HEALTHPLAN MAGAZINE

In the last few months Coronavirus (Covid-19) has spread fear and anxiety all around the world.

To date over 113,000 people worldwide have been infected, with over 4,000 losing their lives to the disease.

China, where the outbreak began, has been the most affected country with 80,924 confirmed cases and 3,140 deaths, this is according to the World Health Organisation (WHO).

At the time of writing, stats from the WHO, also show that Italy has 9,172 cases confirmed, with 463 deaths. South Korea has 7,513 confirmed cases and 54 deaths and Spain has 1,703 cases confirmed with 35 deaths.

So who is more at risk?

This week the Chinese Centre for Disease Control and Prevention (CDC) published the largest analysis on Coronavirus to date. Figures showed that although men and women have both been infected in equal measures, more men have actually died.

The study case looked at 44,000 people and showed that 1.7% of infected women have died, compared to 2.8% of infected men and just 0.2% of children and teenagers have died compared to nearly 15% of people over the age of 80.

In previous outbreaks such as Sars and Mers, which were also caused by coronaviruses, men again were disproportionately affected.

In 2003, in Hong Kong, more women than men were actually infected by Sars, but according to a study published in the Annals of Internal Medicine, the death rate among men was 50% greater.

Again in the case of the Middle East Respiratory Syndrome, 32% of men infected died, compared to 25.8% of women and during the influenza epidemic in 1918, young adult men also died at a higher rate than their female equals.

Why are men more at risk?

Scientists say that there are a number of key factors that could be working against men in this current Coronavirus epidemic, including some that are down to their lifestyle and some that are biological.

When it comes to fighting infections and despite the stereotypes, men are the weaker sex.

Sabra Klein, a scientist who studies sex differences in viral infections at the John Hopkins Bloomberg School of Public Health said “This is a pattern we’ve seen with many viral infections of the respiratory tract — men can have worse outcomes. We’ve seen this with other viruses. Women fight them off better”.

Regarding lifestyle, men are more likely to smoke than women and this puts them at higher risk when it comes to this type of disease. There is evidence that having a pre-existing lung-related illness definitely increases the risk as does having a non-smoking related condition such as asthma.

Why are women less at risk?

It is no surprise to scientists that there is a difference between the death rates of men and women from the coronavirus, as they have seen the same effect in many other infections including the flu.

Women produce stronger immune responses after having vaccinations. They also have enhanced memory immune responses, these protect adults from pathogens that they were exposed to as children.

“There’s something about the immune system in females that is more exuberant,” said Dr Janine Clayton, director of the Office of Research on Women’s Health at the National Institutes of Health.

There are also differences in how the immune systems of men and women respond to infections.

Prof Paul Hunter, from the University of East Anglia claims "Women have intrinsically different immune responses to men. Women are more likely to suffer from auto-immune diseases, and there is good evidence that women produce better antibodies to vaccines against flu,"

Another factor is of course smoking, fewer women smoke compared to men and we all know that smoking damages your lungs.

This may be a particular problem in China, where it is estimated that only 3% of women smoke compared to 52% of men.

How are children affected by the Coronavirus?

There are important differences between an adult’s immune system and that of a child’s.

During childhood, the immune system is still immature and tends to overact. That is why high temperatures (fevers) are so common.

An immune system that goes into overdrive is never a good thing because it can damage the rest of the body and is one of the reasons why the coronavirus can be deadly.

"You'd expect it to go haywire and it's not doing that,” said Dr Nathalie MacDermott, from King's College London.

"There must be something this virus does that is not as readily stimulating the immune system in children, but what that is is unclear.

"They don't seem to be mounting a disproportionate immune response and some seem to be asymptomatic.

"My concern is we haven't had enough cases to really know what the mortality is, particularly in the under-ones and newborn infants," Dr MacDermott continues.

With very limited information on how the Covid-19 affects children, it can only be said that at present the symptoms appear to be a fever, runny nose and a cough.

Generally, you would expect the very young among us to be quite poorly and this is certainly the case in illnesses such as the flu, where children under five years of age are at a higher risk of complications.

There have been cases where there have been some severe complications, for instance, those with other health problems. Children with health problems such as a weakened immune system or severe asthma will be at greater risk.

Overall though the virus appears to be milder in children.

Why are the elderly more at risk?

This is a combination of two things, firstly they have a much weaker immune system and secondly they have a body that is less able to cope, as we know that our immune system gets weaker as we get older.

"The quality of the antibodies you produce when you're 70 is a lot worse than when you're 20," says Professor Hunter.

There are also some suggestions that older men may be more prone to high levels of inflammation which can become deadly.

A lifetime of wear-and-tear takes its toll on your body's organs and that, unfortunately, leaves you less able to survive an infection.

"If you're 95 and your kidney function is already at 60% of what it used to be and then you hit it with something else, then your kidneys may no longer be functioning at the level required for life," says Dr MacDermott.

Those at higher risk are people with pre-existing medical conditions. The highest death rates are from people who suffered from cardiovascular disease, Diabetes, Chronic Respiratory Disease, Hypertension and Cancer.

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