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Why does coronavirus kill more men than women? Researchers may have found an important clue.
Men take longer to clear COVID-19 from their systems; a male-only coronavirus repository may be why.
- A new study found that women clear coronavirus from their systems much faster than men.
- The researchers hypothesize that high concentrations of ACE2-expressing cells in the testes may store more coronavirus.
- There are many confounding factors to this mystery—some genetic, others social and behavioral.
There's much we don't know about novel coronavirus. We don't know how the virus leaped from bats to humans—though pangolins seem the intermediate hosts. We don't know the levels of antibodies among recovering individuals or if warmer weather will curb the virus's transmission rate.
One of the more perplexing COVID-19 mysteries is why the disease kills men at roughly twice the rate of women. As of this writing, New York City has suffered 146 COVID-19 deaths for every 100,000 men, according to the city's Health Department data. Conversely, 84 women have died in the city per 100,000. Men have also been hospitalized at a higher rate.
"More than two-thirds of the intubated patients are men," Dr. Joseph Lowy, a palliative care and hospice doctor at NYU Langone Health, told the New York Times. "I know of no other disease that has that type of predilection for one gender over another [excluding reproductive diseases]."
But a recent study may have found an important clue in solving this mystery—a potential coronavirus repository found only in men.
Where is coronavirus hiding?
A laboratory technician at Queen Elizabeth University Hospital, Glasgow, holds a container of test-tube samples from people tested for novel coronavirus.
The study, uploaded to MedRxiv, found that men take longer to clear the virus from their systems than women. Researchers at Montefiore Health System and Albert Einstein College of Medicine, in collaboration with Kasturba Hospital for Infectious Diseases, Mumbai, nasal swabbed patients to determine an active COVID-19 infection.
They then retested the individuals every day until the tests turned negative. The women took a median time of four days to clear the virus, while the men's median time was six days.
"COVID-19 studies worldwide have consistently shown a higher incidence and greater severity of the disease in men compared with women," Aditi Shastri, assistant professor of medicine at Einstein College and lead author of the study, said in the release. "Our collaborative study found that men have more difficulty clearing coronavirus following infection, which could explain their more serious problems with COVID-19 disease."
For coronavirus to infect a cell, it must latch onto an angiotensin-converting enzyme II, or ACE2. These enzymes are attached to the cellular membranes of cells in organs such as the heart, lungs, kidneys, and intestines.
The researchers theorize that bodily areas with cells sporting high levels of ACE2 would be more susceptible to infection. After consulting three independent RNE expression databases, they found that ACE2 was highly expressed in testicular cells but had little expression in ovarian cells.
Taking men's slow viral clearance and the ACE2 expression of testicular cells together, they hypothesize that the testes may serve as a repository for the virus, explaining its extended occupancy in men.
Further research required
The Montefiore-Einstein study is currently preliminary, and further research will be required before researchers can determine what, if anything, its results illuminate.
Preprints allow researchers to communicate their findings before official publication, which can take months if not a year or longer. This pre-publication can lead to early feedback, increased visibility, and new collaborations. It's especially helpful for early-career researchers trying to establish themselves.
However, given the speed at which coronavirus is spreading, researchers have leaned on preprints as a means of disseminating data to other experts faster than the peer review allows. As a result, Medrixiv has seen a surge of preprint studies, but they must be read within the context of their preliminary status.
The Montefiore-Einstein also has its limitations. The study had an initial sample size of only 68 subjects (48 males, 20 females) and a further examination of three families. And the connection of coronavirus to ACE2 enzymes in the testes came from database research, not direct observation.
The researchers acknowledge the need for further investigation. In particular, Shastri stresses the need to confirm the coronavirus's ability to infect and multiply in testicular tissue. If other researchers find their data promising, they could move forward with new research to build upon the study and see if this clue fits into the mystery.
One clue among many
Coronavirus protesters in Los Angeles. Men are more likely than women to disregard health warnings from officials.
Men's severe response to COVID-19 could be due to several factors, of which a viral repository is just one. Another could simply be the fact that men are, well, men.
