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Keenan: COVID and its complications not in men’s favour

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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’s not done with us. Shocking data from the United Kingdom’s statistics agency revealed that 1 out of 13 people there had been infected with the COVID-19 virus in just a single recent week.

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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. Fortunately, it is also less likely to land you in the hospital or the ICU, especially if you are vaccinated and boosted.

While the overall COVID-19 case numbers reported to the Public Health Agency of Canada skew slightly in the female direction (966,543 compared to 900,448 males), there are some uniquely male features of COVID-19. All this data is based on biological sex, which can be different from gender identity.

A recent article by Georgios Karaigas of the University of Iceland found that “male COVID-19 patients appear to be at higher risk of 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’s website, “The 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 U.S. by Mendel Singer and colleagues found that males are definitely more likely to have this complication of COVID-19. The adjusted rates were 450 cases per million in teenage males and 213 per million for comparable females. One expert speculated that males in this age range may mount a particularly robust immune reaction. As Karaigas notes, when infected immune cells invade the heart muscle, “the host responds with systemic inflammation and cytokine storm” and the person’s heart muscle cells become collateral damage.

It’s important to note that, even in teenage males, myocarditis after COVID-19 is a very rare complication. Rarer still is myocarditis after vaccination with one of the mRNA vaccines. According to a presentation of U.S. data given by Dr. John Su of the Centers for Disease Control (CDC), “As of Oct 6, 2021, a total of 402,469,096 doses of COVID-19 vaccines were administered … with 3,336 reports of myocarditis and pericarditis.” That gives an astronomically low rate, in the same range as your child’s chance of getting struck by lightning.

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Therefore, Dr. Su, and his employer, the CDC, definitely recommend vaccination, even for teenage males. On an information webpage from the Children’s Hospital of Philadelphia, cardiologist Dr. Matthew Elias summarizes the situation as follows: “the risk of getting COVID-19 and developing severe illness that could seriously impact the heart is far greater than the risk of experiencing post-vaccine myocarditis.”

It’s also worth noting that these heart complications in young people tend to be temporary and relatively mild. In Dr. Su’s report, 77 per cent of the myocarditis and pericarditis cases in people under the age of 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 puzzle out why men are more vulnerable to serious COVID-19 outcomes than women, other factors include biology, genetics and lifestyle. The coronavirus uses an enzyme called ACE2 to break into cells, and men tend to have a higher concentration of that enzyme. Also, having two X-chromosomes may give women a stronger immune system.

Lifestyle factors were prominent in early studies coming out of China. Researchers there noted that Chinese men were much more likely to smoke than women and to work in riskier occupations.

A recent U.S. study led by Harvard researcher Sarah Richardson found significant state-by-state variation. In Texas, men were more likely to die of COVID-19 than women in every week studied. In Connecticut, women were more likely to die of COVID-19 in 22 of the 55 weeks reviewed. Richardson and colleagues speculate that occupation may be important since industries like construction and agriculture, which are somewhat male-dominated, have higher risks of COVID-19 exposure. Behavioural factors, like mask-wearing and adhering to public health guidelines were also factors where males seemed to be lagging, at their own peril.

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Aside from discovering how much the data varied by geography, one of the key insights of this study was that COVID-19 amplified the existing health gender gap. As Richardson notes, coronary heart disease “occurs at higher rates among men in nearly every age stratum above 45 years.” So when these men got COVID-19, they got sicker.

This research should give males a powerful incentive to improve health in general. That way, when, not if, another serious challenge comes along, we won’t get killed off disproportionately. 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, public speaker, professor in the School of Architecture, Planning and Landscape at the University of Calgary, and author of the best-selling book, Technocreep: The Surrender of Privacy and the Capitalization of Intimacy.

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