Coronavirus: Why are men twice as likely to die as women?

With more than 70,000 deaths and counting worldwide from Covid-19, one pattern is clear – men are much more likely to die from coronavirus than women.

Charity Global Health 50/50, which campaigns for gender equality in health, has been tracking the breakdown internationally for deaths from the virus. In every country that publishes the data, significantly more men than women have died.

In Italy, which has the highest number of deaths from the disease, men account for 58 per cent of all hospitalised cases and 72 per cent of all deaths. In Spain, men account for 59 per cent of all hospital admissions, 72 per cent of intensive care unit admissions and 65 per cent of all deaths. In China, where the virus first started, 64 per cent of fatalities have been men.

The worldwide trend is replicated in the Republic. Figures from the Health Protection Surveillance Centre (HPSC) show that men account for less than half (46 per cent) of all confirmed cases, but 71 per cent of deaths.

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As of Monday evening, there have been 174 fatalities in the Republic as a result of coronavirus with 124 men and 60 women.

Northern Ireland, which has recorded 36 deaths, does not break the figures down by gender. Neither does the rest of the UK.

Biology vs behaviour

Speaking at the daily press conference hosted by the Department of Health, deputy chief medical officer Dr Ronan Glynn said there were a number of hypotheses as to why this phenomenon was happening and it had also been observed in previous coronavirus outbreaks.

“It is either biology or behaviour or a mixture of both,” he said. “In some countries significantly greater proportions of men smoke. The activity of smoking is often associated with touching your face.”

Royal College of Surgeons in Ireland (RCSI) professor of medicine Sam McConkey believes the reasons may be the same as to why men in general die younger than women.

“It’s just speculation, but I’m happy to speculate that men in general do not look after themselves,” he said. “We drink too much and we smoke too much and we do not go to the doctor. Women are much better at getting proper diagnosis and taking the proper tablets.”

Men have higher rates of smoking than women, which can lead to worse outcomes with coronavirus.

This is particularly true in China where half of all men smoke and only a small percentage of women do.

But this is not the only reason, according to Prof Sabra Klein, from Johns Hopkins Bloomberg School of Public Health in Washington DC, who specialises in gender differences in infectious diseases.

Male lifestyles

She said people aged 75 and older were most at risk from dying with coronavirus. Men in that age bracket are twice as likely as women to die from the disease and account for a disproportionate number of dead.

She suggested too that male lifestyles may be a factor and they in turn contribute to the number of men dying who have underlying conditions such as heart disease and high blood pressure. The overwhelming majority of people who die with Covid-19 have an underlying condition.

She also believes there may be biological factors involved.

“There can be biological differences in the immune system between men and women which impacts our ability to fight infections,” she said.

“Our blood chemistry and our immune cell count do differ between men and women and may be contributing to some of the differences that we are observing in the severity of the disease.”

When asked on France 24 if it meant men were immunologically weaker than women, she responded: "Yes, generally speaking women mount greater immune responses to a variety of viruses and other infectious agents than do men."