- Countries around the world are reporting the mortality rate of COVID-19 is significantly higher in men than it is in women.
- Research suggests that mast cells in women are able to initiate a more active immune response, which may help them fight infectious diseases better than men.
When it comes to surviving critical cases of COVID-19, it appears that men draw the short straw.
Initial reports from China revealed the early evidence of increased male mortality associated with COVID. According to the Global Health 50/50 research initiative, nearly every country is now reporting significantly higher COVID-19-related mortality rates in males than in females as of June 4. Yet, current data suggest similar infection rates for men and women. In other words, while men and women are being infected with COVID-19 at similar rates, a significantly higher proportion of men succumb to the disease than women, across groups of similar age. Why is it then that more men are dying from COVID-19? Or rather, should we be asking why are more women surviving?
I am an immunologist, and I explore how stress and biological sex can impact a person’s vulnerability to immune-mediated disease. I study a specific immune cell called the mast cell. Mast cells play a pivotal role in our immune systems as they act as first responders to pathogens and orchestrate immune responses that help clear the invading pathogens.
Our research shows that mast cells from females are able to initiate a more active immune response, which may help females fight off infectious diseases better than men. But the trade-off may be that women are at higher risk for allergic and inflammatory diseases. Recent evidence indicates that mast cells are activated by SARS-CoV-2 which causes COVID-19.
Some clues to why females have higher survival rates may be found in our current understanding of differences in the immune systems of men versus women.
Could sex differences in immune system play a role?
In general, females have a more robust immune response than men which may help females fight off infections better than males. This could be a result of genetic factors or sex hormones such as estrogen and testosterone.
Biological females have two copies of the X chromosome, which contains more immune genes. While the genes on one X chromosome are mostly inactive, some immune genes can escape this inactivation, leading to double the number of immune-related genes and thus double the quantity of certain immune proteins compared with biological men who have only one X chromosome.
Sex hormones such as estrogen and testosterone can also impact the immune response. In one study, researchers showed that activating the estrogen receptor in female mice provided them protection against SARS-CoV. And there is an approved clinical trial that will examine the effects of estrogen patches on the severity of COVID-19 symptoms.
It is, however, interesting that the current data showing that women have better survival rates than men applies to even men and women in the 80-plus age group, when hormone levels in both sexes equalize. This suggests that factors other than adult sex hormone levels are contributing to sex differences in COVID-19 mortality.
Androgens, a group of hormones – including testosterone – that are best known to stimulate the development of male characteristics and can cause hair loss, have also received recent attention as a risk factor for COVID-19 in males. In a study conducted in Italy, prostate cancer diagnosis increased the risk for COVID-19. However, prostate cancer patients who were receiving androgen-deprivation therapy (ADT), a treatment that suppresses the production of androgens which fuels prostate cancer cell growth, had a significantly lower risk for SARS-CoV-2 infection. This suggests that blocking androgens in men was protective against SARS-CoV-2 infection.
It is unknown how ADT works to reduce infection rates in men and whether this has been shown in other countries has yet to be determined. Testosterone, which is an androgen hormone has immune-suppressive effects so one explanation could be that ADT might boost the immune system to combat SARS-CoV-2 infection.
There is also evidence that males and females have different quantities of certain receptors that recognize pathogens or that serve as an invasion point for viruses like SARS-CoV-2. One example is the quantity of angiotensin converting enzyme 2 (ACE2) receptors, which SARS-CoV-2 binds to in order to infect cells. While there is currently no conclusive evidence for a role of ACE2 receptors impacting sex differences and the severity of COVID-19 disease, it remains a potential contributing factor.
Gender, sex and COVID-19 risk
A number of factors can interact with biological sex to increase or decrease one’s susceptibility to COVID-19. Another major factor is gender, which refers to social behaviors or cultural norms that society deems appropriate. Males may be at increased risk for severe disease, because in general, they tend to smoke and drink more, wash their hands less frequently and often delay seeking medical attention. All of these gender specific behaviors may put men at higher risk. While there is no current data yet on how gender plays a role in COVID-19, it will be a critically important factor to account for in order to understand sex differences in mortality.
