Why COVID-19 Is Hitting Men Harder Than Women
Note: This story was originally published on Healthline on April 26, 2020. All data and statistics are based on publicly available data at the time of publication.
By Bob Curley
More men are dying from COVID-19 worldwide than women, and the potential reasons run the gamut from biology to bad habits.
The World Health Organization (WHO) reports that 68 percent of deaths related to COVID-19 in Europe have been among men.
A study by the Higher Health Institute of Rome found that among Italians hospitalized for the novel coronavirus, 8 percent of men died compared to 5 percent of women.
In New York City, men have been dying of coronavirus at almost twice the rate of women. The city's health department reports 43 COVID-19 deaths for every 100,000 men, compared with 23 deaths for every 100,000 women.
The Centers for Disease Control and Prevention (CDC) currently isn't reporting COVID-19 deaths by gender, but experts see no reason the trend would differ elsewhere in the country.
"Some of the underlying reasons why COVID-19 may be more deadly for men than women may include the fact that heart disease is more common in elderly men than in elderly women," Dr. Stephen Berger, an infectious disease expert and co-founder of the Global Infectious Diseases and Epidemiology Network (GIDEON), told Healthline. "Studies also find that high blood pressure and liver disease are more prevalent in men and these all contribute to more negative outcomes with COVID-19."
"Genetics may also play a big role," Berger said. "Women, because of their extra X chromosome, have a stronger immune system and response to infections than men."
"You can't get away from biology and genetics," agreed Salvatore J. Giorgianni, PharmD, a pharmacist and senior science advisor for the Men's Health Network, which advocates for the health of men and boys.
The phenomenon has actually prompted the launch of two clinical trials in the United States.
In these trials, scientists are giving men with COVID-19 sex hormones such as estrogen to see if that will help them recover from the illness.
Men Are Actually the ‘Weaker Sex’
Males are culturally conditioned to think of themselves as strong, Giorgianni told Healthline, but "women are not the 'weaker sex' when it comes to immunity."
Moreover, he noted, men have higher rates in 9 out of 10 of the leading causes of death in the United States.
That means they're more likely to have preexisting conditions that can make COVID-19 more dangerous.
Behaviors that impact lung health, such as smoking, also may play a role in the disease's deadly impact on men.
"In China, for example, smoking is largely a male habit, resulting in many men suffering from chronic lung disease," Berger said. "This puts men at a much greater disadvantage should they get COVID-19."
The WHO estimates that air pollution kills more than 4 million people annually by contributing to illnesses such as asthma, bronchitis, emphysema, lung and heart diseases, and respiratory allergies.
A recent study from the Harvard T.H. Chan School of Public Health in Massachusetts reported that people who live in areas with high levels of air pollution are also more likely to die of COVID-19 than those in less polluted areas.
Pollution could also be playing a role in elevated COVID-19 mortality rates among men.
"In most cultures, men are more likely to be engaged in outdoor work, exposing them to conditions associated with extreme climate and pollution," Berger said. "This could directly impact their response to an infection like COVID-19."
High-risk occupations deemed "essential" under pandemic emergency orders — notably first responders — also may be "disproportionately jobs men traditionally do," Derek M. Griffith, PhD, director of the Institute for Research on Men's Health at Vanderbilt University in Tennessee, told Healthline.
Higher rates of death among men in pandemics is not new.
Research on the worldwide flu of 1918, for example, found that non-elderly adult males died at a much higher rate than women, possibly because more men had a history of lung-damaging tuberculosis.
Risk Taking May Play a Role
Male behavior during the pandemic also could be increasing their exposure to the novel coronavirus.
A Gallup poll taken between March 2 and 13 found that women were more concerned about COVID-19 than men were (by a 62 to 58 percent margin).
"It's possible that men are more at risk because they tend to expose themselves more to larger crowds and social exchanges, including things like handshaking and sporting events," Berger said.
"There are men with invincibility syndrome that underpins a lot of behaviors, and they tend to be less compliant" with pandemic-related restrictions such as physical distancing, Giorgianni said.
For other men, he said, the issue isn't so much a cavalier attitude as simply being conditioned "to think of health as 'not their job.'"
COVID-19 prevention messages aimed at men should focus on these traditional male roles, "not ignore millions of year of biology and natural selection," Giorgianni said.
"Guys are very concerned for their families, so tell them don't do it for yourself, do it for those who love you," he said. "Even if they feel like they're in good shape and can fight it off, they can still be a carrier and can cause the death of their spouse or daughter or their dad."
Griffith cautioned, however, that much remains unknown about COVID-19, including its different impact on men and women.
"It's worth considering these factors, but it's a little premature," he said. "Most of these statements seem to assume we know more about this disease than we do."
Taking Symptoms Seriously
One thing that is well-proven, however, is that men tend to delay seeking healthcare and ignore or dismiss symptoms of illness.
