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COVID-19 affects people differently, in terms of infection with the virus SARS-CoV-2 and mortality rates. In this Special Feature, we focus on some of the sex differences that characterize this pandemic. Share on Pinterest The data that are available so far indicate that there are significant differences between how the sexes respond to the new coronavirus.

All data and statistics are based on publicly available data at the time of publication. Some information may be out of date. Visit our coronavirus hub for the most recent information on the COVID-19 pandemic.Was this helpful?

There are many ways in which the pandemic itself affects peoples day-to-day lives, and gender understood as the ensemble of social expectations, norms, and roles we associate with being a man, woman, trans- or nonbinary person plays a massive part.

On a societal level, COVID-19 has affected cis- and transwomen, for example, differently to how it has cismen, transmen, and nonbinary people. Reproductive rights, decision making around the pandemic, and domestic violence are just some key areas where the pandemic has negatively impacted women.

However, sex differences understood as the biological characteristics we associate with the sex that one is assigned at birth also play an undeniable role in an epidemic or pandemic.

While sex and gender are, arguably, inextricably linked in healthcare, as in every other area of our lives, in this Special Feature, we will focus primarily on the infection rates of SARS-CoV-2 and the mortality rates that COVID-19 causes, broken down by sex.

In specialized literature, these effects fall under the umbrella term of primary effects of the pandemic, while the secondary impact of the pandemic has deeper social and political implications.

Throughout this feature, we use the binary terms man and woman to accurately reflect the studies and the data they use. Sex-disaggregated data lacking

Before delving deeper into the subject of sex differences in COVID-19, it is worth noting that the picture is bound to be incomplete, as not all countries have released their sex-disaggregated data.

A report appearing on the blog of the journal BMJ Global Health on March 24, 2020, reviewed data from 20 countries that had the highest number of confirmed cases of COVID-19 at the time.

Of these 20 countries, Belgium, Malaysia, Netherlands, Portugal, Spain, United Kingdom, and the United States of America did not provide data that was disaggregated, or broken down, by sex.

At the time, the authors of the BMJ report appealed to these countries and others to provide sex specific data.

Anna Purdie, from the University College London, United Kingdom, and her colleagues, noted: We applaud the decision by the Italian government to publish data that are fully sex- and age-disaggregated. Other countries [] are still not publishing national data in this way. We understand but regret this oversight.
At a minimum, we urgently call on countries to publicly report the numbers of diagnosed infections and deaths by sex. Ideally, countries would also disaggregate their data on testing by sex.

Anna Purdie et al.

Since then, countries that include Belgium, the Netherlands, Portugal, and Spain have made their data available.

The U.K. have made only a part of the sex-disaggregated data available for England and Wales, without covering Scotland and Northern Ireland while Malaysia and the U.S. have not made their sex-disaggregated data available at all.

At the time of writing this article, the U.S. still have not released their sex-disaggregated data despite the country having the highest number of COVID-19 cases in the world.

For more research-backed information and resources for mens health, please visit our dedicated hub.Was this helpful? Men more than twice as likely to die

Global Health 5050, an organization that promotes gender equality in healthcare, has rounded up the total and partial data that is available from the countries with the highest numbers of confirmed COVID-19 cases.

According to their data gathering, the highest ratio of male to female deaths, as a result of COVID-19, is in Denmark and Greece: 2.1 to 1.

In these countries, men are more than twice as likely to die from COVID-19 as women. In Denmark, 5.7% of the total number of cases confirmed among men have resulted in death, whereas 2.7% of women with confirmed COVID-19 have died.

In the Republic of Ireland, the male to female mortality ratio is 2 to 1, while Italy and Switzerland have a 1.9 to 1 ratio each.

The greatest parity between the genders from countries that have submitted a full set of data are Iran, with 1.1 to 1, and Norway, with 1.2 to 1.

In Iran, 5.4% of the women patients have died, compared with 5.9% of the men. In Norway, these numbers stand at 1.3% and 1.1%, respectively.

China has a ratio of 1.7, with 2.8% of women having died, compared with 4.7% of men.
Infection rates in womenand men

A side-by-side comparison of infection rates between the sexes does not explain the higher death rates in men, nor is there enough data available to draw a conclusion about infection rates broken down by sexes.

