Descriptive characteristics of hospitalized adult smokers and never-smokers with COVID-19

Abstract

A meta-analysis done by Guo 1 that was published in Tobacco Induced Diseases, reported a pooled odds ratio of 2.20, concluding that active smoking is significantly associated with the risk of severe COVID-19. Another current meta-analysis reported greater odds of COVID-19 progression among smokers compared to never smokers 2. Most of the studies in these meta-analyses were from China and focused only on cigarette smoking 1,2. Here, we describe characteristics of tobacco use among 193 confirmed COVID-19 patients who were interviewed during their hospitalization from 15 March to 15 April 2020, in the Imam-Khomeini Hospital of Ardabil University of Medical Sciences (ArUMS) in Iran. The protocol was approved by the Institutional Review Board of Ardabil University of Medical Sciences (Approval ID: IR.ARUMS.REC.1399.044) and verbal informed consent was obtained from the patients. All patients tested positive for SARS-CoV-2 by nasopharyngeal swabs using real-time reverse-transcription-polymerase-chain-reaction (rRT-PCR) assay; they were at least 18 years old and willing to participate in an approximately 5-min interview. Interviews were administrated in the first two days of hospitalization to collect information regarding demographics, COVID-19-associated symptoms, and use of tobacco products including waterpipe (WP, hookah), cigarettes, and e-cigarettes. As shown in Table 1, 15 (7.8%) and 14 (7.3%) of the patients reported current (past-month) WP or cigarette use, respectively. No patients were dual WP/cigarette or e-cigarette users. Of the 14 cigarette smokers, 2 had cardiovascular disease (CVD), 1 chronic respiratory illness, 1 diabetes, 2 other conditions (e.g. kidney illness or rheumatoid arthritis), and 4 reported having >1 chronic condition. Among 15 WP smokers, 3 reported having CVD, 1 other condition, and 2 having >1 chronic condition. The average time between the onset of symptoms and hospitalization was approximately 4 days for WP smokers, 3 days for cigarette smokers, and 5 days for neversmokers. More than half (n=8) of cigarette smokers and 40% (n=6) of WP smokers reported their COVID-19 symptoms as severe compared to 22% (n=36) of never-smokers. In line with a previous report 3 , the most common COVID-19 symptoms were fever and dry cough, which did not differ significantly between smokers (cigarettes or WP) and never-smokers. However, shortness of breath was reported more frequently by cigarette smokers compared to never-smokers and WP smokers. Body pain was reported more frequently among WP smokers compared to cigarette smokers and never-smokers.

Tobacco use as a well-recognized cause of severe COVID-19 manifestations

“…A study in Iran showed that among 193 confirmed COVID-19 patients, more than half of cigarette smokers and 40% of waterpipe smokers reported their COVID-19 symptoms as severe compared to 22% of never-smokers [34]. In a retrospective study, an observational cohort study of 112 in-patient adults, diagnosed with COVID-19, between March 12 and April 16, 2020, in Los Angeles, smoking history along with obesity and elevated inflammatory markers was associated with an increased need for invasive mechanical ventilation in patients with COVID-19 [35].…”

COVID‐19 and tobacco products use among US adults, 2021 National Health Interview Survey

“…Unlike other tobacco products that are typically used solitarily, hookah smoking usually occurs in groups, where smokers often pass the same hose to smoke with friends 26 . It is possible that because of the sharing culture of hookah smoking, smokers are more concerned regarding the risk of infection, 27 therefore, were more likely to get tested for COVID‐19. Although it is hard to parse out the pipe from a hookah in NHIS (since they were asked within the same item), this finding has important public health implications while awaiting future studies to explore vaccine hesitancy and acceptance based on the specific type of tobacco product as well as the pattern of use (e.g., intensity and frequency).…”