LAUSR

Understanding gender-bias in COVID-19 infection is of paramount importance, not only from an epidemiological point of view but also in terms of clinical management. It is largely acknowledged that men and women exhibit a different degree of susceptibility to a number of infectious diseases and that this is far from being solely an exposure bias. In acute infections, women generally have a better prognosis compared to men, due to their robust and effective immune defense. Recent clinical and demographical studies on patients with COVID-19 have yielded convergent findings indicating that men might be more severely affected than women. However, in most studies, the data are not stratified by sex, thereby limiting our understanding of how gender impacts outcomes. In this article, we discuss observational clinical studies arguing that the rate of severe cases requiring intensive care is higher in men compared to women. We highlight the importance of using gender as a biological variable to determine whethermen andwomen exhibit distinct clinical and biological characteristics that could explain gender-bias. As the hallmark of the disease severity is excessive inflammation in response to viral infection, we make inferences based on the sexual dimorphism of the inflammatory response seen in different infectious models and we focus our discussion on major inflammatory processes that are relevant to COVID-19.