However, it is worth noting that in Denmark, where men are more than twice as likely to die of COVID-19 as women, the proportion of women who contracted the virus was 54%, while that of men was 46%.

By contrast, in Iran, where the ratio of deaths between men and women is less different (1.1 to 1), just 43% of cases are female compared with 57% cases in men.

Until we know the proportion of people from each sex that healthcare professionals are testing, it will be difficult to fully interpret these figures.

What we do know so far is that, overall, nine of the 18 countries that have provided complete sex-disaggregated data have more COVID-19 cases among women than they do among men. Six of the 18 countries have more cases among men than they do among women.

Norway, Sweden, and Germany have a 5050% case ratio.

Other countries where more women have developed COVID-19 include:
Switzerland (53% of women to 47% of men)Spain (51% to 49%)The Netherlands (53% to 47%)Belgium (55% to 45%)South Korea (60% to 40%)Portugal (57% to 43%)Canada (52% to 48%)Republic of Ireland (52% to 45%)

Greece, Italy, Peru, China, and Australia all have a higher number of confirmed cases among men than women.Why are men more likely to die?

Part of the explanation for why the new coronavirus seems to cause more severe illness in men is down to biological sex differences.

Womens innate immune response plays a role. Experts agree that there are sex differences, such as sex chromosomes and sex hormones, that influence how a persons immunity responds to a pathogen.

As a result, women are in general able to mount a more vigorous immune response to infections [and] vaccinations. With previous coronaviruses, specifically, some studies in mice have suggested that the hormone estrogen may have a protective role.

For instance, in the study above, the authors note that in male mice there was an exuberant but ineffective cytokine response. Cytokines are responsible for tissue damage within the lungs and leakage from pulmonary blood vessels.

Estrogens suppress the escalation phase of the immune response that leads to increased cytokine release. The authors showed that female mice treated with an estrogen receptor antagonist died at close to the same rate as the male mice.

As some researchers have noted, lifestyle factors, such as smoking and alcohol consumption, which tend to occur more among men, may also explain the overall higher mortality rates among men.

Science has long linked such behaviors with conditions that we now know are likely to negatively influence the outcome of patients with COVID-19 cardiovascular disease, hypertension, and chronic lung conditions. Why women might be more at risk

On the other hand, the fact that societies have traditionally placed women in the role of caregivers a role which they continue to fulfill predominantly and the fact that the vast majority of healthcare workers are women cold place them at a higher risk of contracting the virus and might explain the higher infection rates in some countries.

An analysis of 104 countries by the World Health Organization (WHO) found that Women represent around 70% of the health workforce. In China, women make up more than 90% of healthcare workers in Hubei province.

These data emphasize the gendered nature of the health workforce and the risk that predominantly female health workers incur, write the authors of a report on the gendered impacts of the pandemic that appears in The Lancet.

Although we cannot yet draw definitive conclusions because sex-disaggregated data is not yet available from all the countries affected, The Lancet report looks at previous epidemics for clues.

During the 201416 west African outbreak of Ebola virus disease, the authors write, gendered norms meant that women were more likely to be infected by the virus, given their predominant roles as caregivers within families and as frontline healthcare workers.

The authors also call out for governments and health institutions to offer and analyze data on sex and gender differences in the pandemic.
Why sex-disaggregated data are urgent

The report in The Lancet reads, Recognising the extent to which disease outbreaks affect women and men differently is a fundamental step to understanding the primary and secondary effects of a health emergency on different individuals and communities, and for creating effective, equitable policies and interventions.

For instance, identifying the key difference that makes women more resilient to the infection could help create drugs that also strengthen mens immune response to the virus.

Devising policies and intervention strategies that consider the needs of women who work as frontline healthcare workers could help prevent the higher infection rates that we see among women.

Finally, men and women tend to react differently to potential vaccines and treatments, so having access to sex-disaggregated data is crucial for conducting safe clinical trials.

As Anna Purdie who also works for Global Health 5050 and her colleagues summarize in their article, Sex-disaggregated data are essential for understanding the distributions of risk, infection, and disease in the population, and the extent to which sex and gender affect clinical outcomes.
Understanding sex and gender in relation to global health should not be seen as an optional add-on but as a core component of ensuring effective and equitable national and global health systems that work for everyone. National governments and global health organizations must urgently face up to this reality.

