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Smoking significantly worsens COVID-19, according to a new analysis by UC San Francisco of the association between smoking and the progression of infectious disease.
In a meta-analysis of studies that included 11,590 patients with COVID, the researchers found that among people with the virus, the risk of disease progression in those who currently smoke or previously smoked was nearly twice that of nonsmokers. They also found that when the disease worsens, current or former smokers had more acute or critical conditions or death. Overall, smoking was associated with almost twice the risk of disease progression.
The report was published on May 12, 2020 in Nicotine and tobacco research.
“Smoking is associated with a substantially increased risk of COVID-19 progression,” said Stanton A. Glantz, PhD, professor of medicine and director of the UCSF Center for Research and Education for Tobacco Control. “This finding suggests that California’s ongoing strong tobacco control measures that have reduced smoking may, along with other strong state public health interventions, contribute to California’s efforts to thwart the effect of COVID-19.”
Smoking and e-cigarette use increase the risk and severity of lung infections due to damage to the upper respiratory tract and decreased overall lung immune function, although these effects have not yet been studied for SARS-VOC -2, the virus that causes COVID -19. Smokers have a higher known risk of infection and mortality from MERS-VOC, a viral respiratory illness caused by a different coronavirus.
In the new meta-analysis, the authors identified 19 peer-reviewed scientific papers published in PubMed as of April 28, 2020, which included data on smoking behavior and COVID-19 severity. The studies, from China, Korea, and the United States, were based primarily on inpatients, although two studies included inpatients and outpatients.
The reviewed studies used a variety of definitions of “smoking”, which sometimes included both current and former smokers. There was also variability in how the “progression” of the disease was defined. In addition, the reported levels of smoking were below the levels reported in the population.
Finally, a total of 11,590 patients were identified for the study: 2,133 (18 percent) experienced disease progression and 731 (6.3 percent) had a history of smoking. Among smokers, 218 patients (29.8 percent) experienced disease progression, compared to 17.6 percent of nonsmoking patients.
“The fact that smoking prevalence is lower among COVID patients than the general population has been cited as evidence of a protective effect of smoking,” said Roengrudee Patanavanich, MD, PhD, visiting researcher at the UCSF Department of Community Medicine of the Ramathibodi Hospital. at Mahidol University, Thailand. “But this low prevalence may actually be due to an underestimation of smoking, especially when considering the difficult conditions involved when caring for people in often overwhelmed health systems.”
The authors note that limitations in the bias results of studies to underestimate the risks of smoking.
All 19 studies were of patients who had already developed COVID-19, so the risk estimation report does not represent the effect of smoking on the risk of contracting COVID-19 in the general population. As evidence increases at the population level, the authors said it would be helpful to collect data on cigarette and e-cigarette use to determine what risks these behaviors pose to infection.
They suggested that both smoking cessation and smoking cessation, given the lung effects of the electronic cigarette, be added to the list of practices to mitigate the COVID-19 pandemic.
Money: The work was supported by the National Institutes of Drug Abuse awarded R01DA043950; cooperation agreement U54HL147127 of the National Heart, Lung, and Blood Institute; the Center for Food and Drug Administration for Tobacco Products; and Ramathibodi Hospital Medical School, Mahidol University, Thailand.
Disclosures: None reported.
UCSF Health is recognized worldwide for its innovative patient care, reflecting the latest medical knowledge, advanced technologies, and pioneering research. It includes the iconic UCSF Medical Center, which is among the top 10 hospitals in the country, as well as UCSF Benioff Children’s Hospitals, with campuses in San Francisco and Oakland, Langley Porter Hospital and Psychiatric Clinics, UCSF Benioff Children’s Physicians and the UCSF School of Practice. . These hospitals serve as the academic medical center of the University of California, San Francisco, which is known worldwide for its education in health sciences and biomedical research at the graduate level. UCSF Health has affiliations with hospitals and health organizations throughout the Bay Area.
