Since its inception on December 2019, COVID-19 epidemic now has been titled a global emergency. Rich literature on the global descriptive epidemiology of the cases has shown that the burden of COVID-19 epidemic in terms of both morbidity and mortality is more pronounced among men. Physiological and genetic traits along with numerous differences in social and cultural profile of men are attributed to this discrepancy. This review attempted to delineate various proposed explanations for the observed gender-differences in COVID-19 morbidity and mortality.
Zhu N, Zhang D, Wang W, al. e. A Novel Coronavirus from Patients with Pneumonia in China, 2019 N Engl J Med. 2020;382:727-33. DOI: 10.1056/NEJMoa2001017.
Yoo JH. The fight against the 2019-nCoV outbreak: an arduous march has just begun. J Korean Med Sci. 2020;35(56. Doi: 10.3346/jkms.2020.35.e56).
World Health Organization.Coronavirus disease 2019 (COVID-19)Situation Report -72:Data as reported by national authorities by 10:00CET1 April2020. Available at:https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200401-sitrep-72-covid-19.pdf?sfvrsn=3dd8971b_2 on March 2, 2020.
Zhao S, Lin Q, Ran J, Musa SS, Yang G, Wang W, et al. Preliminary estimation of the basic reproduction number of novel coronavirus (2019-nCoV) in China, from 2019 to 2020: a data-driven analysis in the early phase of the outbreak. Int J Infect Dis. 2020;92:214-17. doi: 10.1016/j.ijid.2020.01.050.
Wu JT, Leung K, Leung GM. Nowcasting and forecasting the potential domestic and international spread of the 2019-nCoV outbreak originating in Wuhan, China: a modelling study. Lancet Jan 31 [Epub ahead of print] doi: 101016/S0140- 6736(20)30260- 9 2020.
Backer JA, Klinkenberg D, Wallinga J. Incubation period of 2019 novel coronavirus (2019-nCoV) infections among travelers from Wuhan, China, 20–28 January Euro Surveill 2020;25:Doi: 10.2807/1560-7917.ES.2020.25.5. 20 0 0 062 .
Ministry of Health & Medical Education: Center for Disease Control and Prevention (CDC): Series 15 of the Epidemiologic Calendar of COVID-19 in Iran. Published by March 31, 2020.
Karlberg J, Chong DS, Lai WY. Do men have a higher case fatality rate of severe acute respiratory syndrome than women do? . Am J Epidemiol. 2004;159:229–31.
Leong HN, Earnest A, Lim HH, Chin CF, Tan C, Puhaindran ME, et al. SARS in Singapore–predictors of disease severity. Ann Acad Med Singapore. 2006;35:326–31.
Zhang DX, Cao YY, Yuan YD, Yang YB, Yan YQ, Akdis CA, et al. Clinical characteristics of 140 patients infected by SARS-CoV-2 in Wuhan, China. Allergy 2020 Feb 19 doi: 101111/all14238 [Epub ahead of print].
Li Q, Guan X, Wu P, al. e. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia. N Engl J Med 2020;382:1199-207. DOI: 10.056/NEJMoa2001316.
Chih-Cheng L, Tzu-Ping S, Wen-Chien K, Hung-Jen T, Po-Ren H. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): The epidemic and the challenges. International Journal of Antimicrobial Agents 2020;55(105924).
Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet (London, England). 2020;395:07–13. doi: 0.1016/ S0140- 6736(20)30211- 7 .
Zhang L, Yunhui L. Potential interventions for novel coronavirus in China: A systematic review. Journal of Medical Virology. 2020:https://doi.org/10.1002/jmv.25707Citations.
Alghamdi IG, Hussain II, Almalki SS, Alghamdi MS, Alghamdi MM, El-Sheemy MA. The pattern of Middle East respiratory syndrome coronavirus in Saudi Arabia: a descriptive epidemiological analysis of data from the Saudi Ministry of Health. Int J Gen Med. 2014;7:417–23.
Yang JK, Feng Y, Yuan MY, etal. Plasma glucose levels and diabetes are independent predictors for mortality and morbidity in patients with SARS. Diabet Med. 2006;23(6):623-8.