Anna Purdie et al

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How Britain’s most notorious gangster turned up at a charity lunch to fact-check a retired detective’s talk

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How Britain's most notorious gangster turned up at a charity lunch to fact-check a retired detective's talk

Britain’s most notorious gangster and the detective who pursued him have been involved in a bizarre confrontation…at a charity lunch.

Former Detective Superintendent Ian Brown was at a Kent golf club and about to give a talk on the infamous £26m Brink’s-Mat gold robbery when he was summoned from the stage by officials.

Mr Brown, who appeared on the award-winning Sky News StoryCast podcast The Hunt For The Brink’s-Mat Gold in 2019, said: “I go outside and they say ‘he’s here’ and I say ‘who’s here’ and they say that table over there in the corner, that’s Kenny Noye with a baseball cap pulled down over his head.”

Noye stabbed to death an undercover policeman during the Brink’s-Mat investigation, but was acquitted of murder, though he was jailed for handling the stolen gold.

After his release, he used a knife again in the M25 road-rage murder of motorist Stephen Cameron.

“They said what are we going to do?” said Mr Brown.

“I said are you serving food? Well, just use plastic knives.”

Former Detective Superintendent Ian Brown
Image:
Former Detective Superintendent Ian Brown. Pic: Robert Mulhern

Although Mr Brown had not personally arrested Noye over Brink’s-Mat he had identified him as a suspect months after the robbery.

Years later he met him during an ill-fated TV interview in which he quizzed him about his role in the robbery.

He said: “He told me everything I wanted to know except the truth. He still insists he had nothing to do with it.”

The interview was never broadcast after the prison authorities threatened to send Noye back to jail for a breach of his parole.

Read more:
What happened to the Brink’s-Mat gold?

Kenneth Noye and Stephen Cameron
Image:
Kenneth Noye, left, and Stephen Cameron

Mr Brown, 86, said: “I went over to him and said ‘thanks for coming, nice of you to pop in’, but I don’t believe you’ve turned up with your sons and grandkids to listen to me telling how you killed a police officer.

“And he said ‘I want to make sure you don’t say I’ve been dealing drugs’ and I said ‘I’ve never said that Kenny’.”

The retired detective told Noye he wasn’t going to change his presentation just because he was there.

“He said ‘mate, I wouldn’t expect you to and I’ll come up [on stage] if you want me to’.

“Can you think how he’s turned up with his family to listen to somebody talking about you killing the police? Now, you put logic on that.”

The bizarre story emerged when I rang Mr Brown after I’d been told about the meeting.

A series of podcast documentaries from Sky News, telling compelling and unheard real life stories from around the UK.
Image:
A Sky News podcast told the story of the Brink’s-Mat heist in 2019

I also wanted to ask him about the recent BBC hit drama series The Gold which retold the story of the Brink’s-Mat heist at Heathrow Airport in 1983.

“It was an absolute shambles, far too much dramatic licence and the real story was so much better,” said the ex-detective, whose job had been to follow the trail of the 6,800 gold bars to the US and the Caribbean.

He said he chatted to one of the show’s writers for a long time in a phone call but then heard no more.

“They invented people, changed a bit here and there and made it politically correct in so many ways. I’m just very sad that that is what people will believe.

“And I couldn’t work out who my character was supposed to be. I could have been one of the female cops.”

He also criticised the portrayal of Noye, now 78, as a likeable jack-the-lad character when the truth about the double killer with a volatile temper was quite different.

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L.A. routed 18-1 in worst loss at Dodger Stadium

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L.A. routed 18-1 in worst loss at Dodger Stadium

LOS ANGELES — The Los Angeles Dodgers suffered their worst loss ever in Dodger Stadium, an 18-1 blowout at the hands of the Houston Astros on Friday night in the series opener of a matchup between division leaders.

The 17-run loss marked the Dodgers’ largest margin of defeat at home since the team moved to Dodger Stadium in 1962, and the franchise’s worst home loss since July 3, 1947, when Brooklyn lost 19-2 to the New York Giants.

