Examining COVID-19 gender differences

Men more likely to die, so why not in Massachusetts?

THE STATE’S DASHBOARD of COVID-19 statistics indicates that deaths from the virus are split evenly between men and women, which is surprising given that in most other states and countries around the world men represent a higher proportion of COVID-19 fatalities.

Numerous publications have reported that men tend to get more seriously ill and die in greater numbers from the coronavirus than women. No one is quite sure why that’s the case, but some are suggesting that perhaps women have stronger immune systems, or gain some protection from their female hormones. The latter idea is even being investigated, with some researchers starting to test whether the female hormones estrogen and progesterone could be used to treat COVID-19.

Based on numbers available from this week, men represent a higher proportion of total COVID-19 deaths. In New York, men make up almost 60 percent of COVID-19 deaths. In Michigan, the percentage was 54 percent; Illinois 58 percent; Louisiana 57 percent; Pennsylvania, 54 percent, and Connecticut 51 percent. New Jersey does not report deaths by sex, but recent data I found for some of the state’s most populated counties indicate men accounted for 55 percent of COVID-19 deaths.

Why is Massachusetts different? Why are men dying here at the same rate as women? Is biology different in Massachusetts? Are we somehow more aggressively and successfully treating men here who are seriously ill with COVID-19?

I think not.

In fact, I think that the most probable and straightforward answer can be found in our state’s nursing homes, which have been on fire with COVID-19 disease for a number of weeks.

Nursing homes in Massachusetts account for 57 percent of all of the state’s COVID-19 deaths. Aside from the all-male Holyoke Soldiers’ Home and the Chelsea Soldiers’ Home, nursing homes are primarily female. Of the 38,000 people in Massachusetts nursing homes, roughly 68 percent are women, according to the latest Medicare data.

So it is not that surprising that, as COVID-19 ravages nursing homes, filled primarily with older women who manifest some combination of chronic illnesses and frailty, a disproportionate number of women will die.

Other states have also seen COVID-19 outbreaks in their nursing homes, likely increasing the proportion of COVID-19 deaths in their states among women. In Rhode Island, where the majority of COVID-19 deaths involve nursing home residents, women make up about 51 percent of the 239 COVID-19 deaths reported Tuesday. In Delaware, the state with the highest proportion of its total state COVID-19 deaths coming from long-term care facilities (58 percent), the state noted on Tuesday that women accounted for 69 out of 137 deaths—just over half.

It should be of epidemiologic interest to see if this relationship between nursing home outbreaks and the sexual distribution of COVID-19 deaths plays out in other states as the pandemic continues. A very worrisome part of the country could be the Central Plains states that have some of the highest proportions of their elders living in long-term care facilities.

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Much has already been written in recent weeks about the many factors that have likely resulted in our nursing homes and other long-term care facilities being at such great risk for COVID-19 transmission. Clearly, once inside a nursing home, the virus represents a great mortality threat to facility residents, likely even more so for men. But as men are fewer in number, it will be women who in absolute terms will likely continue to bear the net absolute burden of COVID-19 mortality in these and other congregate facilities for seniors.

Gov. Charlie Baker on Monday proposed spending $130 million to try to strengthen the ability of Massachusetts nursing homes to improve care, conditions, and staffing to help fight off more COVID-19 illness. Short term, keeping residents segregated by COVID infection status and keeping outside visitors away should help reduce deaths. Herd immunity may contribute to some degree  in already infected facilities and, even longer term, a vaccine would help this vulnerable group. Let’s hope we can prevent additional deaths, as well as help all facilities mitigate harms that are likely to come if there’s another surge.