Are women less likely to get infected and die from COVID-19? Current data says: Yes. As of April 15th, the death rate among confirmed cases of COVID-19 in men is 4.7% while only 2.8% in women. In Italy, 70% of people who died from the virus are men. Are women just naturally resistant to the virus? Current hypotheses are that there are three main elements that increase risk in men: smoking, comorbidities, and physiology.
Anything that increases respiratory damage exacerbates COVID-19 related symptoms. Smoking and vaping have been linked to an increase in risk of death from COVID-19. There tends to be a gender bias related to smoking. In China, smoking is less prevalent among women than men: 3% vs 50%. In Italy, 11.6% of men smoke compared to 7.5% of women. Smoking causes lung tissue scarring, effectively decreasing the number of healthy alveoli and blood vessels in the lungs. COVID-19 related pneumonia can lead to alveolar failure as well, so the combination of already weakened lungs with virus-related respiratory complications can be devastating. As air sacs fill with mucus, fluid, and immune cells that are fighting off the infection, oxygen exchange decreases, leading to metabolic acidosis and other complications.
Another risk factor that is more prevalent in men than women is pre-existing conditions. People who have comorbidities seem to have worse outcomes if they catch COVID-19. Wang et al. found that hypertension, diabetes, COPD, cardiovascular disease, and cerebrovascular disease were major risk factors associated with patients who died from COVID-19. A similar report claims that almost 90% of COVID-19 admissions involve comorbidities, with the leading condition being hypertension. In New York, about 60% of deaths from COVID-19 were male vs 40% female.
Finally, there have been some reports that suggest that physiological components may play a role in this sex difference. Channappanavar et al. found that female hormones may play a protective role against the virus. In mice models, female mice had lower mortality due to estrogen when infected with another type of coronavirus. There seems to be estrogen receptor signaling that is critical in protecting females. Furthermore, immune response in women may be stronger than in men. Unfortunately, this has also been linked to autoimmune diseases, which are much more prevalent in women than men (80%).
What about pregnant women? There is much anxiety around what COVID-19 could do to a developing fetus. We already know that complications can arise when pregnant women contract the flu or other viral infections, such as premature births or birth defects. But we have yet to uncover if COVID-19 has similar effects. Thankfully, the current (but limited) evidence suggests that pregnant women are less likely to become infected and develop complications. Though all data so far has been reassuring, given the limited cases to study, the American College of Obstetrics and Gynecology (ACOG) currently classifies pregnant women as high risk, out of an abundance of caution.
The sum of the currently available lends to better outcomes in women related to contracting SARS-CoV-2 and/or become severely ill or dying from COVID19. Pregnant women and their developing fetuses also seem to fare as well as the general population. But of course, there’s so much to learn over the next 6-12 months, and we’ll do our best to keep you updated!
El Camino Women’s Medical Group offers the latest Minimally Invasive Solutions for gynecologic problems. Drs. Amy Teng, Erika Balassiano, and Pooja Gupta, all members of AAGL (American Association of Gynecologic Laparoscopy) are highly trained and experienced in the field of Minimally Invasive Gynecologic Surgery. Dr. Erika Balassiano has also completed a Minimally Invasive Gynecologic Surgery Fellowship, under the supervision of world-renowned Dr. Camran Nezhat.
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