COVID-19 Reasons WhY: The XX Advantage (Nature) & Mask-ulinity (Nurture) (Reasons 2–7)

Women are naturally hotter than men by .17°C, women are more likely to wear glasses than men, your COVID risk may depend on the sex (and height) of who you’re walking with, & hunters may be more likely to break quarantine than gatherers.

In this article, we continue our discussion of why women survive COVID19 at significantly higher rates than men; a trend that is visible around the world.

Coauthor: Brian Gutierrez, M.S., CPT, UQ — Ochsner M.D. Candidate
Coauthor: Yasmine Saraf, B.S.
Coauthor: Daniel Javidi, B.S.

Quiz

Katniss Swan learns she is pregnant & celebrates with her magically happy husband Harry. During pregnancy, the baby’s protection from disease is provided by the immune system of which soon-to-be parent?

A. Katniss’ immune system because Katniss is pregnant
B. Harry’s immune system because Katniss is pregnant
C. Edward’s immune system because he’s hotter than Jacob

Correct answer & explanation provided below.

By @ATJCagan (Not Katniss, but still awesomeness)

We now present reasons 2–7 of women’s survival advantage against COVID

Reason 1 — Contraception — can be read here.

2β. Women are Naturally Hotter Than Men

Women are naturally hotter than men (Neff et al., 2016; Waalen & Buxbaum, 2011) & COVID may be more potent at lower body temperatures (Kang & Ellgen, 2020).

Per Kang & Ellgen (2020) → “Lower temperatures may make the upper respiratory tract exceptionally conducive to SARS-CoV-2 replication… as lower core body temperatures may enable more rapid viral growth.

There are substantially more men with unusually low body temperatures than there are women: a large cross-sectional study found that mean body temperature is 0.17°C lower in men than in women. The heat sensitivity of COVID19 suggests that the virus benefits from decreases in temperature from 37°C to 33°C.”

Thus, low body temperature, a characteristic more prevalent in men than women, is “a significant risk factor for COVID-19” (Kang & Ellgen, 2020).

The most deaths/yr occur in December-February. This can be partially attributed to:
- lower temperatures
- less sunlight → higher Vitamin D deficiency
- less exercise (least amount of exercise per year is in December)
- not eating as healthy in December as in July/August

3β. Mask-ulinity

It was long opined that the male ego is as fragile as a flower.
Upon reflection, that was disrespectful to flowers.

Women aren’t concerned that wearing a mask will hurt their femininity. Men show reluctance to wear masks due to their fear that wearing masks will harm their sense of masculinity (Capraro and Barcelo, 2020).

Belongingness & Mask Adherence

Women are significantly more likely to adhere to wearing a mask than men. In a study of mask adherence while outside on campus here at UC San Diego from August 10th to September 6th, we found that women were more likely to adhere overall, and that sex difference was more pronounced for individuals outside walking with someone else.

Sexual Composition & Mask Adherence

Both men & women are less likely to wear a mask in opposite-sex groups that are numerically even (mostly dyads). However, women are strikingly more likely to wear a mask in majority male groups… because males.

#WearAMask

Masks help protect the people wearing them & the people they may encounter (Chu et al., 2020; Johansson, 2020; Leung et al., 2020; Seminara et al., 2020; Sommerstein et al., 2020; Viola et al., 2020). Wearing a mask is simultaneously egoistic & altruistic. It’s patriotic. It moral.

Sidenote 1 → Women may benefit from increased nasal resistance after taking off their mask. Indeed, individuals who wear a mask for 3 hours or longer experience a period of nasal resistance due to nasal physiological changes (Zhu et al., 2014).

4β. Social Distancing

Counties with a higher proportion of women exhibited greater adherence to social distancing (Okten et al., 2020). You’ll have even greater appreciation of this observation when considered in the context of gender socialization.

Walking: Ladies First vs. Tall Men First

In opposite-sex dyads, males usually walk in front of women (Costa, 2009). In addition, in mixed-height dyads, the taller person usually walks in the front. In the human population, the average height for men is 5–9, for women is about 5-4, and only 1% of women are 5 feet 11 inches or taller (Willis et al., PrePrint). Stated differently, women are more likely to be positioned behind a taller, haphazardly unmasked male, while walking.

Given that males are less likely to be wearing a mask, this puts the women positioned downwind of their male friends & baes at higher risk. As such, our novel policy recommendation is Ladies First.

Gender Socialization of Spacing

Males friend groups tend to walk & sit down at greater distances from each other than female friend groups (Aiello 1987; Crawford & Unger 2000; Hall 1984; Heshka & Nelson 1972). Male friends are less likely to use a public bathroom at the same time compared to female friends due to the codified laws of BroCode (Elizabeth Plank, 2019 — For the Love of Men).

Given that female friends tend to interact at closer distances than male friends, the finding that adherence to social distancing is higher in areas with more women is truly praiseworthy.

It indicates that women have enacted a greater degree of adjustment in their behavior than men.

It also makes the other side of the coin that much more disappointing, as the fact that men historically walk at greater distances from each other should have given them a head start in adherence to social distancing.

[Image Above]
Straight male friends are far less likely than female friends (of any orientation) to lay down in close proximity to each other as displayed in the image above…

..It’s the reason why this bed scene near the end of Superbad was funny in the first place
[Image Below]

Superbad (but also see Scott Pilgrim vs the World)

Center of the Sidewalk vs. The Sides

Finally, men are more likely to walk down the center of the sidewalk. To quote Jessica Nathanson (2010): “Walking down the middle of the sidewalk is a male entitlement, as is expecting others to get out of one’s way in other crowded spaces. …it is also a way of performing maleness, so that NOT doing these things marks one as less than manly.”