"We see that even among individuals without known health issues and in children, males have worse outcomes," Ryan Steele, an assistant professor of clinical medicine in rheumatology, allergy, and immunology at Yale School of Medicine, told Health. "This would indicate that the underlying differences in the immune response among genders may play a larger role than we have appreciated so far."
Women have a far stronger immune system response, which researchers think may stem from their second X chromosome. Since the largest number of immune-related genes are X-linked, women may get a boost in immune expression—though, they are more at risk of autoimmune diseases. Hormones may play a role, too. Estrogen has been shown to activate the cells involved in antiviral responses, while testosterone suppresses inflammation.
Scientists can't rule out behavioral factors either. In the United States, men are more likely to be smokers than women and more likely to suffer from alcohol use disorder. Smokers are in the high-risk group for COVID-19, while heavy alcohol use has been shown to suppress a wide range of immune responses.
Men have also been shown to delay seeking medical care, wash their hands less frequently, and be more disregarding of health warnings about the coronavirus.
"There are profound sex differences in immune systems, and this pandemic is revealing them," Marcia Stefanick, professor of medicine at Stanford University School of Medicine, told the Wall Street Journal. "What is biology versus what are our social norms and gender behaviors confounds our ability to understand what's going on."
While we wait for researchers to separate the clues from the red herrings, men can do their part: Listen to the experts, seek care when necessary, and washing your hands.
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- How does coronavirus compare to the flu? - Big Think ›
What is human dignity? Here's a primer, told through 200 years of great essays, lectures, and novels.
- Human dignity means that each of our lives have an unimpeachable value simply because we are human, and therefore we are deserving of a baseline level of respect.
- That baseline requires more than the absence of violence, discrimination, and authoritarianism. It means giving individuals the freedom to pursue their own happiness and purpose.
- We look at incredible writings from the last 200 years that illustrate the push for human dignity in regards to slavery, equality, communism, free speech and education.
The inherent worth of all human beings<p>Human dignity is the inherent worth of each individual human being. Recognizing human dignity means respecting human beings' special value—value that sets us apart from other animals; value that is intrinsic and cannot be lost.</p> <p>Liberalism—the broad political philosophy that organizes society around liberty, justice, and equality—is rooted in the idea of human dignity. Liberalism assumes each of our lives, plans, and preferences have some unimpeachable value, not because of any objective evaluation or contribution to a greater good, but simply because they belong to a human being. We are human, and therefore deserving of a baseline level of respect. </p> <p>Because so many of us take human dignity for granted—just a fact of our humanness—it's usually only when someone's dignity is ignored or violated that we feel compelled to talk about it. </p> <p>But human dignity means more than the absence of violence, discrimination, and authoritarianism. It means giving individuals the freedom to pursue their own happiness and purpose—a freedom that can be hampered by restrictive social institutions or the tyranny of the majority. The liberal ideal of the good society is not just peaceful but also pluralistic: It is a society in which we respect others' right to think and live differently than we do.</p>
From the 19th century to today<p>With <a href="https://books.google.com/ngrams/graph?year_start=1800&year_end=2019&content=human+dignity&corpus=26&smoothing=3&direct_url=t1%3B%2Chuman%20dignity%3B%2Cc0" target="_blank" rel="noopener noreferrer">Google Books Ngram Viewer</a>, we can chart mentions of human dignity from 1800-2019.</p><img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDg0ODU0My9vcmlnaW4ucG5nIiwiZXhwaXJlc19hdCI6MTY1MTUwMzE4MX0.bu0D_0uQuyNLyJjfRESNhu7twkJ5nxu8pQtfa1w3hZs/img.png?width=980" id="7ef38" class="rm-shortcode" data-rm-shortcode-id="9974c7bef3812fcb36858f325889e3c6" data-rm-shortcode-name="rebelmouse-image" />
American novelist, writer, playwright, poet, essayist and civil rights activist James Baldwin at his home in Saint-Paul-de-Vence, southern France, on November 6, 1979.
