Male patients are at higher risk of dying from Covid-19 and are also more likely to become seriously ill than female patients. The immune system in particular seems to play a role in this.
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Regular fever measurements are to detect Sars-CoV-2 infected earlier. EPA / CARLOS BARROSO
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At the beginning it could still be considered a data distortion. But the picture seems to be slowly consolidating: Men are more likely to develop Covid-19 and die more often. This is indicated by the medical data of all countries that represent the gender ratio. In Switzerland, according to the Federal Office of Public Health, 295 people died of Covid-19 by March 30, 60 percent were men. Men are also more strongly represented in the number of hospitalized people, at 59 percent.
Men are more seriously ill than women
Reported cases of Covid-19 in Switzerland and Liechtenstein by age group, status 30.3.
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And that is not because men are more likely to become infected with the virus – for example because they are less strict about the recommended hygiene measures, as has already been said. Because in most countries that have sufficient data, the gender ratio in terms of infections is fairly balanced. In Switzerland, for example, 52 percent are women and 48 percent men. An exception to this is Italy, where 60 percent of the confirmed Covid 19 cases are male.
An initial explanation was that men’s more serious illnesses are related to smoking. Because smoking is considered a risk factor for severe courses and is much more common among men in China. However, figures from Europe make this thesis seem unlikely: Although both sexes smoke about the same amount across Europe, men there also suffer more frequently from Covid-19.
But is it special that Covid-19 kills more men than women? Experts say: No – the opposite would be surprising. “Women generally get along better with viral infections than men,” says the immunologist Marcus Altfeld from the Heinrich Pette Institute of the Leibniz Institute for Experimental Virology in Hamburg, who examines gender-specific differences in viral diseases. Men and women also reacted differently to HIV or hepatitis, he explains, and it was the same with Sars.
The reason for this is that the innate immune system of women is more sensitive to viral infections than that of men and is therefore faster and more responsive to an infection. The early response and control of viruses lowers the risk of the disease escalating because the viruses can be better controlled. In relation to Covid-19, this means that the infection in women is contained more quickly, so that the damage to the lungs remains less and there is less often a severe course with massive damage to the lung tissue.
This phenomenon can be explained evolutionarily, says Altfeld. The immune system of women has the task of protecting unborn and newborn life. If possible, it must prevent a virus from gaining a foothold and causing serious damage to the fetus. In addition, the newborn should be supplied with the widest possible range of maternal antibodies through breast milk. The same phenomenon as with viral infections can also be found in many diseases caused by parasites. (A notable exception are flu viruses, which, according to the researcher, are particularly dangerous for pregnant women.)
But men do not only have disadvantages: they suffer from autoimmune diseases much less often, which the scientists attribute to the anti-inflammatory effects of testosterone. Since many of the autoimmune diseases only break out after the most fertile phase, evolution is less interested in this “side effect” of the female immune system.
But what is the underlying physiological difference? The researchers assume two influencing factors. One is the hormone system, more precisely the sex hormones. In a study with the first Sars virus, female mice died of Sars less than male. If the researchers stopped the production or effects of estrogen, this advantage was lost.
There is also another explanation for this, according to Altfeld: The fact that women have two X chromosomes (female sex chromosomes) while men only have one. There are a number of important genes that regulate the immune system on this chromosome. It has been known for a long time.
However, it was initially assumed that in women only one X chromosome was active in each cell and the other was shut down, thus restoring the “balance” between men and women. In recent years, however, scientists have found that the inactive X chromosome can “escape” this condition from women and is then actively read. This increases the dose of the gene products of this chromosome in the affected cells, which are important for the immune response. This could increase the responsiveness of the female immune system and explain some of the gender differences in the immune response.
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