WHY IS IT KILLING MORE MEN THAN WOMEN?

It’s one of the most striking things we’re learning about this terrible disease. Our experts investigate...

AVICIOUS fever, terrifying bouts of breathlessness and excruciating headaches – all culminating in a 999 dash to Edinburgh Royal Infirmary, emergency oxygen and intravenous fluids in an isolation ward.

For Scott Dixon, suffering Covid-19 has been a harrowing ordeal. ‘The memory will never leave me,’ he says.

It is also a state in which he never believed he would find himself.

Just shy of his 50th birthday, Scott is fit and healthy, rarely suffering as much as a cold. He is not overweight,

exercises regularly and has none of the underlying risk factors that would have made him an obvious candidate for severe disease.

Apart from one, that is – he is a man. A growing body of evidence now suggests that men are far more likely to be hit hard by the virus.

While infection rates between men and women – based on positive tests – appear equal, men are more likely to end up in intensive care and are far more likely to die.

Scott, who is now recovering at home, notes with some surprise that ‘all the other patients on the ward were men’.

The story of Mark and Kathy Anders, both 57, from Rugby in Warwickshire, is another stark example. The couple started experiencing mild flu-like symptoms four weeks ago. While Kathy, a GP’s secretary, recovered after a fortnight, the condition of paramedic Mark – a fit non-smoker – worsened and he suffered a relentless fever of almost 40C.

LAST Friday he was rushed to hospital for emergency treatment. ‘He wasn’t getting any better and he’d developed an agonising chest pain every time he breathed in,’ says Kathy, who is now self-isolating at home.

‘At first, he was taken to an acute ward but he quickly deteriorated. Scans showed traces of Covid-19 on his lungs and he had pneumonia.

‘On Sunday I got a call from him saying, “I think they’re taking me into intensive care tomorrow – and I don’t think I’m going to come out.”’

But in a remarkable turnaround, doctors got Mark’s temperature under control and were able to manage his breathlessness with supplementary oxygen within 24 hours.

‘So far he’s dodged intensive care, but we’ve been told that if his condition deteriorates any further, he’ll have no choice,’ Kathy says.

Unlike Mark, Kathy has been unable to secure a test but she is in no doubt about her diagnosis.

She says: ‘We’re NHS workers so we are exposed to infected patients. We became ill within days of each other. Although my symptoms were mild, I’ve never felt anything like this before.’

And no one is more surprised by how differently their bodies have coped than Kathy.

‘I was convinced that if either of us were going to get it – and suffer badly – it would be me,’ she says.

‘I’ve had treatment for cancer twice and I am the one who picks up bugs, whereas Mark rarely even gets a cold.’

This experience is familiar across the country. As Covid-19 cases surge, a startling report from the Intensive Care National Audit & Research Centre (ICNARC) reveals that men account for 73 per cent of the more than 2,000 most seriously ill patients admitted to critical care units.

Outcomes for these patients, aged between 52 and 70, are not yet known as many remain in hospital. But this is not just a British phenomenon. Global Health 50/50, an initiative which campaigns for health equality between the sexes, has been collecting information on male and female coronavirus cases.

So far, it has reliable figures from 18 countries. In each, the proportion of men and women testing positive for Covid-19 remains roughly equal. But overwhelmingly more men are dying.

In Greece and Peru, 72 per cent of those who died with the virus are male. In Italy, 68 per cent of the deaths have been men, along with 64 per cent each in China, Denmark and Germany.

The UK data has not been updated since the end of March. However, it, too, seems to reveal the same stark picture – 61 per cent of more than 6,000 deaths have been men.

The data is incomplete at present. Significant numbers of deaths in care homes – either with confirmed coronavirus or suspected infections – have not yet been counted in official figures, with a lag of about 17 days.

Industry body Care England has said the death toll in homes could already be close to 1,000, many of them frail and elderly women. So it is therefore likely that the number of female deaths in this country is being under-reported.

But the Global Health 50/50 report does conclude that men are between 50 and 80 per cent more likely than women to die following a coronavirus diagnosis.

So the obvious question is why?

THE discrepancy was first noticed in China, the origin of the pandemic. An analysis of 44,672 confirmed cases up to February 11 found the death rate among men was 2.8 per cent, compared with 1.7 per cent among women.

Some experts at the time wondered whether lifestyle factors were to blame. In China, 50 per cent of men smoke compare to fewer than four per cent of women.

Smoking, as is well known, increases the risk of lung and heart disease, high blood pressure and cancer, all of which make suffering severe Covid-19 more likely.

But the explanation did not hold up when the virus moved into Western countries. In Europe, the smoking rate is lower – 29 per cent on average, according to the World Health Organisation. And while men are still more likely to use cigarettes, there are high smoking rates among women, too.

There had to be something else in play. In truth, men have long been known as the frailer sex when it comes to viruses.

It was the same picture with SARS – another coronavirus that rampaged across the world in 2003. It is known to have killed only 780 people globally, while Covid-19 has already led to more than 90,000 deaths. But SARS was also disproportionately more lethal in men – 21 per cent of infected men died, compared with 13 per cent of women.

In 2012, 63 per cent of those infected with the MERS coronavirus were also men.

‘This is a pattern we’ve seen with many viral infections of the respiratory tract – men can have worse outcomes,’ says Sabra Klein, a scientist who studies sex differences in viral infections and vaccination responses at the Johns Hopkins Bloomberg School of Public Health in Baltimore. ‘We’ve seen this with other viruses. Women fight them off better.’

Dr James Gill, a locum GP and honorary clinical lecturer at Warwick Medical School, believes one reason is that men ‘simply don’t look after their bodies as well’ and, on average, drink more alcohol.

Studies suggest that they are less likely to follow healthy diets or seek medical help if they need it.

As a result, men are more likely than women to suffer from chronic conditions such as heart and lung disease, cancer, high blood pressure and type 2 diabetes – all of which can lead to more serious coronavirus symptoms.

Other studies have shown that men are less likely to wash their hands and use soap or abide by public health advice. This could, in theory, involve ignoring social-distancing policies, although there is no direct evidence for it.

Immunologist Professor Philip Goulder, from Oxford University, says these are important behavioural differences between the sexes which ‘have a huge impact on the outcome from infections such as coronavirus’.

There is also an ongoing debate over whether obesity in itself, rather than as a contributory factor to high blood pressure and diabetes, increases the risk of coronavirus problems. The Health Survey for England 2017 found men are more likely to be overweight or obese than women (67 per cent compared with 61 per cent). The latest ICNARC data does not suggest that those with a Body Mass Index above 25 are any more likely to require hospital treatment with coronavirus than those with a healthy weight.

But those who are obese are more likely to die in critical care.

Based on the more limited data available on outcomes, 57 per cent of people with a BMI over 30 died, compared to 43 per cent of those with a normal BMI.

DUNCAN Young, Professor of Intensive Care Medicine at Oxford University, says: ‘The numbers are small but there does appear to be an increased risk of death in obese patients admitted to an intensive care unit with a Covid-19 infection.’

Dr Gill says one plausible theory is that, in men, the way that their weight is distributed could be having an effect.

‘Broadly, men have an appleshaped weight distribution which means fat will be distributed more widely across their torsos,’ he says. ‘It could put extra pressure on respiratory muscles, which work harder if you’re carrying more