Credit: Ralph Gatti/AFP via Getty Images
The future of dignity<p>Around the world, people are still working toward the full and equal recognition of human dignity. Every year, new speeches and writings help us understand what dignity is—not only what it looks like when dignity is violated but also what it looks like when dignity is honored. In his posthumous essay, Congressman Lewis wrote, "When historians pick up their pens to write the story of the 21st century, let them say that it was your generation who laid down the heavy burdens of hate at last and that peace finally triumphed over violence, aggression and war."</p> <p>The more we talk about human dignity, the better we understand it. And the sooner we can make progress toward a shared vision of peace, freedom, and mutual respect for all. </p>
Scientists find that bursts of gamma rays may exceed the speed of light and cause time-reversibility.
- Astrophysicists propose that gamma-ray bursts may exceed the speed of light.
- The superluminal jets may also be responsible for time-reversibility.
- The finding doesn't go against Einstein's theory because this effect happens in the jet medium not a vacuum.
Jet bursting out of a blazar. Black-hole-powered galaxies called blazars are the most common sources detected by NASA's Fermi Gamma-ray Space Telescope.
Cosmic death beams: Understanding gamma ray bursts<div class="rm-shortcode" data-media_id="cu2knVEk" data-player_id="FvQKszTI" data-rm-shortcode-id="c6cfd20fdf31c82cb206ade8ce21ba3f"> <div id="botr_cu2knVEk_FvQKszTI_div" class="jwplayer-media" data-jwplayer-video-src="https://content.jwplatform.com/players/cu2knVEk-FvQKszTI.js"> <img src="https://cdn.jwplayer.com/thumbs/cu2knVEk-1920.jpg" class="jwplayer-media-preview" /> </div> <script src="https://content.jwplatform.com/players/cu2knVEk-FvQKszTI.js"></script> </div>
Is Bitcoin akin to 'digital gold'?
- In October, PayPal announced that it would begin allowing users to buy, sell, and hold cryptocurrencies.
- Other major fintech companies—Square, Fidelity, SoFi—have also recently begun investing heavily in cryptocurrencies.
- While prices are volatile, many investors believe cryptocurrencies are a relatively safe bet because blockchain technology will prove itself over the long term.
Presentation slide from Sanja Kon's presentation on the evolution of money at 2020 Web Summit
Credit: Sanja Kon<p>The move came shortly after the payments company Square invested $50 million into Bitcoin, and after Fidelity announced that it was opening a Bitcoin fund into which qualified purchasers could invest <a href="https://www.bloomberg.com/news/articles/2020-08-26/fidelity-launches-inaugural-bitcoin-fund-for-wealthy-investors" target="_blank">(minimum investment: $100,000)</a>. Together, this institutional backing might have something to do with Bitcoin's recent surge back to near its 2017 price peak of $19,783. (Bitcoin is listed at 19,384.30 as of Dec. 3.)<br></p>
Presentation slide from Sanja Kon's presentation on the evolution of money at 2020 Web Summit
Credit: Sanja Kon<p>But more importantly, it suggests cryptocurrencies might soon have the opportunity to prove themselves in real-world use cases. After all, skeptics have long doubted the ability of cryptocurrencies to go mainstream as a form of everyday payment. But people seem increasingly comfortable with digital payment systems.</p><p style="margin-left: 20px;">"The entire world is going to come into digital first," Schulman said at Web Summit, adding that PayPal's services already go hand-in-hand with cryptocurrencies. "As we thought about it, digital wallets are a natural complement to digital currencies. We've got over 360 million digital wallets and we need to embrace cryptocurrencies."</p><p>Sanja Kon, vice president of global partnerships at the cryptocurrency payments processor company UTRUST, also spoke at Web Summit about the increasing adoption of digital payments:</p><p style="margin-left: 20px;">"Physical cash is becoming more and more obsolete. And the next step in the evolution is digital currency."</p><p>Kon noted some of the inherent advantages of cryptocurrencies, namely ownership. </p><p style="margin-left: 20px;">"For many people, this is really the main benefit of cryptocurrency: Users owning cryptocurrencies are able to control how they spend their money without dealing with any intermediary authority like a bank or a government, for example," Kon said, adding that there are no bank fees associated with cryptocurrencies, and that international transaction fees are significantly lower than wire transfers of fiat currency.</p><p>Kon said cryptocurrencies have unique growth opportunities in areas where people aren't integrated into modern banking systems:</p><p style="margin-left: 20px;">"With cryptocurrencies and blockchain, with the use of just a smartphone and access to internet, Bitcoin and cryptocurrencies can be available to populations of people and users without access to the traditional banking system."</p>
