Have you ever sat in the passenger seat of a car and pressed down on an imaginary brake because you were _ increasingly uncomfortable by the driver’s speed and their brazen flirtation with disaster? In the past week, life as we know it has been unprecedentedly disrupted by COVID-19. Right now, we are all riding shotgun and COVID-19 is behind the wheel. The question is, are we all wearing our seatbelts?
So why are a frontline emergency medicine physician and a business CEO teaming together to write about COVID-19? Because we are both experts in how biological sex and gender influence our bodies and behaviour and we realise that the actions people take or don’t take in the next few weeks will heavily impact the overall mortality rates of this virus. So, we think it’s time we have a frank talk about sex, gender and COVID-19.
From the data we have so far, physiologically, males appear to be at greater risk of having symptoms, and of dying from COVID-19. In Italy, currently 58per cent of confirmed cases are male, and in Chinasources have shown the death rate to be between2.8 to 4.7 per cent in men versus 1.7 to 2.8 per cent in women. Of note, previous coronavirus outbreaks including the severe acute respiratory syndrome (SARS) and the Middle East respiratory syndrome (MERS) also killed more men. Some of this gap is due to differences in gender-based cultural habits, for example, in China, far more men than women smoke. However, there also appears to be a biological sex-based difference in immunology. Detailed basic science research on SARS showed that after being inoculated with similar amounts of virus, male mice experienced higher viral titers and greater inflammatory changes in their lungs. Importantly, their findings correlated with age. In those at the extreme of age there were no significant differences, but for those in between it was quite pronounced, with a group of middleaged mice infected with a moderate amount of virus showing a 90 per cent mortality in the males but only a 20 per cent mortality in females.
Sex-based differences in COVID-19 death rates are likely due to both sex chromosomes and hormones. Men and women may share over 98 per cent of the same DNA, but we now know which genes get turned on and off after an environmental trigger like an infection can be quite sex-specific. Although we once thought our X- and Y-chromosomes were mostly involved with hormonal reproductive housecleaning tasks, recent research suggests that these chromosomes also contain genes that regulate our immune response and actually influence which genes on other chromosomes get read. Interestingly, there is now evidence that COVID-19 infects lung tissue via attaching to the angiotensin-converting enzyme 2 (ACE2) receptor, and the gene for ACE2 is on the X chromosome.
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