Age, psychological stress level, coexisting conditions such as obesity, diabetes and cardiovascular disease can also interact with biological sex to increase disease.
While COVID-19 highlights the importance of biological sex in disease risk, sex biases in disease in general is not a new concept. COVID-19 is just another example of a disease that will be added to the growing list of diseases for which males or females are at increased risk.
A history of male-biased research
You might be wondering that if biological sex is so important, then why don’t we know what is causing disparities in disease prevalence between the sexes and why are there no sex-specific therapies?
One major reason is when it comes to being included in scientific research, it is mostly males who have been studied.
This disparity between biological sex differences in research has only recently been remedied. It has only been in the last five years that the National Institutes of Health has required sex difference data to be collected for all newly funded preclinical research grants.
While there may be several reasons for choosing one sex over the other in research, the huge disparity that now exists is likely a major reason why we still know relatively little about sex differences in immunity, including the current COVID-19 pandemic.
This has clearly hindered advancement of women’s health, but also has negative consequences for men’s health. For example, given the biological differences between the sexes, it is very possible that drugs and therapies will have different effects in females than males.
Biological sex is clearly a major factor determining disease outcomes in COVID-19. Precisely how your biological sex makes you more or less resilient to diseases such as COVID-19 remains to be elucidated. Future basic research with animals and clinical trials in people need to consider biological sex as well as interactions with gender as an important variable.
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Interior Health identifies more potential COVID-19 exposure locations in Kelowna – Globalnews.ca
Interior Health, after further testing of individuals, has identified additional Kelowna locations where people may have been exposed to COVID-19 between June 25 and July 6.
Individuals who visited the following locations on the dates noted are asked to self-monitor themselves closely for symptoms of COVID-19 and get tested if they have those symptoms:
* Cactus Club, #1-1370 Water St., from July 3-6.
* Pace Spin Studio, #5-1717 Harvey Ave, Kelowna from July 2, 4, 5, 7, 8 and 9.
Interior Health is also reminding individuals who attended gatherings at the following locations on the dates noted to self-isolate and monitor themselves closely for symptoms:
* Discovery Bay Resort (1088 Sunset Dr., Kelowna) from July 1 to 5.
* Boyce Gyro Beach Lodge (3519 Lakeshore Rd., Kelowna) on July 1.
IH says public health contact tracing is under way, and where possible, health officials are reaching out directly to exposed individuals.
Anyone who participated in events in the Kelowna downtown and waterfront area between June 25 and July 6 is asked to monitor closely for symptoms of COVID-19 and get tested if they develop symptoms.
Individuals seeking a test should call their primary care provider, family physician, nurse practitioner or the closest Interior Health community testing and assessment centre.
Testing is recommended for anyone experiencing symptoms of COVID-19, including fever, cough, shortness of breath, difficulty breathing, or loss of sense of taste or smell.
Other milder symptoms may include runny nose, fatigue, body aches (muscles and joints aching), diarrhea, headache, sore throat, vomiting and red eyes.
IH reminds everyone of the importance of following COVID-19 precautions:
* Stay home and avoid travel if you have symptoms, even mild ones.
* Maintain physical distancing (two metres apart) and use masks when distancing is not possible.
* Wash your hands regularly and do not touch your face.
* Do not plan or attend gatherings of more than 50 people. Limit gatherings to out of doors whenever possible.
For answers to frequently asked questions, you can go to the Interior Health public website https://news.interiorhealth.ca/news/frequently-asked-questions/
Interior Health provides two more COVID-19 exposure locations – Kelowna News – Castanet.net
Individuals who visited the following locations on the dates below may have been exposed to the virus:
- Cactus Club, 1370 Water St., from July 3-6
- PACE Spin Studio, 1717 Harvey Ave., on July 2, 4-5 and 7-9
IH is requesting those individuals closely self-monitor for virus symptoms and get tested if any symptoms show.
On Saturday, IH announced residents who visited Discovery Bay Resort from July 1-5 or Boyce Gyro Beach Lodge on July 1 may have come in contact with COVID-19. IH directed individuals who attended gatherings at Discovery Bay Resort or Boyce Gyro Beach Lodge on those dates to self-isolate and monitor themselves closely for symptoms.
