Researchers suggest that men may be more prone to getting COVID-19 (or experiencing severe symptoms) because men in China tend to smoke more than woman (288 million men versus 12.6 million woman in 2018). One study found that ACE2 expression was significantly higher in current smokers of Asian ethnicity as compared to Asian non-smokers. Although intriguing, no concrete conclusions can be drawn about this hypothesis, because, so far, it lacks strong evidence. 

Sex difference and smoking predisposition in patients with COVID-19:Reasoning 

A study of 140 COVID-19 patients in China showed an equal sex distribution, but a study of critically ill COVID-19 patients found men to be more affected (67%) compared to woman. In the most recent report of 1099 COVID-19 patients from 552 Hospitals in over 30 provinces of China, 58% of the patients were men. Overall, these data indicate men may be more susceptible to the virus. 

Smith College

COVID-19 and Gender by Geographic Location 

Cai, H. (2020). Sex difference and smoking predisposition in patients with COVID-19. The Lancet Respiratory Medicine, 8(4). doi:10.1016/s2213-2600(20)30117-x
https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30117-X/fulltext?utm_source=mp-fotoscapes

Sex difference and smoking predisposition in patients with COVID-19

Data were used from a case series of 43 patients, a public data set of the first 37 cases of patients who died of COVID-19 and 1,019 patients who survived in China, and information about 524 patients with SARS (139 deaths) from Beijing in 2003. 

Gender Differences in Patients With COVID-19: Focus on Severity and Mortality: Background Information

Sex difference and smoking predisposition in patients with COVID-19: Results

- The Iwasaki Group examined sex differences in viral loads, SARS-CoV-2-specific antibody titers, plasma cytokines, as well as blood cell phenotyping in COVID-19 patients with moderate disease who had not received immunomodulatory medications. 

- The study revealed that male patients had higher plasma levels of innate immune cytokines such as IL-8 and IL-18 along with more robust induction of non-classical monocytes. In contrast, female patients mounted significantly more robust T cell activation than male patients during SARS-CoV-2 infection, which was sustained in old age. 

- Researchers also found that a poor T cell response negatively correlated with patients’ age and was associated with worse disease outcome in male patients, but not in female patients. Conversely, higher innate immune cytokines in female patients associated with worse disease progression, but not in male patients. 

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