Yang JK, Lin SS, Ji XJ, Guo LM. Binding of SARS coronavirus to its receptor damages islets and causes acute diabetes. Acta Diabetol 2010;47(3):193-9.
Patel SK, Velkoska E, Burrell LM. Emerging markers in cardiovascular disease: where does angiotensin-converting enzyme 2 fit in? . Clin Exp Pharmacol Physiol. 2013;40(8):551-9.
Channappanavar R, Fett C, MackPatrick N, Eyck T, Meyerholz DK, Perlman S. Sex-based differences in Susceptibility to Sever Acute Respiratory Syndrome Corona Virus Infection. The Journal of Immunology. 2017;198:4046-53.
Roberts A, Deming D, Paddock CD, Cheng A, Yount B, Vogel L, et al. A mouseadapted SARS-coronavirus causes disease and mortality in BALB/c mice. PLoS Pathog. 2007;3: e5.
Cousins SW, Marin-Castan˜o ME, Espinosa-Heidmann DG, Alexandridou A, Striker L, Elliot S. Female gender, estrogen loss, and Sub-RPE deposit formation in aged mice. Invest. Ophthalmol Vis Sci. 2003;44:1221–9.
Heil F, Hemmi H, Hochrein H, Ampenberger F, Kirschning C, Akira S, et al. Species-specific recognition of single-stranded RNA via toll-like receptor 7 and 8. Science 2004;303:1526–9.
Channappanavar R, Fehr AR, Vijay R, Mack M, Zhao J, Meyerholz DK, et al. Dysregulated type I interferon and inflammatory monocyte-macrophage responses cause lethal pneumonia in SARS-CoV–infected mice. Cell Host Microbe. 2016;19: 181–93.
Sims AC, Baric RS, Yount B, Burkett SE, Collins PL, Pickles RJ. Severe acute respiratory syndrome coronavirus infection of human ciliated airway epithelia: role of ciliated cells in viral spread in the conducting airways of the lungs. J Virol. 2005;79:15511–24.
Klein SL, Flanagan.K.L. Sex differences in immune responses. Nat Rev Immunol 2016;16:626–38.
Klein SL. Implications of X-linked gene regulation for sex differences in disease pathogenesis (comment on DOI 10.1002/bies.201100047). BioEssays. 2011;33:789–90.
Meier A, Chang JJ, Chan ES, Pollard RB, Sidhu HK, Kulkarni S, et al. Sex differences in the Toll-like receptor-mediated response of plasmacytoid dendritic cells to HIV-1. Nat Med. 2009;15:955–9.
Robinson DP, Hall OJ, Nilles TL, Bream JH, Klein.S.L. 17b-estradiol protects females against influenza by recruiting neutrophils and increasing virus-specific CD8 T cell responses in the lungs. J Virol. 2014;88:4711–20.
Peretz J, Pekosz A, Lane AP, Klein SL. Estrogenic compounds reduce influenza A virus replication in primary human nasal epithelial cells derived from female, but not male, donors. Am J Physiol Lung Cell Mol Physiol. 2016;310: L415–L25.
Shaw AC, Goldstein DR, Montgomery RR. Age-dependent dysregulation of innate immunity. Nat Rev Immunol. 2013;13:875–87.
Cai H. Sex difference and smoking predisposition in patients with COVID-19. Lancet Respiratory medicine 2020;8:S2213-600.
Cai G. Bulk and single-cell transcriptomics identify tobacco-use disparity in lung gene expression of ACE2, the receptor of 2019-nCov. medRxiv 2020; published online Feb 28.DOI:10.1101/2020.02.05.20020107 (preprint).
Zhang JJ, Dong X, Cao Y. et al. Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China. Allergy; published online Feb 19 DOI:101111/all14238. 2020.
Guan W, Ni Z, Liang W. et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med; published online Feb 28 DOI:101056/NEJMoa2002032. 2020.
Hooper A, Gwendolyn L. Health Seeking in Men: A Concept Analysis. Urologic Nursing. 2016;36(4):163-72.