draught pints, and capping corporation tax.”

Business rates, which are a tax on commercial properties in England and Wales, are calculated through a complex formula of the value of the property, assessed by a government agency every three years, combined with a national “multiplier” set by the Treasury, giving a final cash amount.

Over the last few years, small businesses were given business rates relief of 75% to support them over the COVID pandemic, and Ms Reeves reduced that to 40% at last year’s budget.

The idea was that at the budget this year, the chancellor would remove that remaining relief in favour of reforming the business rates system to compensate for that drop, while shifting the tax burden on to much bigger businesses and companies like Amazon with lots of warehouse space.

However, the chancellor only announced a 5p in the pound discount for small retail, hospitality, and leisure businesses, rather than the assumed 20p drop which the government gave itself the powers to implement, and which trade bodies had been lobbying for.

On top of that, small businesses have seen the government-assessed value of their property increase dramatically, which wipes out the discount, and sees their business rates bill shoot far above what they had previously been paying.

One pub owner near Hull, Sam Caroll, has seen the assessed value of one of his two properties increase from £67,000 to £110,000 in just three years – a 64% increase.

He told Sky News that there is a “continual question” of business viability, and while he thinks they can “adapt” in the short term, “there will be a tipping point at some point”. Even at the moment, packing out their pubs seven nights a week, “it’s difficult for us to break even”, he said.

There will be a discount for small businesses to transition to the higher business rates level, but by year three, almost the full amount is expected to be payable, and Mr Carroll described it as “getting f***** slowly, instead of getting f***** overnight”.

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Sean Hughes, who owns multiple hospitality venues in St Albans, has also seen vast increases in the assessed value of his properties, and was sharply critical of the transitional arrangements the government is implementing.

He told Sky News: “Fundamental business rate reform was promised and we have total chaos. If [the system] was fair, why would they need transitional relief periods?”

A spokesperson of the Valuation Office Agency (VOA), which assesses the value of commercial properties for business rates purposes, told Sky News: “At the last revaluation, some sectors including hospitality were significantly affected by the pandemic, which resulted in much lower rateable values than they would have seen otherwise. Businesses that have now seen a recovery in trade are also likely to see an increase in their rateable value.”

However, Sky News has seen evidence of businesses whose assessed value did not decrease when assessed during the pandemic, but actually rose, and has risen dramatically this year.

Data compiled by the Pubs Advisory Service, shows that the number of pubs in the UK has decreased by nearly 5% in three years, but the average value of the properties has risen by an average of 36.82% per pub.

And analysis by UK Hospitality, the trade body that represents hospitality businesses, has found that over the next three years, the average pub will pay an extra £12,900 in business rates, even with the transitional arrangements, while an average hotel will see its bill soar by £205,200.

The body adds that by 2028/29, an average pub’s business rates will have increased by 76% and an average hotel’s by 115%, compared to 16% for a distribution warehouse like the ones the web giants use.

It’s not just the business rates rise that is worrying owners – it is the increase in employers’ national insurance implemented at the last budget, the increase in energy bills over the last few years, and the rise in the minimum wage, particularly for young people.

With the budget set to squeeze disposal income, there is little room for price increases to make up the shortfall either.

In a letter to the chancellor on Friday, Liberal Democrat deputy leader Daisy Cooper said small business owners “have been pushed to tears as they’re hit with the bombshell of higher business rates bills”, noting that “the government has chosen not to use the full powers it gave itself to throw high streets a lifeline”.

She added that businesses had been promised “permanently lower business rates”, but it appears the government has “broken yet another promise, by imposing a stealth tax not just on people, but on treasured high street businesses too”, and called on ministers to “throw our high streets and Britain’s hospitality sector a lifeline”.

Conservative shadow business secretary Andrew Griffith published his own analysis of the government’s budget measures on Friday morning, that found they will “hammer British pubs”.

Of the chancellor, he said: “She pretended in her budget speech to be supportive, whilst the true detail is that a combination of rate revaluations and scrapping reliefs will leave most pubs paying thousands of pounds more than they cannot afford.”

Kate Nicholls, Chair of UKHospitality, said in a statement: “The government promised in its manifesto that it would level the playing field between the high street and online giants. The plan in the budget to achieve this is quickly unravelling, and will deliver the exact opposite.”

She said they “repeatedly warned the Treasury” of the impending impacted of the value reassessment, but nonetheless, hospitality businesses are now facing “eye-watering increases”.

She added: “We agree with its reforms to deliver permanently lower business rates for hospitality and we appreciate the package of transitional relief, but its current proposal is not delivering lower bills. A 20p discount for hospitality would. We urge the chancellor to revisit.”

US

Trump says he will cancel all Biden executive orders ‘signed with autopen’

Published

4 hours ago

November 29, 2025

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Trump says he will cancel all Biden executive orders 'signed with autopen'

Donald Trump has said he will cancel all executive orders that he claims were signed with an autopen by his predecessor Joe Biden.

The US president alleged Mr Biden was “not involved” in signing the orders and claimed “the radical left lunatics circling Biden around the beautiful Resolute Desk in the Oval Office took the presidency away from him”. He did not provide any evidence for his claims.