— — — — —

Sidenote 2 → Putting 2β & 3β together, Marchiori (2020) found that people (ironically) create distance between themselves & someone wearing a mask than someone NOT wearing a mask. The mask is a salient cue reminding people of COVID health recommendations, which leads to people creating more space when passing by someone wearing a mask.

Sidenote 3 → If mandrills, ants, honeybees, & lobsters can successfully practice social distancing, so can humans (Lucy Hicks, 2020).

5β. Wash Your Hands, Man

Women are significantly more likely to wash their hands (Cory Clark et al., 2020; Everett, 2020; Park et al., 2010).

That sense of safety when it says “Mary” is preparing your ‘za as opposed to “Harry Chad

6β. Women Wear Glasses More Than Men

Chu et al. (2020) reported that eye protection reduced the risk of infection by 48–78%.

Women are more likely to be prescribed glasses & research suggests that glasses are helpful for preventing COVID19 (Chu et al., 2020; Edwan, 2020; Lu et al., 2020; Yan et al., 2020).

Of course, masks, social distancing, & washing your hands still matter most, but wearing glasses (which may be ranked in 4th place) is also recommended.

According to the Vision Council of America, approximately 75% of adults use some sort of vision correction (~64% eyeglasses; ~11% contact lenses, either exclusively, or with glasses).

Over ~50% of women & about 42% of men wear glasses.

Similarly, more women (18%) than men (14%) wear contacts. Of those who use both contacts and eyeglasses, 62% wear contact lenses more often.”

Males & Wearing Contacts (connecting reason 5-Handwashing)

Individuals who already wear contacts should obviously continue to do so, but handwashing is of paramount importance. Given that males are less likely to thoroughly wash their hands than women, and the fact that the eye is a site of potential infection, glasses may be safer than contacts for males at this time.

— — — — —

But what if my glasses or goggles get foggy/misty?
Aisling B. McGlacken-Byrne (2020) → “wash goggles and lenses with soapy water. This creates a thin surfactant film that reduces surface tension, causing the water molecules to spread out evenly into a transparent layer, reducing misting.

VisionWorks → Pull Your Mask Higher On Your Nose
This is a common method among medical professionals. Consider wearing your mask higher on your face and using your glasses to hold the mask in place or weigh it down so air doesn’t escape from the top as you exhale.”

Important note: glasses are NOT the same thing as proper goggles. However, given the difficulty of encouraging adherence to the mask economy, it’s unlikely that the goggle economy would fare any better. Never say never, but until fashionable goggles are on sale at Target & Etsy, please keep wearing your glasses.

7β. Of Hunters & Gatherers: You Can’t Hunt in Quarantine

Despite the fact that the sex ratio is 1 at UCSD, significantly more males were observed on campus than females during our August 11th — September 6th study of mask adherence, (1, N = 910) = 43.36, p < .001.

X2(1, N = 910) = 43.36, p < .001

This is consistent with other research finding that males are more likely to break quarantine than females (Lima et al., 2020).
Males would rather electrocute themselves than be bored (Wilson et al., 2014). This may help explain what happened in Michigan in mid-Spring: many males reached their threshold of boredom.

Put simply, males are less likely to adhere to quarantine for as long as women. Indeed, hunters may be driven to abandon quarantine sooner than gatherers.

— — — — — — — — — — — — — — — — — — — —

Quiz Answer =^.^=

The answer is obviously A.
Given the importance of XX in humans not going extinct, it makes perfect evolutionary sense that women have a stronger immune system than men.

At no point in a man’s life is he going to have provide immunity for himself & another life developing inside of his body for 9 months.

— — — — — — — — — — — — — — — — — — — —

Here are the previously mentioned studies documenting an XX Advantage against COVID (months are reported instead of year, because obviously): Antonio Guimarães et al., September;
Berlin et al., May;
Chakravarty et al., July;
Chengzhen Dai et al., October;
Conti et al., April;
Di Stadio et al., April;
Ding et al., July;
Jeremy Gold et al., April;
Jin et al., April;
Kabarriti et al., September;
Nascimento et al., March;
Price-Haywood et al., June;
Richardson et al., April;
Sara Cromer et al., September;
Scully et al., June;
Silvia Munoz-Price et al., September;
Takahashi et al., June;
Tian Gu et al., October;
Wang et al., 2020;
Wenham et al., March;
Yehia et al., August;
Zhao et al., 2020;
Zijian et al., 2020.

Outtakes

When researchers want to create an antibody to study, they use a female animal, not a male. You get more antibodies” (Richtel, 2019, p. 215).

Men have an immunological clock
→ T cell responses to COVID are negatively correlated with age in men; not women (Takahashi et al., June).

Do not clean your glasses with toothpaste.
Toothpaste can have grainy substances mixed in, such as baking soda, that can cause abrasions on your lenses making it more difficult to see.

Saving this discussion for one of our next 19 Reasons pieces

References

Chan, K. H., Peiris, J. M., Lam, S. Y., Poon, L. L. M., Yuen, K. Y., & Seto, W. H. (2011). The effects of temperature and relative humidity on the viability of the SARS coronavirus. Advances in virology, 2011.

Kang, D., & Ellgen, C. (Preprints, May). The role of temperature in COVID-19 disease severity and transmission rates. https://www.preprints.org/manuscript/202005.0070/v1

Takehiro Takahashi et al. “Sex differences in immune responses to SARS-CoV2 that underlie disease outcomes.” Posted on medRxiv.org on June 9, 2020.

I'm passionate about making a tangible difference in the lives of others, & that's something I have the opportunity to do a professor & researcher.

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