In Italy, Coronavirus Takes a Higher Toll on Men

Being male may be a risk factor for illness, just as being older is, experts say.

Credit...Andreas Solaro/Agence France-Presse — Getty Images

The coronavirus is striking, and felling, more Italian men than women, and some experts are warning that being male may be a risk factor for the illness, just as older age is.

The Italian trend mirrors one seen in China, where men were more likely than women to die of Covid-19.

In Italy, more men than women have been infected, and a higher proportion of infected men have died. Some 8 percent of male patients died, compared with 5 percent of female patients, according to a Higher Health Institute of Rome analysis of 25,058 cases.

“Being male is as much a risk factor for the coronavirus as being old,” said Sabra Klein, a scientist who studies sex difference in viral infections at Johns Hopkins Bloomberg School of Public Health. “People need to be aware that there is this pattern. Just like being old means you’re at higher risk, so does being male. It’s a risk factor.”

She said the vulnerability could be biological or behavioral. Women have more robust immune systems, Dr. Klein said. And more men smoke in higher numbers, and they are less likely to wash their hands, studies show.

“We don’t always understand why something is a risk factor, and we’re probably not going to be able to pinpoint one thing,” Dr. Klein said. “But it’s remarkable that we’re seeing this across such socially and culturally distinct countries as Italy and China. More needs to be made of this fact.”

On Friday, Dr. Deborah Birx, the coronavirus response coordinator for the White House, mentioned the gender disparity in deaths in Italy, but said the gender gap was “twice” as high in men at all ages. In fact, the report mentioned no deaths in people under 30 and very few deaths among men and women in their 40s and 50s. The heightened risk to men becomes apparent in their 50s, with the gender gap tapering off somewhat only at 90, probably because there are fewer men in this age group.

Over all, men represented 58 percent of 25,058 coronavirus cases in Italy, and 70 percent of the 1,697 deaths described in the report.

In China, the death rate for men was 2.8 percent, compared to 1.7 percent for women, according to the largest analysis of cases by the Chinese Center for Disease Control and Prevention.

Men also were disproportionately affected during the SARS and MERS outbreaks, which were caused by coronaviruses. More women than men were infected by SARS in Hong Kong in 2003, but the death rate among men was 50 percent higher, according to a study published in the Annals of Internal Medicine.

Some 32 percent of men infected with Middle East Respiratory Syndrome died, compared with 25.8 percent of women. Young adult men also died at higher rates than female peers during the influenza epidemic of 1918.

Women appear to have stronger immune systems than men. The female sex hormone estrogen appears to play a role in immunity, as does the X chromosome, which contains immune-related genes. Women carry two X chromosomes; men only one.

But women also develop more autoimmune diseases such as lupus and rheumatoid arthritis, in which the immune system attacks the body’s own organs and tissues.

  • Frequently Asked Questions and Advice

    Updated May 26, 2020

    • How can I protect myself while flying?

      If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)

    • What are the symptoms of coronavirus?

      Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.

    • How many people have lost their jobs due to coronavirus in the U.S.?

      Over 38 million people have filed for unemployment since March. One in five who were working in February reported losing a job or being furloughed in March or the beginning of April, data from a Federal Reserve survey released on May 14 showed, and that pain was highly concentrated among low earners. Fully 39 percent of former workers living in a household earning $40,000 or less lost work, compared with 13 percent in those making more than $100,000, a Fed official said.

    • Is ‘Covid toe’ a symptom of the disease?

      There is an uptick in people reporting symptoms of chilblains, which are painful red or purple lesions that typically appear in the winter on fingers or toes. The lesions are emerging as yet another symptom of infection with the new coronavirus. Chilblains are caused by inflammation in small blood vessels in reaction to cold or damp conditions, but they are usually common in the coldest winter months. Federal health officials do not include toe lesions in the list of coronavirus symptoms, but some dermatologists are pushing for a change, saying so-called Covid toe should be sufficient grounds for testing.

    • Should I wear a mask?

      The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.

    • What should I do if I feel sick?

      If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.

    • How can I help?

      Charity Navigator, which evaluates charities using a numbers-based system, has a running list of nonprofits working in communities affected by the outbreak. You can give blood through the American Red Cross, and World Central Kitchen has stepped in to distribute meals in major cities.


Other health and behavioral factors may also be contributing to men’s vulnerability. Men develop cardiovascular disease and hypertension at younger ages than women, and both of these conditions increase the potential for severe disease, said Kathryn Sandberg, director of the Center for the Study of Sex Differences in Health, Aging and Disease at Georgetown University.

Men also smoke at higher rates than women. In China, more than half of all men smoke, compared with less than 3 percent of women; in Italy nearly 30 percent of men smoke, compared with 19 percent of women. In the United States, the smoking gap is smaller, with 17.5 percent of men smoking compared with 13.5 percent of women.

A World Health Organization report on cases from the European region noted that of 11,228 coronavirus infections with known data, 57 percent were in men. Of 1,032 deaths for which records were available, only 295, or 28 percent, were in women.