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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 Some information may be out of date.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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Guardians promote top prospect for Tigers series

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Guardians promote top prospect for Tigers series

Chase DeLauter, an outfielder with no major league experience, was included on the Cleveland Guardians‘ roster for their wild-card series against the Detroit Tigers.

Selected 16th in the 2022 amateur draft, DeLauter hit .278 with five homers and 21 RBIs in 34 games at Triple-A Columbus. He turns 24 on Oct. 8.

DeLauter was sidelined by injuries for much of this year. He was hurt during a pregame workout at spring training on Feb. 28 and had bilateral core muscle surgery on March 4 for a sports hernia.

After eight games at the rookie-level Arizona Complex League Guardians, DeLauter played his first game this year for Triple-A Columbus on May 23, but he stayed in the lineup only until July 12. He had surgery 11 days later to repair a fractured hamate bone in his right wrist.

DeLauter could be the first player to debut in the postseason since 2020, when Tampa Bay pitcher Shane McClanahan, San Diego pitcher Ryan Weathers and Minnesota outfielder Alex Kirilloff all accomplished the feat.

Manager Stephen Vogt said DeLauter has been taking batting practice at the organization’s Arizona complex. DeLauter had been slated to play in the Arizona Fall League.

“As we were talking through it and looking through the series with three games, we felt 11 pitchers was the right move,” Vogt said. “When we looked at at-bats, Chase was healthy, and he’s the best bat we have available to us. We thought it would be a good idea to get him on the roster.”

DeLauter is among seven left-handed bats on the Guardians’ bench and could come in to play center or right field.

Detroit manager A.J. Hinch said DeLauter’s promotion was not a surprise.

“You can’t get into the building and not be seen by somebody. So we had some time to talk. And we have some pitchers and position players who spent some time in Toledo this year as well,” Hinch said. “Our teams, not only are we sort of intimately close at the big league level, but in Triple-A, in Double-A, in Single-A. We play these guys coming up throughout. And so you’ll hear our hitters talk about facing these guys in Akron or facing these guys in Erie, along with Toledo and Columbus.”

The Tigers left off right-handers Chris Paddack and Tanner Rainey but included right-hander Paul Sewald for the best-of-three series that started Tuesday.

Yankees rookie catcher J.C. Escarra and pitchers Paul Blackburn and Will Warren made roster against the Boston Red Sox, while pitchers Luis Gil and Ryan Yarbrough were left off along with outfielder Austin Slater.

New York is carrying 12 pitchers and 14 position players. Escarra is the third catcher after Austin Wells and Ben Rice, giving manager Aaron Boone pinch-hitting and pinch-running options.

Warren is viewed as a better relief option than Gil, who averaged 5.2 walks per nine innings.

Boston included a pair of speedy potential pinch runners, infielders Nate Eaton and David Hamilton, and rookies left-handers Connelly Early and Payton Tolle. Red Sox manager Alex Cora said Monday that right-hander Lucas Giolito will miss the series because of an ailing elbow.

Catcher Elias Díaz, who has a sore left oblique, was left off San Diego’s roster for its series at the Chicago Cubs, and the Padres included three catchers: Luis Campusano, Freddy Fermin and Martín Maldonado.

Rookie infielder Mason McCoy was on the roster, and left-hander Yuki Matsui was left off.

Chicago included rookie outfielder Kevin Alcántara and catcher Moisés Ballesteros but left off right-hander Javier Assad and catcher Miguel Amaya.

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Bochy, winningest active manager, out in Texas

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Bochy, winningest active manager, out in Texas

ARLINGTON, Texas — Bruce Bochy will not return as manager of the Texas Rangers after a three-year stint that began with the franchise’s first World Series championship in 2023 before missing the playoffs and not having a winning record in both seasons since then.

The Rangers said Monday night that the team and Bochy mutually agreed to end his managerial tenure in Texas. Bochy was offered a front office role to stay in an advisory capacity, the team said.

The move came a day after the Rangers finished 81-81. That was the first .500 record for the franchise that began as the Washington Senators in 1961 before moving to Texas in 1972, and a first for Bochy in 28 seasons managing San Diego, San Francisco and Texas.

Bochy was at the end of the three-year contract he got when Chris Young, one of his former pitchers, hired him after the Rangers’ sixth consecutive losing season. Bochy went 249-237 with the Rangers.

“Bruce Bochy is one of the greatest managers in baseball history, and he will forever hold a place in the hearts of Ranger fans after bringing home the first World Series title in franchise history in 2023,” said Young, then their general manager and now the Rangers’ president of baseball operations. “Boch brought class and respect to our club in his return to the dugout, and we will always take pride in being part of his Hall of Fame career.”

After turning 70 this season as baseball’s winningest active manager, Bochy has a career record of 2,252-2,266, with those wins ranking sixth among all managers — the five ahead of him are all in the Hall of Fame. No managers in the past 60 years have more than Bochy’s four World Series titles, and the only ones with more are Joe McCarthy, Casey Stengel and Connie Mack.

Bochy had been out of managing for three seasons when he was hired by Texas. He had stepped out of the Giants dugout at the end of 2019 after 13 seasons and three championships from 2010 to 2014. That followed 12 seasons and another National League pennant with the Padres.

San Francisco, also 81-81 this season, fired second-year manager Bob Melvin on Monday after the Giants missed the playoffs for the fourth year in a row. Minnesota fired Rocco Baldelli, ending his seven-year tenure that included three American League Central titles, but only one playoff appearance, over his final five seasons.

