CORONAVIRUS – Being a man is a risk factor if you are affected by coronavirus. Since the beginning of the Covid-19 epidemic now striking the whole world, this observation holds true in almost all the affected countries: the mortality rate for male patients is much higher than that for women.
In France, out of the 3,523 deaths recorded at the hospital, around 60% are men, generally elderly but not only. On average, there are three times more men than women treated for severe forms of Covid-19. In early March, a very large study of China Center for Disease Control and Prevention noted that the death rate was around 2.8% for men against 1.7% for women. Of more than 1,000 people who died, 63.8% were men compared to 36.2% of women.
In Spain, this proportion is even higher with 65% of male patients dying from coronavirus. In Italy, statistical discrimination at the expense of men could reach 71%.
Figures to be taken with caution but which call out all the more since the virus affects, a priori, both men and women. In Spain, the Carlos III Health Institute (ISCIII) notes that the people currently infected are men in 50.4% of the cases and women in 49.6%. Suffice to say that the proportion is almost equivalent.
More men than women in risk groups
How can we explain then that the mortality rate is skyrocketing among men? For the moment, there is no definitive scientific explanation for this question, just as it is not yet established why the epidemic seems save the youngest. But data are already available to identify possible causes.
In Spain, “men have a higher prevalence of symptoms (fever and cough), pneumonia, underlying diseases (cardiovascular, respiratory, diabetes) and a higher percentage of hospitalization, admission to intensive care and lethality than women ”, noted the ISCIII report.
Within the group of health professionals concerned (15.5% of all infections), which is one of the most worrying for the WHO and the Spanish health authorities, the proportion of infections among women (21.7 %) is however much higher than that of men (9.5%). And yet it is the latter who are hospitalized much more frequently because they develop more severe symptoms.
Teresa Pérez Gracia, professor of microbiology at CEU Cardenal Herrera University, underlines that this may be “associated with the fact that there are more men than women in the risk groups, who are those with cardiovascular diseases and respiratory, as well as diabetes ”. In these cases, “the inflammatory response is much more important and therefore the disease more severe,” she says. Indeed, we find that “there are more cases of severe pneumonia with respiratory distress syndrome in men than in women”. If the inflammatory response is much greater in men, the disease is more severe and potentially more lethal.
“Men, people over 64 and people with an underlying disease (especially cardiovascular) are more represented among patients with pneumonia,” corroborates the report of the Carlos III Health Institute. While the disease affects both men and women in men under the age of 25, “cases of Covid-19 are overrepresented in the group of men over the age of 50,” the study said.
Estrogens, a key hormone?
Comorbidities – underlying diseases – are therefore a possible explanation, but to which it may be necessary to add possible genetic predispositions. José Prieto, professor of microbiology at the Complutense University of Madrid, believes that “chronic diseases such as bronchitis and hypertension, which generally occur more in men”, play an important role against the virus. But it indicates that the coronavirus can also react to prior biological factors.
Estrogens, the hormone secreted by the ovaries and therefore more present in women, could explain why the virus affects women less. In an interview with the BBC, Sabra Klein, of the Department of Molecular Microbiology and Immunology at John Hopkins University School of Public Health, believes that “estrogens can stimulate important immune reflexes to clear a viral infection and respond well to vaccines ”.
“Various studies in mice infected with the previous SARS epidemic have shown that estrogen plays a role in how female mice control infection better than their male counterparts,” notes Sabra Klein.
At the end of February, when this BBC article was published, the country most affected by the coronavirus was China, where it was observed that more than 54% of hospitalized cases were men. Currently Italy and Spain have surpassed the Asian country in terms of death rates, which a month ago seemed unthinkable.
Manuel Menduiña, a specialist in internal medicine at the Virgen de las Nieves Hospital in Granada, even goes so far as to speak of a possible predisposition “not only among men, but also among Latin men”. “There is a theory that Latinos – Spanish and Italian – have a predisposition to generate an inflammatory hyperimmune response so exaggerated that it ultimately does harm,” he said.
Lifestyles and calculation methods
This theory is far from unanimous, however, as certain specialists refuse to make a distinction between the immune systems of men and women.
“If in terms of pure resistance, men and women are strictly identical, there may be differences in lifestyles,” said Eric Leroy, director of research and member of the Academy of Medicine, in early March. cited by LCI. “Cigarette, alcohol, customs, habits … Many secondary factors specific to men or women can explain this difference in sensitivity,” he said.
In China, almost 50% of men smoke compared to only 2% of women, which may explain why men suffered more from worsening lungs. Sabra Klein also points out that men, including in the medical community, tend to wash their hands or use soap less than women.
However, the gap between the mortality rate for men and women could also be accentuated by statistical bias. In France, deaths in nursing homes, where the population is overwhelmingly female, have not yet been included in the daily count of victims operated by the Ministry of Health.
In any case, the coronavirus epidemic “is a moving ground and we are learning from day to day”, admits the doctor Manuel Menduiña who, at the same time, focuses on “comorbidities” as the first possible cause of this mismatch between the mortality rate of men and women affected by the disease.
“In the middle age group, there are more men who smoke than women and therefore they are also more likely to suffer from asthma or chronic obstructive pulmonary disease (COPD), risk factors for this disease ”, He underlines. “In a few years we will be able to draw many conclusions, but for the moment it seems that to develop the disease seriously, there is a certain predisposition,” says Manuel Menduiña.
This subject is a partially translated adaptation of an article previously published on El HuffPost Spain.
See also on The HuffPost: 3,523 dead in France at the hospital, update on Tuesday, March 31