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Men and women sometimes react differently to illness and medication. When men have a heart attack, it usually manifests as chest pain that radiates to other regions. If women are affected, they also suffer from shortness of breath, nausea, and pain in the upper abdomen. Doctors have to adapt to these differences. This also applies to the new corona virus.
At the beginning of the pandemic it became clear: older people, people with certain previous illnesses, and men are more likely to develop Covid-19, and they also die more frequently. As of Wednesday, according to the Robert Koch Institute in Germany, about 75,700 crown infections were detected in men, about 3,440 died. Accordingly, the mortality rate among men is 4.6 percent. On the other hand, only 3.3 percent of infected women demonstrably died.
57 percent of crown deaths are caused by men, and are infected as often as women.
Corona virus: Corona viruses are a family of viruses that also include the currently rampant Sars-CoV-2 virus. Since it initially had no name, it was referred to as a “new type of corona virus” in the first few weeks.
Sars-CoV-2: WHO gave the new coronavirus the name “Sars-CoV-2” (“Severe Acute Respiratory Syndrome” -Coronavirus-2). By the term is meant the virus that can cause symptoms but does not have to.
Covid-19: The respiratory disease caused by Sars-CoV-2 was named “Covid-19” (Coronavirus Disease-2019). Consequently, patients with Covid-19 are people who carry the Sars-CoV-2 virus and show symptoms.
A recent study from China reaches a similar conclusion and has systematically analyzed the phenomenon for the first time. Data evaluated from the first Sars pandemic in 2002/2003 also indicates that men generally have a significantly higher risk of dying from Sars viruses. The analysis also provides a cautious hint as to why this might be.
Men are more seriously ill.
Jin-Kui Yang researchers at Tongren Hospital in Beijing evaluated data from 43 patients who were treated at a Wuhan hospital in late January and early February. There was also information on 1,056 Covid-19 patients whose data had been collected by the Chinese authorities. The age and number of infected men and women were comparable in both data sets, the scientists report in the journal “Frontiers in Public Health.”
In the smallest data set, the researchers compared blood values and severity of disease course in men and women. Consequently, some levels of inflammation were higher in male patients than in women. While of the 43 patients, more than ten men were seriously ill, there were not even five among the women. At the same time, however, 13 men also had previous illnesses such as high blood pressure, diabetes, cardiovascular disease, or chronic lung disease. There were only seven women.
Official data also showed that 70 percent of a total of 37 deceased were men. As a result, their risk of dying from Covid-19 is more than double that of women.
The official number of infected people only relates to infections that have been proven by testing. It is unclear how many people actually get new infections every day and have been infected so far without a positive result. Antibody tests are expected to solve this problem in the coming months.
The official death toll describes how many people have died from the virus. However, in how many cases the infection was the cause of death, it cannot be deduced from this. When making cross-border comparisons, it should be noted that different criteria are sometimes used to record an infection and count deaths.
Read more about this and what else you need to know about Corona data here.
This confirms the general trend that men are more severely affected by crown infections. However, the exact numbers are still subject to great uncertainties. Because only a small number of cases and deceased data were considered, chance may have played an important role. Therefore, the results cannot be generalized.
Men smoke more often and are overweight
The researchers are now trying to understand where the gender difference comes from. In the China data, it was often assumed that men smoked there more frequently than women. “Smoking is definitely a risk factor,” said Marcus Altfeld of the Heinrich Pette Institute (HPI) for SPIEGEL (read the interview here). However, there are doubts that it is the only one.
In European populations, there are often not as many more men who smoke than women, Altfeld says. Therefore, more studies would have to be expected. Also in Germany, the ratio of male to female smokers is gradually adjusting. Right now, men make up the majority of smokers at 58 percent. There are many ex-male smokers, particularly in the particularly crown-prone group of older people. This obviously worsens the course of Covid 19 disease.
Regardless of smoking, it could also play a role that men and women have different pre-existing conditions that increase the risk of severe courses of Covid 19. Men are overweight more often than women. A higher proportion suffers from diabetes and high blood pressure. The amount of female and male sex hormones in the body also plays a role.
Researchers in the US USA They are now investigating whether a higher concentration of the female sex hormones estrogen and progesterone can protect men from the life-threatening Covid 19 course. In two hospital studies on Long Island and Los Angeles, a total of 75 patients with Covid-19 will be treated with the hormones. Another 75 serve as a control group.
55 patients are treated with estrogens for one week, 20 with progesterone for five days. At the moment, the researchers will only include patients with mild or moderate courses. For a short period of time, administration of estrogens and progesterone in the concentration used is not problematic.
The complex effects of hormones.
The increased amount of estrogen and progesterone in women’s bodies apparently reduces their risk of high blood pressure and diabetes until menopause. However, this is also a problem with current research.
If a high proportion of female sex hormones were the reason women are less likely to develop life-threatening Covid-19, this protection would have to disappear in older menopausal women. “But that’s not the case,” said Sabra Klein of the New York Times’ Johns Hopkins Bloomberg School of Public Health. Examine the different gender responses to viral infections.
The researchers involved in the studies can’t stop: “We may not understand exactly how estrogen works, but we can check to see if the patient’s condition changes.”
Estrogen plays a complex role in the immune system. It affects both the early immune response, which can end the infection, and the secondary response of the immune system. In severe cases, this can lead to an uncontrolled overreaction.
The body releases masses of inflammatory messengers, the so-called cytokines. Inflammation caused in this way can further damage the lungs of ventilated patients.
“We see that the second unregulated immune response is less common in women,” said Sharon Nachman, who leads the study on Long Island, according to the New York Times. Women over 55 can also participate in the exam. Other research groups are also working on developing therapies against overreaction of the immune system. But they are still at the beginning.
Estrogen can make it difficult for viruses to enter cells.
Hormones not only affect the immune system, but also the properties of cells in the tissue. The fact that men are more often life threatening with coronaviruses could also be due to the fact that their cells carry the Ace2 protein in greater numbers on the surface.
This protein serves as a gateway for the coronavirus to enter the body. There is evidence from animal studies that estrogen inhibits Ace2 production in the body. This could hinder the spread of the virus through the woman’s body. This is also indicated by data from the first Sars pandemic 18 years ago.
The Sars virus of that time is also a corona virus and is closely related to the current pathogen. However, it was much more deadly. Of the 524 patients whose data the Chinese researchers analyzed around Yang, 139 died. The male death rate was 31 percent, while that of infected women was 23 percent.
Sars 2002/2003 pandemic spread: about 8000 people became infected, about ten percent died
Maximilian Dörrbecker / CC BY-SA 4.0
Interesting: the Sars virus also enters the body through the Ace2 protein. In addition to those of men, the cells of people with cardiovascular disease and diabetes also transport more of them to the surface; in other words, precisely those in which a crown infection is most dangerous to life.
Therefore, it suggests that there is a connection between the amount of Ace2 and the course of Covid-19 diseases. So far, however, it has not been proven. The role of estrogens in detail should also be further investigated.
More research is needed to better understand why men with Covid-19 are worse off on average than women, Yang says. The researchers would have to consider the differences in biology between men and women, as well as the different behaviors.
Until the situation clears up, Yang and colleagues advocate a pragmatic approach: “Hospitals must be prepared for the fact that older male patients more often need additional supportive measures and immediate access to the care unit. intensive “.
