Are males at a greater risk of SARS-CoV-2 infection?
Given that the human ACE2 protein is encoded on the X chromosome, this may be relevant for male-female differences in outcomes. Particularly in males with rare ACE2 coding variants as they will express those variants in all ACE2-expressing cells compared to a mosaic pattern of expression in females.235
Males may also have differences in certain innate antiviral responses compared to female counterparts.236 Outcomes in COVID-19 can be worse (~1.5-4 times worse) in terms of mortality, ICU admissions, hospitalisations95,237,238and case identifications239 for males than for females. Mortality in females can be lower by 30% up to age 60 in certain (but not all) countries. Outcomes after 60 years of age seem to continue unbalanced between the sexes.240,241