New York City has become the center of the battle against COVID-19 here in the United States. While it’s infecting all people across the state, new numbers show that it’s hitting men harder and killing them at twice the rate. Per the city’s health department, there are 932 cases per 100,000 men versus women who have 712 cases for every 100,000. Men are having to be hospitalized with severe disease at higher rates with 228.7 admissions for every 100,000 men to only 140.3 admissions for every 100,000 women. When it comes to fatalities, there have been nearly 43 deaths for every 100,000 men, whereas there are only 23 deaths for every 100,000 women.

These numbers don’t really come as a surprise because similar situations were seen in China and Italy. In China, they reported a 2.8 percent fatality rate among men and only a 1.7 percent rate among women. In Italy, the fatality rate was 8 percent for men and 5 percent for women. Here in the US, the disparity isn’t just in New York City. California has reported the number of infected individuals to be 7,296 men and 6,740 women.

The reason for this isn’t really know yet. Some experts feel that it’s the result of behavior differences between the genders, such as men are more likely to smoke than women. Other experts think it’s related to biological differences, like the fact women have more robust immune systems than men as the result of the extra estrogen in their bodies. Another potential explanation may have to do with angiotensin-converting enzyme 2 (ACE2). This is a protein on the surfaces of cells the lungs and other organs that is key in regulating blood pressure. This is controlled differently between the genders and men are more likely to heart disease and high blood pressure earlier in life than women. The issue is that COVID-19 binds to ACE2, which can impact blood pressure and other factors.

Some good news is that children are less likely than adults to be impacted by the virus. Currently, they only make up a small portion of the infected cases. In addition, they’re less likely to become seriously ill or die, although three children have died so far. The Center for Disease Control recently released a study saying that children are less likely to experience the same symptoms that adults do, such as fever, cough or shortness breath. The study reported that only 2,572 of the nearly 150,000 confirmed coronavirus cases reported between February 12th and April 2nd were patients under 18 with the median age being 11. This indicates that they can contract the virus, but may only have mild or no symptoms. The study did point out that children with the highest risk for serious complications include very young children (under the age of 1) and those with underlying health conditions.

Experts are looking at several theories as to why this is happening. One leading thought is that the ACE2 receptor is not expressed as prominently in young children or might be a different shape than it is in adults. This means that the virus might have more difficulty attaching to and entering cells, which is necessary for the virus to replicate and spread throughout the body. An additional theory is that children’s immune systems don’t respond as forcefully to the virus as adults. In adults, this process can quickly get out of control and cause as much damage as the infection.

The concern with children having minimal, or no, symptoms is that they could still spread the disease to others. This is why it’s vital to know at what rate the virus is impacting them. Also, knowing the rate at which spread is occurring among children is essential to deciding how to manage the pandemic in relation to when schools should reopen. In addition, it could give a clearer picture as to how to predict future waves of infection.