Men, women … what is the most “at risk” population facing coronavirus? We know that the Covid-19 unfortunately spares no one, but by analyzing the data published every day by Santé publique France via its Géodes site, we can see that men are more vulnerable than women, at all levels.
In France, approximately 59% of Covid-19 patients are men compared to 41% women. Above all, 74% of patients admitted to intensive care are men.
At the regional level, we find these strong differences. Of all the statistics available (as of April 12):
- There are more men hospitalized: 1,278 versus 11,179 women.
- There are more men in intensive care: 393 against 152 women.
- There are more male deaths: 490/344
And if we look at the daily evolution of the number of hospitalizations, resuscitation patients or deaths, all three show that this gap has existed since the start of the confinement period. With the height of the epidemic, big differences: there were 424 men in intensive care on April 7 against 156 women.
Why ?
Men more affected by the coronavirus than women: this is a fact observed in Hauts-de-France, in France but also in the world. In China, the first country affected, the proportion of men and women is estimated at 58/42. 59/41 in Italy. The WHO says that 57% of coronavirus infections in Europe affect men.
Scientists were obviously quick to try to analyze this difference. Their explanation is not unique but multifactorial and mixes biological factors and others linked to lifestyle. Here is a summary, in no order of importance:
– Men have different habits regarding hand washing
-The male immune response is weaker
“Women have a stronger immune system“says Dr. Klein of the Johns Hopkins Bloomberg School of Public Health.”There is clearly a protective effect of estrogens, explains in Sciences et Avenir Jean-Charles Guéry, head of the Inserm research team “Gender-related differences in immunity: mechanisms and pathophysiology” in Toulouse. When mice are infected with SARS, the mortality of males is much higher than that of females. When the ovaries of the females are removed (and therefore the source of estrogen), or when they are treated with drugs that block the estrogen receptor (like those used in the treatment of breast cancer), mortality reaches that more than 80% of males. It is currently unknown whether this is a direct effect on the immune system or other tissues. “ Estrogens and a gene carried by the X chromosome would therefore have a positive influence to protect against infections.
– Men smoke more.
In China, more than half of men smoke, compared to less than 3% of women. In Italy, almost 30% of men smoke, compared to 19% of women. In Hauts-de-France, 34% of men smoke, 16% of women. According to an American study, smokers have more ACE2 in the lungs, a receptor that allows Covid-19 to infect the body.
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On a simple level, smoking involves repetitive hand-to-face movements, which could put smokers at higher risk of contracting the virus.This association is conjectural but plausible.https: //t.co/oJTocc4mpt
– Avraham Z. Cooper, MD (@AvrahamCooperMD) March 21, 2020
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-Men develop cardiovascular disease and hypertension at a younger age than women. These are additional risk factors.
Men most affected by all viruses
Men have also been more affected by other coronaviruses or viruses in the past 20 years. During the 2003 SARS epidemic in Asia (Hong Kong), the death rate among men was 50% higher, according to a study published in the Annals of Internal Medicine. In 1918, the Spanish flu also killed more men. And even in the case of seasonal flu, we know that women develop the same immunity as men by having a lesser dose of vaccine injected.
This statistical reality has been the subject of few scientific studies until now. “Sex is a neglected variable in infectious diseases “, wrote in 2017 Molly Ingersoll, from the Institut Pasteur Paris.
For the Covid-19 coronavirus, studies are lacking to really specify the scientific hypotheses valid to explain these male / female differences. Analysis of global epidemiological data will no doubt provide more answers in the months and years to come.
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