Abstract
The current novel coronavirus disease 2019 (COVID-19) pandemic is revealing profound differences between men and women in disease outcomes worldwide. In the United States, there has been inconsistent reporting and analyses of male–female differences in COVID-19 cases, hospitalizations, and deaths. We seek to raise awareness about the male-biased severe outcomes from COVID-19, highlighting the mechanistic differences including in the expression and activity of angiotensin-converting enzyme 2 (ACE2) as well as in antiviral immunity. We also highlight how sex differences in comorbidities, which can be associated with both age and race, impact male-biased outcomes from COVID-19.
Highlights
Like the 1918 influenza pandemic [1], men are at greater risk of more severe COVID-19 outcomes than women, with both sex and gender playing fundamental roles
Of the data from the remaining 23 states, 7 states replicate the epidemiological pattern seen in New York City (NYC) (Fig 1) and elsewhere in the world [3], in which numbers of COVID-19 cases are similar between men and women
Using the four core genotype mouse model in which gonadal sex is separated from the sex chromosome complement (XX versus XY) [12], we found renal angiotensin-converting enzyme 2 (ACE2) activity was greater in the male kidney regardless of the sex chromosome complement [11]
Summary
The current novel coronavirus disease 2019 (COVID-19) pandemic is revealing profound differences between men and women in disease outcomes worldwide. We highlight how sex differences in comorbidities, which can be associated with both age and race, impact male-biased outcomes from COVID-19.
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