"Many men see self-care as an admission of weakness," David Ezell, chief executive officer of Darien Wellness, a mental health group in Connecticut, told Healthline. "We are taught to be self-sufficient and there for everyone but ourselves. That results in ignoring telltale symptoms of not only COVID but any life-threatening condition."
Dr. Deborah Birx, the COVID-19 response coordinator for the Trump administration, noted at an April 9 briefing that 56 percent of people who have been tested for the illness are male compared to 44 percent female.
Of the men who were tested, 23 percent were positive for COVID-19, compared to 16 percent of women.
"It gives you an idea about how men often don't present in the healthcare delivery system until they have greater symptomatology," Birx said. "This is to all of our men out there, no matter what age group: If you have symptoms, you should make sure that you are tested."
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By Simon Montlake
For more than a decade, Susan Jane Brown has been battling to stop a natural gas pipeline and export terminal from being built in the backcountry of Oregon. As an attorney at the nonprofit Western Environmental Law Center, she has repeatedly argued that the project's environmental, social, and health costs are too high.
All that was before this month's deadly wildfires in Oregon shrouded the skies above her home office in Portland. "It puts a fine point on it. These fossil fuel projects are contributing to global climate change," she says.
Moderates Feeling the Heat<p>If elected, Mr. Biden has vowed to stop new drilling for oil and gas on federal land and in federal waters and to rejoin the 2015 Paris climate accord that President Donald Trump gave notice of quitting. He would reinstate Obama-era regulations of greenhouse gas emissions, including methane, the largest component of natural gas.</p><p>The Biden climate platform also states that all federal infrastructure investments and federal permits would need to be assessed for their climate impacts. Analysts say such a test could impede future LNG plants and pipelines, though not those that already have federal approval. </p><p>Climate change activists who pushed for that language say much depends on who would have oversight of federal agencies that regulate the industry. Some are wary of Biden's reliance on advice from Obama-era officials, including former Energy Secretary Ernest Moniz, who is now on the board of Southern Company, a utility, and a former Obama environmental aide, Heather Zichal, who has served on the board of Cheniere Energy, an LNG exporter. </p>
The Push for U.S. Fuel Exports<p>As vice president, Biden was part of an administration that pushed hard for global climate action while also promoting U.S. oil and gas exports to its allies and trading partners. As fracking boomed, Obama ended a 40-year ban on crude oil exports. In Europe, LNG was touted both as an alternative to coal and as strategic competition with Russian pipelines.</p><p>That much, at least, continued with President Trump. Under Energy Secretary Rick Perry, the agency referred to liquified U.S. hydrocarbons as "<a href="https://www.nytimes.com/2019/05/29/us/freedom-gas-energy-department.html" target="_blank">freedom gas</a>."</p><p>Mr. Trump has also championed the interests of coal, oil, and gas while denigrating the findings of government climate scientists. He rejected the Paris accord as unfair to the U.S. and detrimental to its economy, but has offered no alternative path to emissions cuts. </p><p>Still, Trump's foreign policy has not always served the LNG industry: Tariffs on foreign steel drove up pipeline costs, and a trade war with China stayed the hand of Chinese LNG importers wary of reliance on U.S. suppliers. </p><p>Even his regulatory rollbacks could be a double-edged sword. By relaxing curbs last month on methane leaks, the U.S. has ceded ground to European regulators who are drafting emissions standards that LNG producers are watching closely. "That's a precursor of fights that will be fought in all the rest of the developed world," says Mr. Hutchison. </p><p>Indeed, some oil-and-gas exporters had urged the Trump administration not to abandon the tougher rules, since they undercut their claim to offer a cleaner-burning way of producing heat and electricity. "U.S. LNG is not going to be able to compete in a world that's focused on methane emissions and intensity," says Erin Blanton, a senior research scholar at the Center on Global Energy Policy at Columbia University. </p>
Stepping on the Gas<p>In July, the Department of Energy issued an export license to Jordan Cove's developer, Canada's Pembina Pipeline Corp. In a statement, Energy Secretary Dan Brouillette said the project would provide "reliable, affordable, and cleaner-burning natural gas to our allies around the world."</p><p>As a West Coast terminal, Jordan Cove offers a faster route to Asia where its capacity of 7.8 million tons of LNG a year could serve to heat more than 15 million homes. At its peak, its construction would also create 6,000 jobs, the company says, in a stagnant corner of Oregon.</p><p>But the project still lacks multiple local and state permits, and its biggest asset – a Pacific port – has become its biggest handicap, says Ms. Blanton. "They are putting infrastructure in a state where there's no political support for the pipeline or the terminal, unlike in Louisiana or Texas," she says. </p><p>Ms. Brown, the environmental lawyer, says she wants to see Jordan Cove buried, not just mothballed until natural gas prices recover. But she knows that it's only one among many LNG projects and that others will likely get built, even if Biden is elected in November, despite growing evidence of the harm caused by methane emissions. </p>
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