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Researchers Look To Behavior To Explore Why The Coronavirus May Hit Men Harder

A man wearing a face mask walks in Moscow in mid-April during a strict lockdown to stop the spread of the coronavirus.
Dimitar Dilkoff
AFP via Getty Images
A man wearing a face mask walks in Moscow in mid-April during a strict lockdown to stop the spread of the coronavirus.

Researchers suspect that the coronavirus is hitting men and women differently. Worldwide, men appear more likely to suffer more severely or die from COVID-19 than women.

But experts don't know why. At Johns Hopkins University, researchers have begun towonder whether biological factors — like women's immune systems producing a stronger response than those of men — can help explain the difference.

Sarah Hawkes, a professor of global public health at University College London, has also been looking at global COVID-19 data. Her research has found that men have been 50% to 80% more likely to die from COVID-19 than women.

In an interview Wednesday with NPR's David Greene, Hawkes said biological differences may be part of a larger story.

"If it were all down to biology, you might expect to see really quite similar differences between death rates in men and women in every country, and we don't actually see that," she said.

According to Hawkes, behavior could also help explain the difference.

Interview Highlights

On gendered behavioral factors affecting the heart and lungs

We know from global data that those diseases are more common in men. And from the work that we do, our hypothesis is that those diseases are more common in men because of the gendered behaviors of men.

So heart and lung disease, a large part of the burden of heart and lung disease globally is driven by exposure to factors such as tobacco smoke and drinking alcohol and even things like air pollution — and a lot of that is very gendered behaviors. In many societies, it's men who are more likely to smoke, it's men who are more likely to drink alcohol; and it's men who are frequently exposed to high levels of outdoor air pollution because they are frequently the ones who are driving cars, taxis, buses, trucks, whatever.

On other behavioral factors that could be at play

What could be playing a role and where we've seen this in other diseases — including previous viral epidemics — is that men have tended to seek care later in the course of a disease than women do. So if you look at what happened in the Ebola epidemic, for example, there was a delay in health care seeking amongst men compared to women. There was also a higher death rate from Ebola amongst men compared to women.

On public messaging specifically for men

For men, if our hypothesis turns out to be right — that men are being stoical or are more afraid to seek health care or more reluctant to seek health care — then the obvious intervention, the obvious message there is to say: You need to seek health care as soon as possible.

In terms of the messaging for health policy, we would like to be sure that there isn't a need, for example, for different clinical care pathways for men and women. Do we want to intervene earlier in the stage of a disease amongst men in older age groups with these other coexisting conditions? Is there a case for that? That would clearly require clinicians to start thinking about sex differences and gender differences in their treatment pathways. But we know from lots of previous work that we've done that the profession of health researchers is actually remarkably bad at taking sex and gender into consideration in their health care provision.

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