Bitcoin as 'digital gold'<p>Still, it could take years for people to start using cryptocurrencies for everyday purchases on a large scale. Despite this, many cryptocurrency advocates see digital currencies, particularly Bitcoin, as a way to store value—digital gold, essentially.</p><p style="margin-left: 20px;">"I don't think Bitcoin is going to be used as a transactional currency anytime in the next five years," billionaire investor Mike Novogratz recently told <a href="https://www.bloomberg.com/news/articles/2020-10-23/novogratz-says-bitcoin-is-digital-gold-not-a-currency-for-now?srnd=markets-vp" target="_blank">Bloomberg</a>. "Bitcoin is being used as a store of value. [...] "Bitcoin as a gold, as digital gold, is just going to keep going higher. More and more people are going to want it as some portion of their portfolio."</p><p>There are obvious parallels between gold and Bitcoin: Both are mined, do not degrade over time, are finite in supply, and aren't directly tied to the value of fiat currency, making them <a href="https://www.reuters.com/article/us-gold-inflation/gold-as-an-inflation-hedge-well-sort-of-idUSKCN1GD516" target="_blank" rel="noopener noreferrer">relatively invulnerable to inflation</a>. The obvious objection is that the price of Bitcoin, and cryptocurrencies in general, is far more volatile than gold.</p><p>But for investors who believe the inherent value of cryptocurrency technology will prove itself over the long term, these price fluctuations are just bumps on the long road to the future of currency. </p><p style="margin-left: 20px;">"It's no longer a debate if crypto is a thing, if Bitcoin is an asset, if the blockchain is going to be part of the financial infrastructure," Novogratz said. "It's not if, it's when, and so every single company has to have a plan now."</p>
Singapore has approved the sale of a lab-grown meat product in an effort to secure its food supplies against disease and climate change.
Approve for your dining pleasure<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="dd3f57f8baf14e654812d30a309d1f17"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/307gysA18_E?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span><p><a href="https://www.ju.st/en-us" target="_blank" rel="noopener noreferrer">Eat Just</a>, a company that produces animal-alternative food products, announced the news earlier this week. In what the company is calling a world first, Singapore has given it permission for a small-scale commercial launch of their GOOD Meat brand product line. For the initial run, the cultured chicken meat will be sold as an ingredient in "chicken bites."</p><p>"Singapore has long been a leader in innovation of all kinds, from information technology to biologics to now leading the world in building a healthier, safer food system. I'm sure that our regulatory approval for cultured meat will be the first of many in Singapore and in countries around the globe," Josh Tetrick, co-founder and CEO of Eat Just, <a href="https://www.businesswire.com/news/home/20201201006251/en/Eat-Just-Granted-World%E2%80%99s-First-Regulatory-Approval-for-Cultured-Meat" target="_blank" rel="noopener noreferrer">said in a release</a>.</p><p>According to the release, Eat Just underwent an extensive safety review by the Singapore Food Agency. It provided officials "details on the purity, identity and stability of chicken cells during the manufacturing process, as well as a detailed description of the manufacturing process which demonstrated that harvested cultured chicken met quality controls and a rigorous food safety monitoring system." It also demonstrated the consistency of its production by running more than 20 cycles in its 1,200-liter bioreactors.</p><p>While Eat Just did not offer details on its propriety process, it likely follows <a href="https://www.newscientist.com/article/mg24032080-400-accelerating-the-cultured-meat-revolution/" target="_blank" rel="noopener noreferrer">one similar to other lab-grown meats</a>. It starts with muscle cell samples drawn from a living animal. Technicians then isolate stem cells from the sample and culture them <em>in vitro</em>. These cultured stem cells are then placed in a bioreactor, essentially a fermenter for fleshy cells. The bioreactor contains scaffolding materials to keep the growing tissue from falling apart as well as a growth material—the sugars, salts, and other nutrients the tissue needs to grow. As the cells grow, they begin to differentiate into the muscle, fat, and other cells of meat tissue. Once grown, the tissues are formed into a meat product to be shipped to restaurants and supermarkets.</p>
An abattoir abatement?<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDg2Mjg5OS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYyODg1NDI3N30.AYmFJfWQbPjK-o1IatyFHL-OLjcfXBMmQKYyvz4oT3s/img.jpg?width=980" id="8a82d" class="rm-shortcode" data-rm-shortcode-id="93f824fe4c6f397ab2b65e4665847e71" data-rm-shortcode-name="rebelmouse-image" />
A graph showing the number of animals slaughtered in the United States per year from 1961–2018.
