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Biological sex impacts COVID-19 outcomes
Sabra L Klein1,2, Santosh Dhakal1, Rebecca L Ursin2
1W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
Plos Pathogens
|June 23, 2020
Summary
Men experience more severe outcomes from COVID-19 due to biological differences in ACE2 expression, immunity, and comorbidities. This study highlights these sex-based disparities in disease severity.
Area of Science:
- Infectious Diseases
- Immunology
- Sex Differences in Health
Background:
- The COVID-19 pandemic reveals significant sex-based disparities in disease outcomes globally.
- Inconsistent reporting on male-female differences in COVID-19 cases, hospitalizations, and deaths exists in the U.S.
Purpose of the Study:
- To raise awareness of male-biased severe outcomes in COVID-19.
- To explore mechanistic differences contributing to sex disparities in COVID-19 severity.
Main Methods:
- Review of existing literature on sex differences in COVID-19.
- Analysis of factors influencing disease outcomes, including ACE2 expression, antiviral immunity, and comorbidities.
Main Results:
- Men exhibit a higher incidence of severe COVID-19 outcomes, including increased hospitalizations and mortality.
- Sex differences in angiotensin-converting enzyme 2 (ACE2) expression and activity contribute to male vulnerability.
- Variations in innate and adaptive antiviral immune responses between sexes impact COVID-19 severity.
- Comorbidities, influenced by age and race, exacerbate male-biased COVID-19 outcomes.
Conclusions:
- Biological sex is a critical determinant of COVID-19 severity.
- Understanding sex-based mechanistic differences is crucial for targeted prevention and treatment strategies.
- Addressing sex disparities in comorbidities is essential for mitigating severe COVID-19 outcomes in men.
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