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Men Have More Severe Coronavirus Symptoms. What About Boys?

Studies have shown men have more severe coronavirus symptoms than women. The same is not necessarily true for boys.

Men and women have the same risk of contracting COVID-19, but what happens after they get infected varies with sex. Men are more likely to get severely ill from the disease and are 2.4 times more likely to die, according to a recent study. A complex mix of factors, including biology and lifestyle, put men in harm’s way. Like father, like son, do boys share that risk?

Probably not. So far, the evidence doesn’t point to it, says Susan Hassig, an epidemiologist at Tulane University School of Public Health & Tropical Medicine. “Young boys don’t have a lot of risk,” she says.

One study from the Centers of Disease Control and Prevention (CDC) found that boys are slightly more likely than girls to get COVID-19. Yet this conclusion is unreliable. Because of the way the study was conducted, it’s impossible to tell whether their sample reflects reality, though Hassig doubts it. “I am not aware of any biologic factors that would make boys at more risk of coronavirus infection than girls,” she says.

Though girls and boys may be on an equal playing field in terms of the coronavirus, boys, in general, pick up more infectious diseases and have more severe responses to them, according to a 2014 study. Girls and women have stronger immune systems — a double-edged sword. They are more likely to have autoimmune disorders, but they are also less likely to contract many infectious diseases and get severely ill from them.

Girls and women’s stronger immune systems are largely due to genetics and sex hormones. Females have two copies of the X chromosome, which contains many immune-related genes, while males only have one. And estrogen, more abundant in women, boosts the immune system, but testosterone slightly suppresses it. That’s why some doctors are running trials in which they treat male COVID-19 patients with estrogen and progesterone, another sex hormone higher in women, according to the New York Times.

Men may also get more severely ill from COVID-19 because they have a higher blood concentration of a protein that helps the virus enter healthy cells, according to a new study in older adults with heart failure.

Social factors also make men more likely to develop severe COVID-19 if infected. Men in the U.S. smoke more than women, and smoking increases the risk, according to a new study. Men are also less likely to wash their hands, including after using the bathroom, coughing and sneezing, and handling money. They are 50 percent less likely than women to use non-pharmaceutical methods to protect themselves, such as avoiding crowds and wearing masks, during respiratory disease epidemics and pandemics, according to a 2016 study.

What is true for men’s behavior is not necessarily true for boys under the watchful eyes of their parents. And in general, children who get COVID-19 handle the disease well. Few get severely sick, and many are asymptomatic and don’t even realize they have the disease. As the data comes in, could this understanding change? Experts don’t have a definitive grasp on the question of boys or girls with the data available, so yes, it may turn out boys are at higher risk. But it may not really matter. Even if boys are more likely to get seriously sick, their overall risk would be low because the risk for kids is low. So teach your son healthy habits, and keep an eye out for worrying symptoms and focus on dad’s health. He’s the one who is at greater risk.