ReviewBiology of sex differences2020
Sex differences in severity and mortality from COVID-19: are males more vulnerable?
Review in Biology of sex differences, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 178 papers, 4 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
178 citing papers in PubMed, 4 syntheses or guidelines pooled it, 320 citations in OpenAlex.
- The Effect of COVID-19 on Male Sex Hormones: A Meta-Analysis of Prospective Cohort Study.Journal of epidemiology and global health · 2024Pooled it
- Male Sex Is Associated With Worse Microbiological and Clinical Outcomes Following Tuberculosis Treatment: A Retrospective Cohort Study, a Systematic Review of the Literature, and Meta-analysis.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2021Pooled it
- Sickness and the Social Brain: Love in the Time of COVID.Frontiers in psychiatry · 2021Pooled it
- Pooled it
- Trial
- Endogenous Sex Hormones Explain Variation in Long-Term SARS-CoV-2 Antibody Persistence Beyond Biological Sex.Antibodies (Basel, Switzerland) · 2026Article
- Sex-Specific Association of Toll-like Receptor 8 Polymorphisms with COVID-19 Case Status in a Korean Population.Life (Basel, Switzerland) · 2026Article
- Prognostic Value of the Lactate-to-Albumin and C-Reactive Protein-to-Albumin Ratios in COVID-19-Associated ARDS.Journal of clinical medicine · 2026Article
- Association between dental plaque index and COVID-19 severity: a cross-sectional study in a conflict-affected humanitarian setting.BMC oral health · 2026Article
- Predictors of Mortality in COVID-19 Patients Presenting With Gastrointestinal Bleeding: A Retrospective Cross-Sectional Study.Health science reports · 2026Article
- Androgens protect ILC2S from functional suppression during influenza virus infection.Mucosal immunology · 2026Article
- Characteristics of COVID-19 cases and factors associated with disease severity in Lao People's Democratic Republic: a nationwide study.BMC infectious diseases · 2026Observational
- Electrophysiological and Molecular Features of Remdesivir-Induced Cardiac Toxicity in Male and Female Guinea Pigs.International journal of molecular sciences · 2026Article
- SARS-CoV-2 infection reduces the number of spermatogonial stem cells and dysregulates the transcriptional landscape of the human testis.Research square · 2026Article
- Symptom progression and viral shedding dynamics in children and adolescents with asymptomatic and mild COVID-19 infections.BMC infectious diseases · 2026Article
- COVID-19 primary infection, reinfection, and its associated clinical presentations.Frontiers in public health · 2026Article
- Assessing the impact of COVID-19 pandemic on all-cause mortality and child mortality in a population cohort of Iganga Mayuge HDSS in Eastern Uganda (2015-2021).Population health metrics · 2025Article
- Who got tested and who got sick? Sociodemographic inequalities in COVID-19 testing and hospitalization among 1.48 million individuals in Sweden.European journal of epidemiology · 2025Article
- Hospital readmission rates and factors due to COVID-19 reinfections: a registry-based cohort study in Brazil (2020-2022).BMC public health · 2025Article
- MDR Bacteremia in the Critically Ill During COVID-19: The MARTINI Study.Pathogens (Basel, Switzerland) · 2025Observational
118 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
2 authors at 1 institution in 1 country.
Funding
Abstract
Coronavirus disease 2019 (COVID-19) has shown high infection and mortality rates all over the world, and despite the global efforts, there is so far no specific therapy available for COVID-19. Interestingly, while the severity and mortality of COVID-19 are higher in males than in females, the underlying molecular mechanisms are unclear. In this review, we explore sex-related differences that may be contributing factors to the observed male-biased mortality from COVID-19. Males are considered the weaker sex in aspects related to endurance and infection control. Studies show that viral RNA clearance is delayed in males with COVID-19. A recent study has indicated that the testis can harbor coronavirus, and consequently, males show delayed viral clearance. However, the role of testis involvement in COVID-19 severity and mortality needs further research. Males and females show a distinct difference in immune system responses with females eliciting stronger immune responses to pathogens. This difference in immune system responses may be a major contributing factor to viral load, disease severity, and mortality. In addition, differences in sex hormone milieus could also be a determinant of viral infections as estrogen has immunoenhancing effects while testosterone has immunosuppressive effects. The sex-specific severity of COVID-19 infections indicates that further research on understanding the sex differences is needed. Inclusion of both males and females in basic research and clinical trials is required to provide critical information on sex-related differences that may help to better understand disease outcome and therapy.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.