Credit: Our World in Data<p>Singapore's approval is an important step in support for clean meats—so-called because they don't require animal slaughter and would likely leave a reduced carbon footprint—but hurdles remain before widespread adoption is possible.</p><p>The most glaring is the price. The first lab-grown hamburger was eaten in London in 2013. <a href="https://www.bbc.com/news/science-environment-23576143" target="_blank" rel="noopener noreferrer">It cost roughly $330,000</a>. As with any new technology, investment, iteration, and improved manufacturing will see the price drop substantially and quickly. For comparison, Eat Just's chicken will be priced equivalent to premium chicken.</p><p>Other hurdles include up-scaling production, <a href="https://www.nature.com/articles/d41586-019-00373-w" target="_blank" rel="noopener noreferrer">the need for further research</a>, and developing techniques to reliably produce in-demand meats such as fish and beef. Finally, not all countries may be as receptive as Singapore. Countries with large, entrenched meat industries may protect this legacy industry through a protracted and difficult regulatory process. Though, the meat industry itself is investing in lab-grown meat. Tyson Foods, for example, has <a href="https://euromeatnews.com/Article-Tyson-Foods-announces-investment-in-clean-meat/697" target="_blank" rel="noopener noreferrer">invested in the food-tech startup Memphis Meats</a>, the company that debuted the world's first beef meatball.</p><p>"I would imagine what will happen is the U.S., Western Europe and others will see what Singapore has been able to do, the rigours of the framework that they put together. And I would imagine that they will try to use it as a template to put their own framework together," <a href="https://www.reuters.com/article/us-eat-just-singapore/singapore-approves-sale-of-lab-grown-meat-in-world-first-idUSKBN28C06Z" target="_blank" rel="noopener noreferrer">Tetrick told Reuter's during an interview</a>.</p><p>Regardless of the challenges, the demand for meat substitutes is present and growing. In 2020, plant-based substitutes like Beyond Meat and Impossible foods <a href="https://bigthink.com/coronavirus/plant-based-meat" target="_self">gained a significant foothold in supermarkets</a> as meat-packing factories became coronavirus hotspots. The looming threat of climate change has also turned people away from meat as animal products. Livestock production is environmentally taxing and leaves <a href="http://css.umich.edu/factsheets/carbon-footprint-factsheet" target="_blank" rel="noopener noreferrer">a much larger carbon footprint</a> than grain and vegetable production. </p><p>Then there's the moral concern of animal cruelty. In 2018 alone, 302 million cows, 656 million turkeys, 1.48 billion pigs, and a gob-smacking 68 billion chickens were <a href="https://ourworldindata.org/grapher/animals-slaughtered-for-meat" target="_blank" rel="noopener noreferrer">slaughtered for meat worldwide</a>. And those figures do not include chickens killed in dairy or egg production.</p><p>If brought to scale and widely available, clean meats could become serious competitors to traditional meat. <a href="https://bigthink.com/technology-innovation/meat-alternatives" target="_self">One report has even predicted</a> that 60 percent of the meat people eat by 2040 won't come from slaughtered animals. It could be just the thing for people looking for a meat substitute but who find tofurkey as distasteful as, well tofurkey.</p>