Role of Sex and Age in Fatal Outcomes of COVID-19: Women and Older Centenarians Are More Resilient

Abstract

In the present paper, we have analysed the role of age and sex in the fatal outcome of COVID-19, as there are conflicting results in the literature. As such, we have answered three controversial questions regarding this aspect of the COVID-19 pandemic: (1) Have women been more resilient than men? (2) Did centenarians die less than the remaining older people? (3) Were older centenarians more resistant to SARS-CoV-2 than younger centenarians? The literature review demonstrated that: (1) it is women who are more resilient, in agreement with data showing that women live longer than men even during severe famines and epidemics; however, there are conflicting data regarding centenarian men; (2) centenarians overall did not die less than remaining older people, likely linked to their frailty; (3) in the first pandemic wave of 2020, centenarians > 101 years old (i.e., born before 1919), but not “younger centenarians”, have been more resilient to COVID-19 and this may be related to the 1918 Spanish flu epidemic, although it is unclear what the mechanisms might be involved.

Centenarians, Semi and Supercentenarians, COVID-19 and Spanish Flu: a serological assessment to gain insight into the resilience of older centenarians to COVID- 19

“…[26] and Caruso et al [7], there are anecdotal data suggesting potential resilience to COVID-19 in centenarians, despite surveys suggesting that overall centenarians do not exhibit greater resilience than other older individuals [11][12][13]. Overestimating these anecdotal data may re ect a cognitive bias, as it naturally emphasizes survival rather than COVID-19 mortality.…”

“…Overestimating these anecdotal data may re ect a cognitive bias, as it naturally emphasizes survival rather than COVID-19 mortality. It is worth noting that most observations involve "older" female centenarians (> 101 years old) who were infected with SARS-CoV-2 in 2020 or the early months of 2021 and either recovered spontaneously or after a short hospitalization [7].…”

“…Furthermore, exposed cohorts had excess all-cause mortality attributed to increased noncancer mortality [30][31][32][33][34][35][36][37]. Therefore, we could argue the possibility of the virus or pandemic stress also impacting the immune system, potentially leading to its enhanced resilience (see the reported cancer resistance in 32) in both surviving foetuses and children [7].…”

“…Coming back to COVID-19 older people mortality, there are con icting ndings in the literature [7]. However, this quoted review revealed the following: a) Consistent with evidence indicating that women tend to outlive men even during severe famines and epidemics, women exhibit greater resilience [8], although con icting data exist regarding female centenarians in Northern Italy [9]; b) Due to their frailty [10], centenarians, on the whole, generally succumb to COVID-19 at rates similar to or greater than other older individuals [11][12][13], with the exception of Japan, where their numbers continued to rise due to general precautions against viral infections, such as social distancing [14]; c) During the initial wave of the pandemic in 2020, before introduction of vaccines, "older" centenarians (> 101 years old) exhibited greater resilience to COVID-19 than "younger" ones (< 102 years old) [11,15].…”

The number of centenarians continues to increase during the COVID‐19 pandemic in Japan

“…The centenarians during the COVID-19 pandemic had to survive two world wars, hunger and influenza pandemics, suggesting genetic and/or epigenetic background, especially for better immune defense. [6][7][8] In addition, in Japan, it might be presumed that the centenarians could have survived the COVID-19 pandemic due to thoughtful general precautions against viral infections and the COVID-19 vaccination as a new strategy, although further studies are warranted.…”