Coronavirus exposes gulf between the sexes Janice Turner in The Times 10.04.20

The original article is here.

How can a strong, healthy man be taken so quickly? Not an overweight or an elderly guy, but a Park Run regular, a lycra-clad cyclist, the bloke you ask to shift that heavy table or open a stubborn jar. How are men with years, decades maybe, of active, productive, non-doddery life ahead just being snuffed out?

Sue Martin, a Cardiff civil servant, spoke of her bafflement this week that her husband, Mal, 58, well enough to walk out to the waiting ambulance, now has scant chance of survival. My friends with much older male partners are terrified, forbidding them from shopping and slathering them in anti-bacterial gel. Others with fit, middle-aged husbands were aghast when our force-of-nature, 55-year-old PM entered intensive care. We are more worried for our menfolk than ourselves.

This virus likes to play its cruel wild card, slaying a student, a healthy young mother or a 13-year-old boy. But mainly its appetite is predictable: the very old, the already unwell, the obese and, all research so far shows, mainly men.

In Britain, 61 per cent of Covid-19 recorded deaths are male. This trend, first observed in China, where 2.8 per cent of male cases died compared with 1.7 per cent of women, was initially ascribed to far more Chinese men smoking. But in Italy the male-female mortality rate is 7.2 to 4.1 per cent, and the sexes smoke about the same.

All the NHS doctors who have so far died are men (and from ethnic minorities) including retired physicians Alfa Saadu, 68, and the Essex GP Habib Zaidi, 76. After 40 years’ service, they’d earned their pensions and were entitled to sit this crisis out. But what quiet courage in returning to the medical front line, clear-eyed that you’re the most likely to die.

In fact the coronavirus has exposed the masculine health paradox. Men, who have the greater outward strength, have bigger hearts and lungs, build more muscle, run fastest and lift the heaviest weights, are internally the weaker sex. We’ve rolled our eyes at husbands for lingering in bed with man-flu, wondered why their cuts seem to heal slower than ours and put it down to whingeing self-pity or never washing their hands.

We may have noted that common, cussed male refusal to see a doctor: “Oh stop fussing, I’ll be fine . . .” A machismo that they can soldier on, keep working, that — as with Boris Johnson — they’re indispensable and invincible. Men are far less likely to see a GP, especially if single, without a partner to kick them down to the surgery. They are more obese or overweight than women, more likely to get type 2 diabetes, and less likely to manage it well. They are more commonly boozers and smokers. All factors hamstringing their fight against the virus.

Now we know superior female strength is internal: we may lose every Olympic race to men but we ace the long game. More boys are born, 105 to 100 girls, because nature knows that by the age of 40 this will have evened out. Women are better at enduring famine, infections and cancer. There is an inbuilt female health advantage at every age, from surviving premature birth to living longer as wiry, seemingly indestructible old ladies like my mother: eight in ten centenarians are women. It helps that the greatest female health risk — death in childbirth — has, at least in developed nations, largely been tamed.

But with Covid-19, as with other viruses, the sex factor is stark. This, argues Sharon Moalem, author of The Better Half, is because women are stronger at genetic level. Females have two X chromosomes — one from their mothers, the other from fathers — but males have only a single X, and a Y from their fathers. Having two Xs, says Dr Moalem, can offer a survival advantage because, in essence, women have a spare, meaning fewer congenital birth abnormalities or developmental disabilities such as autism.

And in a pandemic that double X is a true blessing: one X chromosome in a cell can spot the invading virus, while the other X works on killing cells that are infected already. With just a single X and a weedier Y, men lack that double-barrelled protection. Moreover, higher levels of testosterone in men, says Dr Moalem, repress the immune system, while oestrogen stimulates it.

How extraordinary that it took Covid-19 to expose the absurdity of an utterly unscientific argument gaining mainstream traction, and posed as recently as the Labour leadership election, that biological sex is not real but an artificial construct, randomly “assigned” to babies at birth. In fact, sex is coded in our very cells and, as this epidemic reveals, can affect our odds for life or death.

Yet despite these stark differences there has been a paucity of sex aggregated data to help fight the virus and find a possible cure. The Lancet argues this week that “obscuring sex and gender differences in treatment and vaccine development could result in harm”. In Invisible Women, the author Caroline Criado Perez exposed how the default patient in medical research is invariably male, as women with their variable hormone levels are thought to skew data. As Dr Moalem writes: “The medical establishment has largely overlooked the profound chromosomal, hormonal and anatomical uniqueness of genetic females.”

Already, The Lancet notes, the lockdown burdens of impoverishment, housework, care for children and the elderly have fallen disproportionately upon women, while there has been a global rise in domestic violence. But the virus itself is killing more men and this male fragility is a terrifying shock.