Seems like they factored in the obvious stuff, i.e. men having poorer health outcomes in general, so I wonder if this has something to do with reproduction? By that I mean women's immune systems reacting more strongly to protect a (possible) baby?

Men’s immune systems weaken with increased testosterone - speculation is that this allows them to have less immune response so they can keep hunting and fighting.

Interesting; when my wife and I both get sick we always note this recurring theme where I get this intense but brief bout of illness, and her's are more drawn out and prolonged but significantly less intense. Timewise we're talking about 1-3 day sickness for me and 1-2wk sickness on her end. That recurring observation has caused a bunch of speculation between us about evolutionary protections and stuff where perhaps the man being down has more immediate risks that can threaten the family in the protecting role or something like that. Not sure entirely but fun to imagine about.

I thought the issue was the other way around in this case -- people were having bad results from COVID due to too severe of an immune response.

How does an immune response impact physical capability?

Most of "feeling sick" isn't the actual bacteria/virus causing problems, it's your immune system doing things like raising your internal temperature to fight off the virus or generating boatloads of phlegm to do whatever that does.

A fever is the result of an immune response.

As far as I know, pregnancy suppresses the immune response in order to keep the body from attacking the baby itself. That’s why doctors recommend pregnant women not to eat under cooked eggs, sushi and other high risk food items. Flu shots are also heavily encouraged for the same reason - the flu is a lot tougher to beat.

My pet idea that I would be interested in ways to test ultimately links back to what shared restrooms for men look like. Since they have made such a big show of how much we can detect this in wastewater, I am curious if standing urinals and such contribute to higher spread.

Would amusingly fit in with many of the "why aren't crowds getting this?" It is largely crowded places with large communal restrooms that have associated outbreaks.

It looks like the virus is not really present in urine most of the time: https://www.medrxiv.org/content/10.1101/2020.05.15.20094920v...

Thanks for the link! Paper seems to go out of its way to indicate that it is just lower in urine, not absent.

Pardon me, but most men aren't splashing around in the urinals. If you're really curious what it looks like you could just go in one and have a look around... :)

Is this a joke? Just wanted to check because my own shocking results show that we're urinating all over ourselves and without doubt many droplets reach those on neighboring urinals. I bought a nice pair of wool designer shorts by D.gnak $250 and for whatever reason they have the incredible property of causing water to bead up in a way I've never seen before. While wearing them one day, I went to wash my hands and realized I was covered in 20-30 beads of liquid. Yes after using the urinal. I was horrified, soaped up a paper towel and cleaned it. I thought it was a one off event but soon realized it is IMPOSSIBLE no matter how carefully, softly, and at what angle one fires at the urinal to actually get less than 20 beads of pee on oneself. I tried for months, shocked every time. With any other type of clothing the beads don't form but the same liquid is instead instantly absorbed into the fibers.

I'm not accusing us of literally stepping into the urinal. I thought the data was fairly clear that men are worse at washing their hands than women are. And it seems a safe claim that splash back from the urinal is not zero.

That said, I'm calling this my pet idea, in large because I think it is a silly one. Do I think it is in the realm of plausible? I mean, yeah. But I don't think it has stepped into the realm of likely.

Forget washing hands, the urinals are very close to each other and there are no barriers to exhaled air. Someone sneezes, it bounces off the wall to the adjacent users.

I thought y'all were doing physical distancing long before COVID hit -- isn't there a rule against occupying adjacent stations?

In men's restrooms, you are almost certainly getting urine on you from the previous person to use the urinal. I'd be curious to see studies that quantify this.

Yeah there are sex differences in the immune system in general. For example, women get stronger immunity from vaccinations but also have more problems with autoimmune diseases.

https://doi.org/10.1007/s00281-018-00728-x

Yeah, I was most concerned about controlling for BMI, since ~all of the prior evidence for sex differences didn't/couldn't do it.

They controlled for BMI in cohort A, and performed an adjusted analysis in cohort B, so I'm somewhat satisfied on that front.

BMI isn't exactly comparable between the sexes, since males and females have different distributions of adipose and visceral fat, and the impacts of these are clearly different.

And that could maybe contribute to something. There were other studies, though, which didn't take BMI into account at all, even though high BMI is a known risk factor, and generally more men are obese than women.

I saw this study from southern California. They provide risk ratios for different factors. Seems just being male have a higher risk ratio than being overweight.

https://www.acpjournals.org/doi/10.7326/M20-3742#f1-M203742

Those kinds of effects would presumably count as "gender-specific differences". Previous investigations never really took body mass into account at all, which was...bad.

Or perhaps men produce more mucous in their respiratory system, in general?

Is that why professional baseball players can't go more than 45 seconds without spitting?

Not to mention scratching their groins. Some kind of immune response is involved in that, I'm sure. No need for the free clinic to get it cured when you're paid as much as an MLB player.

That's probably tobacco, or at least was stereotyped as such historically.

I think you're right. A bunch of ball parks are now tobacco free so it's no longer the case.

It's funny - when you watch the little league world series, the kids spit too.