The Giants’ president of baseball operations is Buster Posey, the 2012 National League MVP and seven-time All-Star catcher who played all but the last of his 12 MLB seasons with Bochy as his manager.

Over the last week of the regular season, Bochy wouldn’t answer questions about his future with the Rangers, saying that the decision would wait until after the season. But he said he was having a great time and didn’t sound like he was ready to be done as a manager.

“It’s as much fun as I’ve had in the game,” Bochy said last week about managing again. “I said this when I came back, you have a deeper appreciation when you’re out, especially for three years and you realize what you have, how blessed you are to be doing what you’re doing. It’s been a lot of fun, and I still love it, and enjoy it.”

And that was during a strange and frustrating season on the field for the Rangers, who, for the first time, had a pitching staff that led the majors in ERA (3.47). They also set a single-season MLB record with their .99112 fielding percentage, bettering the 2013 Baltimore Orioles‘ mark of .99104.

Among the potential replacements for Bochy in Texas is former Miami Marlins manager Skip Schumaker, who joined the Rangers last November as a senior adviser for baseball operations.

The 45-year-old Schumaker was the 2023 NL Manager of the Year after the Marlins went 84-78 and made the playoffs. They slipped to 62-100 in 2024 with a roster decimated by trades and injuries before the team and Schumaker agreed that he would not return for this season. He was previously a bench coach for St. Louis, where he had played for the Cardinals during their 2011 World Series championship over Texas.

Young said Schumaker would be a candidate, but that there had not yet been conversations within the organization about the search process.

The Rangers went more than a month at the end of the season without their half-billion-dollar middle infield of two-time World Series MVP shortstop Corey Seager (appendectomy) and second baseman Marcus Semien (left foot), as well as 35-year-old right-hander Nathan Eovaldi, who was 11-3 with a career-best 1.73 ERA over his 14 MLB seasons before getting shut down because of a rotator cuff strain.

Even without those standouts and several rookies filling in, the Rangers went on a 13-3 run to get within two games of the AL West lead on Sept. 13, and in the thick of the wild-card chase. They then lost their next eight games and were eliminated from playoff contention.

The only manager older than Bochy this season was 73-year-old Ron Washington, but he didn’t manage a game for the Los Angeles Angels after June 19 because of quadruple bypass heart surgery.

The Associated Press contributed to this report.

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Twins fire Baldelli after roster purge, 70-92 mark

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Twins fire Baldelli after roster purge, 70-92 mark

MINNEAPOLIS — The Minnesota Twins fired manager Rocco Baldelli on Monday, ending his seven-year tenure that included three American League Central titles after a second straight disappointing season.

“This is a difficult day because of what Rocco represents to so many people here,” Twins president Derek Falvey said in a statement. “He led with honesty, integrity, and an unwavering commitment to our players and staff. He gave himself fully to this role and I have tremendous respect and gratitude for the way he carried himself and the way he showed up every single day.”

The Twins, who were expected to contend for the AL Central title this season, faltered in June and became active at the trade deadline, sending away 10 players while cutting $26 million from the payroll. The team went 23-43 after the All-Star break to finish fourth in the division with a 70-92 mark.

Minnesota went 19-35 after the trade deadline passed, with only the Colorado Rockies faring worse over the final two months.

The Twins finished with the fourth-worst record in the major leagues and their worst mark since 2016, when they went 59-103 after firing longtime general manager Terry Ryan at midseason. Falvey was hired to replace Ryan after that.

The 44-year-old Baldelli, who won the 2019 AL Manager of the Year award as a rookie, has led the Twins to three division titles. In 2023, Minnesota ended a record 18-game postseason losing streak and won its first playoff series since 2002.

Baldelli had an overall record of 527-505 in seven seasons, and he’s the third-winningest manager in Twins history behind Tom Kelly and Ron Gardenhire.

Attendance has swooned at Target Field, with the Twins finishing with an 81-home game total of a little more than 1.7 million tickets sold, their lowest number in a non-pandemic season since 2000 when they played at the Metrodome and finished 69-93.

Fans have mostly directed their disdain toward ownership, with deep frustration over cost-cutting that came after the 2023 breakthrough. The Pohlad family put the franchise up for sale last year, but decided last month to keep control and bring on two new investment groups for an infusion of cash to help pay down debt.

The dizzying trade-deadline activity left Baldelli and his staff without much to work with down the stretch, though All-Star center fielder Byron Buxton was a bright spot in a breakthrough season for his health, and rookie second baseman Luke Keaschall provided consistent production and a professional approach at the plate belying his inexperience.

The departures of shortstop Carlos Correa, outfielder Harrison Bader, first baseman Ty France and multi-position player Willi Castro robbed the lineup of experience and steadiness, but that was nothing like what happened to Baldelli’s bullpen.

The Twins traded their five best relievers, from closer Jhoan Duran on down, and left the final 54 games to a ragtag group that had eight blown saves in 18 opportunities during that span.

Baldelli was hired before the 2019 season to replace Hall of Famer Paul Molitor, with Falvey citing his adaptivity to the data-based direction of baseball strategy and his communication skill in distilling it to coaches and players and clearly setting expectations and preferences.

“Over the past seven years, Rocco has been much more than our manager. He has been a trusted partner and teammate to me in leading this organization,” Falvey said in a statement. “Together we shared a deep care for the Twins, for our players and staff, and for doing everything in our power to put this club in the best position to succeed.

“Along the way we experienced some meaningful accomplishments, and I will always be proud of those, even as I wish we had ultimately achieved more.”

The Associated Press contributed to this report.

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