Acute respiratory distress syndrome (ARDS) is one of the main causes of high mortality among coronavirus disease 2019 (COVID-19) patients. This study aimed at determining the association between presence of chronic diseases and smoking behaviors with the development of ARDS among hospitalized COVID-19 patients in Indonesia. This study was carried out in 15 Muhammadiyah-‘Aisyiyah–affiliated COVID-19 referral hospitals in Indonesia. Four hundred ninety participants who tested positive for the COVID-19 were recruited in this study. Demographic data, history of chronic diseases, and the development of ARDS were retrieved from hospital patient records. Information about the smoking behavior was collected after respondents were discharged from the hospital. Presence of chronic diseases such as diabetes, chronic heart disease, hypertension, and chronic liver diseases were significantly associated with the development of ARDS. In a similar regard, patients who currently smoked had a 5 times greater risk of developing ARDS compared with those who never smoked.

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INTRODUCTION Indonesia is ranked fourth among countries with the highest smoking rates and has the highest number of male smokers globally. This study aimed to assess the association between cigarette smoking patterns and the severity of COVID-19 among patients in 15 Indonesian hospitals. METHODS A cross-sectional study was conducted from April to August 2020 using medical records of 490 COVID-19 patients, including the history of their smoking patterns from 15 private referral hospitals in 5 provinces. The severity was defined based on the Guidelines on the Prevention and Control of COVID-19 issued by the Indonesian Ministry of Health, which was indicated by the care provided to patients, namely outpatient, inpatient, and Intensive Care Unit (ICU) services for mild, moderate, and severe symptoms. Smoking patterns were grouped based on adult tobacco use classifications of the Centers for Disease Control and Prevention (CDC). Univariate and bivariate analyses were performed. RESULTS The results showed that 69.8% of respondents had not smoked cigarettes, 17.1% were active smokers, and 13.1% were former smokers. A significant difference was seen in the number of cigarettes smoked by patients in the ICU, inpatients, and outpatients, among current smokers and passive smokers (p=0.018 and p=0.005, respectively). Furthermore, there was no significant difference in the severity of COVID-19 among current smokers, former smokers, and nonsmokers. The time from when smoking was stopped among former smokers was not associated with the severity of COVID-19. CONCLUSIONS There was no significant difference in COVID-19 severity between groups of smokers. Passive smoking and the number of cigarettes smoked by smokers daily were associated with the severity of COVID-19. Smoke-free policies should be implemented continuously to protect people from the dangers of secondhand smoke.

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The Covid-19 pandemic has impacted various sectors such as health, social, economy, including education. Pondok Pesantren (Islamic Boarding School) is one of the educational institutions affected by the emergence of the Covid-19 pandemic. For this reason, efforts are needed in the form of Covid-19 alert activities and increasing the food security of Islamic boarding schools in the face of the COVID-19 pandemic. This activity was carried out during 2020, located at Pondok Pesantren in Bogor Regency and Depok City. This activity adopts the concept of multi-stakeholder involvement or the Helix model, namely educational institutions, business, government, and society. This community service activity consists of several activities, including Design and Distribution of Health Promotion Media related to COVID-19, Creating and duplicating Food Security Strategy (Lele Kangkung/Lekung), Online Workshop and Orientation of COVID-19, Making handwashing places in Islamic Boarding School, Monitoring and Evaluation of health behavior in Islamic Boarding School environment.