Keenan: COVID and its complications are not in favor of men

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It’s wonderful to see smiling human faces, walking through the world without masks. However, while we may be done with COVID-19, it is not done with us. Shocking data from the UK statistics agency has revealed that one in 13 people there have been infected with the COVID-19 virus in the past week alone.
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Experts say this surge is driven by the BA.2 Omicron subvariant, which is much more transmissible than previous versions of COVID-19. Luckily, you’re also less likely to land in hospital or intensive care, especially if you’re vaccinated and boosted.
Although the total number of COVID-19 cases reported to the Public Health Agency of Canada is slightly in favor of women (966,543 versus 900,448 men), there are some uniquely male characteristics of COVID-19. All of this data is based on biological sex, which may be different from gender identity.
A recent paper by Georgios Karaigas from the University of Iceland found that “male patients with COVID-19 appear to be at higher risk for more severe outcomes and mortality than female patients”. Perhaps the most well-known complication is myocarditis, an inflammation of the heart muscle. According to the Mayo Clinic website, “Inflammation can reduce the heart’s ability to pump and cause rapid or irregular heart rhythms.”
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A study of the under-20 age group in the United States by Mendel Singer and colleagues found that men are significantly more likely to have this complication of COVID-19. The adjusted rates were 450 cases per million in adolescent males and 213 per million in comparable females. One expert has speculated that men in this age range may develop a particularly robust immune response. As Karaigas notes, when infected immune cells invade heart muscle, “the host responds with systemic inflammation and a cytokine storm” and the person’s heart muscle cells become collateral damage.
Importantly, even in adolescent males, myocarditis after COVID-19 is a very rare complication. Even rarer is myocarditis after vaccination with one of the mRNA vaccines. According to a presentation of US data given by Dr. John Su of the Centers for Disease Control (CDC), “As of October 6, 2021, a total of 402,469,096 doses of COVID-19 vaccines have been administered…with 3,336 reports of myocarditis and pericarditis. This gives an astronomically low rate, in the same range as your child’s risk of being struck by lightning.
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Therefore, Dr. Su and his employer, the CDC, definitely recommend vaccination, even for teenagers. On an informational web page for Children’s Hospital of Philadelphia, cardiologist Dr. Matthew Elias summarizes the situation as follows: vaccinal myocarditis.
It should also be noted that these heart complications in young people tend to be temporary and relatively mild. In Dr. Su’s report, 77% of myocarditis and pericarditis cases in people under 30 were known to have recovered from symptoms, and only a small number were still hospitalized at the time of the report.
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In trying to understand why men are more vulnerable to severe consequences of COVID-19 than women, other factors include biology, genetics, and lifestyle. The coronavirus uses an enzyme called ACE2 to enter cells, and men tend to have a higher concentration of this enzyme. Also, having two X chromosomes can give women a stronger immune system.
Lifestyle factors figured prominently in early studies in China. The researchers noted that Chinese men were much more likely to smoke than women and to work in riskier occupations.
A recent US study by Harvard researcher Sarah Richardson found significant variations from state to state. In Texas, men were more likely to die from COVID-19 than women each week studied. In Connecticut, women were more likely to die from COVID-19 in 22 of the 55 weeks examined. Richardson and his colleagues think occupation may be important because industries like construction and agriculture, which are somewhat male-dominated, pose higher risks of exposure to COVID-19. Behavioral factors, like mask-wearing and adhering to public health guidelines, were also factors where men seemed to lag behind, at their peril.
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In addition to finding out how much the data varied by geography, one of the key insights from this study was that COVID-19 amplifies the existing gender gap in health. As Richardson notes, coronary heart disease “occurs at higher rates in men in almost every age group above 45.” So when these men got COVID-19, they got sicker.
This research should give men a powerful incentive to improve their overall health. That way, when, not if, another serious challenge presents itself, we won’t be disproportionately killed. Nobody knows what the next pandemic might be, but we really should try to be ready for it.
Tom Keenan is an award-winning journalist, lecturer, professor in the School of Architecture, Planning and Landscape at the University of Calgary and author of the bestselling book Technocreep: The Surrender of Privacy and the Capitalization of Intimacy.