Castanet understands the individual/s who visited Discovery Bay Resort were not staying at the resort, but visiting a specific unit thought to have been on the second floor of the South building.
In response, the resort has closed the pools until further guidance is obtained by IH and increased cleaning and sanitization practices.
IH confirmed public health contact tracing is underway, and individuals who may have been exposed are being contacted directly where possible.
Testing is recommended for anyone experiencing symptoms of COVID-19, including:
- Shortness of breath or difficulty breathing
- Loss of sense of taste or smell
- Other milder symptoms may include: runny nose, fatigue, body aches (muscles and joints aching), diarrhea, headache, sore throat, vomiting and red eyes.
IH reminds everyone of the importance of following COVID-19 precautions:
- Stay home and avoid travel if you have symptoms, even mild ones.
- Maintain physical distancing (two metres apart) and use masks when distancing is not possible.
- Wash your hands regularly and do not touch your face.
- Do not plan or attend gatherings of more than 50 people. Limit gatherings to out of doors whenever possible.
For more information, visit the website.
'Plate-shaming' is happening in Atlantic Canada as locals fear those from outside the 'bubble' – CTV News
Atlantic Canada’s reputation for being warm and welcoming has long been a source of pride.
But instead of hospitality, the pandemic is exposing a glimpse of hostility aimed at those who are assumed to be outsiders.
“Being from Halifax, growing up here all but eight years of my life, I really didn’t expect this,” resident Tony Mountenay told CTV News.
Tony and Debbie Mountenay chose to return to Nova Scotia during the pandemic because they were looking for a laid back retirement.
As required, they isolated after they arrived. But then they decided to go out and run errands.
“And we had three different incidents where people came up beside us, yelling at us, through the window, and when it first happened, we had to try to think, well what was that about?” Debbie said.
The answer was the licence plate on their truck — showing that they came from Ontario.
Visitors from beyond the “Atlantic bubble” have been vilified by locals fearing the virus could be imported.
Though relatively rare, there have been incidents of “plate-shaming.”
A woman from Quebec was told to go home while walking on a New Brunswick beach.
More than 15,000 Newfoundlanders signed a petition demanding their province not open the border to anyone.
Debbie said one woman who had harassed the couple had done so in front of her own children.
“She really shouldn’t have been doing that in my opinion,” she said. “Another man, you could tell he was out of control.”
The Atlantic bubble, which encompasses the provinces of New Brunswick, Prince Edward Island, Nova Scotia and Newfoundland and Labrador, is a concept that was introduced recently to allow easier travel between the Eastern provinces as the region reopens.
People from all across Canada are allowed to travel to any Atlantic province, but those outside of the Atlantic bubble must isolate for 14 days — as leaders in the region are quick to remind people.
“The Atlantic bubble is open today, [but] that does not apply to those who are from Ontario, Quebec or Western Canada,” Nova Scotia Premier Stephen McNeil said. “If you’re coming into our province, you’re required to self isolate as well.”
The Atlantic provinces have largely fared well during the pandemic compared to provinces such as Ontario or Quebec. Of the Atlantic provinces, Nova Scotia has had the most cases in total, at just over 1,000 — a far cry from Quebec’s 56,521 cumulative cases.
The stress for locals in the Atlantic provinces is that out-of-bubble visitors could lead to a second wave of the virus.
Only last week, a string of new cases in Nova Scotia and Prince Edward Island were proven to be related to travel from outside of the bubble. One individual flew from the United States to Toronto, and then to Halifax. This case was then connected to cases in Prince Edward Island.
McNeil said on July 6 that he is frustrated with travellers who do not isolate for the 14 days after they arrive.
“We have worked hard together and sacrificed so much in this province to help flatten the curve only to have some people come into our province who think they’re above it all, who think that the rules don’t apply to them,” he said. “Guess what? They do.”
But the Mountenay’s experience in Nova Scotia suggests that the uncertainty over who has isolated and who has not has led to some rather un-neighbourly behaviour.
In response, the couple has come with a way to alert people they’re not a threat. A piece of paper that clearly states a person has completed isolation.
“I don’t want to get [COVID-19],” Debbie said. “And I don’t want to give it to anybody.”
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