An autopen is a device which reproduces a person’s signature, allowing them to repeatedly sign documents without having to do so by hand each time.

In a post on his Truth Social platform, he said: “Any document signed by Sleepy Joe Biden with the Autopen, which was approximately 92% of them, is hereby terminated, and of no further force or effect.

“The Autopen is not allowed to be used if approval is not specifically given by the President of the United States.”

He added: “I am hereby cancelling all Executive Orders, and anything else that was not directly signed by Crooked Joe Biden, because the people who operated the Autopen did so illegally.

“Joe Biden was not involved in the Autopen process and, if he says he was, he will be brought up on charges of perjury.”

Mr Trump has repeatedly claimed Mr Biden was not mentally capable by the end of his term and his staff made decisions on his behalf, using an autopen to sign them off without his knowledge.

Mr Trump has not provided any evidence for his claims, while Mr Biden and his former aides have denied they made decisions on his behalf.

In June, Mr Biden said: “Let me be clear: I made the decisions during my presidency.

“I made the decisions about the pardons, executive orders, legislation, and proclamations. Any suggestion that I didn’t is ridiculous and false.”

Mr Trump has also used an autopen, but claimed he only used it “for very unimportant papers”.

Earlier this year, Mr Trump replaced a portrait of Mr Biden in the Oval Office with a picture of an autopen signing the former president’s name.

Sports

Kiffin to make ‘hard decision’ on future Saturday

Published

5 hours ago

November 28, 2025

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Kiffin to make 'hard decision' on future Saturday

Mark SchlabachNov 28, 2025, 06:08 PM ET
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- Senior college football writer
- Author of seven books on college football
- Graduate of the University of Georgia

STARKVILLE, Miss. — Lane Kiffin said he’ll decide Saturday whether he will return as Ole Miss‘ coach in 2026 or take another job, presumably at LSU, which is trying to poach him from its SEC rival with a lucrative contract offer that will make him one of the highest-paid coaches in college football.

Kiffin, while speaking to reporters after the No. 7 Rebels’ 38-19 victory at Mississippi State in Friday’s Egg Bowl at Davis Wade Stadium, would only say that he’ll have to make a decision one way or the other, after Ole Miss athletics director Keith Carter and chancellor Glenn Boyce said they needed an answer by Saturday.

“I feel like I’ve got to,” Kiffin said.

When Kiffin was asked if he had made up his mind about where he’ll be coaching next season, he said, “Yeah, I haven’t. Maybe that surprises you. But, you know, I’ve got to do some praying and figure this thing out.”

Kiffin said he planned to attend his son’s high school playoff game in Tupelo, Mississippi, on Friday night. Knox Kiffin is Oxford High’s starting quarterback.

“Tonight, I’m going to go be a dad and watch a more important game to me,” Kiffin said.

Kiffin wasn’t sure what time he would make a decision Saturday.

“There’s a lot [that goes] into it,” Kiffin said. “It’s a hard decision. You guys have them all the time. You’ve got to make decisions about jobs you take and where you move, and we get paid a lot so I understand we’re under a lot of spotlight and scrutiny.”

Kiffin said he regretted not being able to speak to his father, Monte Kiffin, while trying to make one of the most important decisions of his career. The longtime NFL defensive coordinator died in July 2024. He was 84.

Kiffin, 50, has sought the advice of former Alabama coach Nick Saban and Las Vegas Raiders coach Pete Carroll, his former boss at USC, the past few weeks.

ESPN reported earlier Friday that Florida, which was also courting Kiffin, is now focused on other candidates in its search because the Gators believe he’s more interested in other opportunities.

Carter and Boyce met with Kiffin a week ago in Oxford, Mississippi, and the sides came to an understanding that Kiffin would make up his mind the day after the Egg Bowl.

If the Egg Bowl was Kiffin’s last game as Ole Miss’ coach, it was a fitting end to one of the most successful tenures in school history.

As speculation about Kiffin’s future continued to swirl over the past two weeks, the Rebels rolled past their rivals for their fifth win in the past six meetings in the heated series. The Rebels had 545 yards of offense, as quarterback Trinidad Chambliss passed for 359 yards with four touchdowns.

The Rebels (11-1, 7-1 SEC) all but secured a spot in the 12-team College Football Playoff. They’ll have to wait another day to find out whether they’ll play in next week’s SEC championship game in Atlanta.

No. 3 Texas A&M would have to fall at No. 16 Texas on Friday night (7:30 p.m. ET, ABC) and No. 10 Alabama would have to lose at Auburn in Saturday’s Iron Bowl (7:30 p.m. ET/ABC) for the Rebels to clinch a spot in the SEC championship game.

And, of course, Ole Miss fans will be waiting Saturday to find out which coaches will be on the sideline for the CFP, which might begin with a first-round game at home on Dec. 19 or 20.

If Kiffin decides to leave for LSU, former New York Giants coach Joe Judge would likely serve as the Rebels’ interim coach in the CFP, sources told ESPN.