Jose Altuve homered twice while reaching base five times and driving in five runs for the Astros, who held the defending World Series champion Dodgers to six hits including Will Smith‘s solo homer.

“That was one you want to flush as soon as possible,” Dodgers manager Dave Roberts said. “I don’t think there were many positives from this night.”

Dodgers fans relentlessly booed Altuve throughout his at-bats, chanting, “Cheater! Cheater!” He’s one of two players, along with Lance McCullers Jr., remaining from Houston’s 2017 team that beat the Dodgers in the World Series. It later came out that the Astros were stealing signs with the help of video and relaying pitches to batters by banging on a trash can.

The AL West-leading Astros scored 10 runs in the sixth, highlighted by Victor Caratini‘s grand slam and Altuve’s three-run shot. It was the most runs given up in an inning by the Dodgers since April 23, 1999, when they allowed 11 to St. Louis.

McCullers (2-3) allowed one run and four hits in six innings of his second start since returning from a sprained right foot. He struck out four.

Isaac Paredes hit his first career leadoff homer on the first pitch of the game from rookie Ben Casparius. Altuve doubled and scored on Christian Walker‘s RBI single for a 2-0 lead.

Jake Meyers doubled leading off the third and scored on Altuve’s 14th homer. Rookie Cam Smith doubled and scored on Walker’s 417-foot shot halfway up the left-field pavilion to cap four straight hits given up by Casparius and extend Houston’s lead to 6-1.

“I don’t think Ben was good tonight,” Roberts said. “It seemed like they were on everything he threw up there.”

The Astros broke it open in the sixth. Smith had a bases-loaded RBI single, reliever Noah Davis hit Walker with two strikes on him to force in a run and Caratini hit his slam with no outs. Meyers added an RBI single, and Altuve hit his second homer of the night.

Casparius allowed six runs and nine hits in three innings and struck out three.

The Associated Press contributed to this report.

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Raleigh ties M’s record with 35 HRs before break

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Raleigh ties M's record with 35 HRs before break

SEATTLE — Cal Raleigh hit his 34th and 35th home runs to set a career high and match Ken Griffey Jr.’s Seattle record for homers before the All-Star break, helping the Mariners beat the Pittsburgh Pirates 6-0 on Friday.

Raleigh, the major league leader in home runs, turned on a fastball from Bailey Falter (6-4) in the first inning and walloped it well past the wall in left. The exit velocity on the two-run shot was logged at 115.2 mph, per Statcast, making it the hardest-hit ball of his career.

Raleigh topped his previous career high for homers, set last season, in the sixth with a solo shot that chased Falter. The Mariners mustered only one other hit off the left-hander, but it was also a home run courtesy of Randy Arozarena in the fourth inning.

Raleigh’s 35 homers are tied for the fifth most in MLB history before the All-Star break (since 1933), matching Griffey in 1998 and Luis Gonzalez in 2001. Barry Bonds holds the record with 39 at the break in 2001.

Raleigh said he was honored to tie Griffey, whom he called the face of the Mariners.

“To be mentioned with that name, somebody that’s just iconic, a legend, first-ballot Hall of Famer, I’m just blessed,” Raleigh said. “Trying to do the right thing and trying to keep it rolling. If I can try to be like that guy, it’s a good guy to look up to.”

Raleigh is on pace to hit 65 home runs this season, which would break New York Yankees star Aaron Judge‘s American League record of 62, set in 2022.

Manager Dan Wilson, who was a teammate of Griffey Jr.’s in 1998, tried to put Raleigh’s fast start to 2025 in perspective.

“It’s remarkable. It feels like he hits a home run every game, that’s what it feels like,” Wilson said. “And I can remember feeling it as a player, that [Griffey] just felt like he hit a home run every day. Again, that’s the consistency that [Raleigh] has shown. It hasn’t been a streak where he has hit a bunch of home runs in a short amount of time. It’s been kind of 10 per month.”

A switch-hitter, Raleigh has more home runs as a left-handed hitter and as a right-handed hitter than anyone else on the Mariners: He has 21 from the left side and 14 from the right. Arozarena ranks second on Seattle with 13 homers this season.

The Mariners play eight more games before the All-Star break.

The Associated Press and ESPN Research contributed to this report.

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