1/4

So far all existing data show smokers are underrepresented in Covid19 hospitalization data

2 studies from the US

1. https://www.medrxiv.org/content/10.1101/2020.04.08.20057794v1

2.https://www.medrxiv.org/content/1... href=" https://twitter.com/phil_w888/status/1245115268910559232">https://twitter.com/phil_w888...
2/4

13 studies from China

https://www.qeios.com/read/article/561">https://www.qeios.com/read/arti...
3/4

Germany
https://www.aerzteblatt.de/archiv/213454 

France
https://www.aerzteblatt.de/archiv/21... href=" https://fr.calameo.com/read/0062175782dac24c23c92">https://fr.calameo.com/read/0062...
4/4

The default "Smoking makes everything worse" is premature & irresponsible.

Afaik there are no data regarding cannabis consumption & Covid-19.

As for vaping https://abs.twimg.com/emoji/v2/... draggable="false" alt="👇" title="Down pointing backhand index" aria-label="Emoji: Down pointing backhand index"> https://reason.org/commentary/fda-finally-concedes-theres-no-evidence-linking-vaping-to-covid-19-infections/">https://reason.org/commentar...
FDA Finally Concedes There’s No Evidence Linking Vaping To COVID-19 Infections

There is currently no evidence from anywhere in the world showing vapers to be at higher risk for COVID-19.

https://reason.org/commentary/fda-finally-concedes-theres-no-evidence-linking-vaping-to-covid-19-infections/
5/4

The data consistently show that former smokers are more at risk of serious outcomes than current smokers.
6/4
7/4 More from France

"Our cross sectional study in both COVID-19 out- and inpatients strongly suggests that current smokers have a very much lower probability of developing symptomatic or severe SARS-CoV-2 infection as compared to the general population" https://www.qeios.com/read/article/569">https://www.qeios.com/read/arti...
Low incidence of daily active tobacco smoking in patients with symptomatic COVID-19

Importance: As the pandemic of COVID-19 is still under progression, identification of prognostic factors remains a global challenge. The role of cigarette smoking has been suggested among the...

https://www.qeios.com/read/article/569
8/

West Virginia USA: Current smoking rate was 25.2% in 2018.

Source (slide 6) https://dhhr.wv.gov/COVID-19/Pages/default.aspx">https://dhhr.wv.gov/COVID-19/...
9/ US Veterans Age 54-75

"Current smoking (OR 0.45, 95% CI 0.35-0.57), alcohol use disorder (OR 232 0.58, 95% CI 0.41- 0.83), and COPD (OR 0.67, 95%CI 0.50-0.88) were associated with decreased likelihood of Covid-19+."

https://www.medrxiv.org/content/10.1101/2020.04.09.20059964v1.full.pdf">https://www.medrxiv.org/content/1...
10/

France

"The protection associated with smoking in our study was very substantial (75% decrease in risk of infection), and deserves full attention."

https://www.medrxiv.org/content/10.1101/2020.04.18.20071134v1.full.pdf">https://www.medrxiv.org/content/1...
11/

Georgia USA (adult smoking rate was 16.1% in 2019)

"Among 305 patients hospitalized with COVID-19....Current smoking was reported for 5.2% of patients." https://www.cdc.gov/mmwr/volumes/69/wr/mm6918e1.htm?s_cid=mm6918e1_w">https://www.cdc.gov/mmwr/volu...
Characteristics and Clinical Outcomes of Adult Patients Hospitalized..

This report characterizes a cohort of hospitalized adults with coronavirus disease 2019 (COVID-19) in Georgia in which black patients were overrepresented and one in four hospitalized patients ...

https://www.cdc.gov/mmwr/volumes/69/wr/mm6918e1.htm?s_cid=mm6918e1_w
12/

Oregon USA (adult smoking rate was 15.6% in 2019)

Out of 73 deaths, only one was a smoker.

https://govsite-assets.s3.amazonaws.com/U2Ui9gUiSxG1oSnXa3hf_COVID-19-Weekly-Report-2020-04-28-FINAL.pdf">https://govsite-assets.s3.amazonaws.com/U2Ui9gUiS...
13/

1536 patients at 169 hospitals (121 in US, 48 in 10 other countries)

"5.5% were current smokers"

Smoking rates in all 11 countries are considerably higher.

https://www.nejm.org/doi/full/10.1056/NEJMoa2007621">https://www.nejm.org/doi/full/...
14/

Korea (adult smoking rate was 21.1% in 2018)

Small study: Of 27 hospitalized, 5 (18.5%) were smokers.

https://jkms.org/DOIx.php?id=10.3346/jkms.2020.35.e142">https://jkms.org/DOIx.php...
15/

UK (adult smoking rate was 14.7% in 2018)

Of 5,924 patients, 8.7% were smokers. https://www.medrxiv.org/content/10.1101/2020.04.23.20076042v1">https://www.medrxiv.org/content/1...
Features of 16,749 hospitalised UK patients with COVID-19 using the ISARIC WHO Clinical Character...

Objective: To characterize the clinical features of patients with severe COVID-19 in the UK. Design: Prospective observational cohort study with rapid data gathering and near real-time analysis,...

https://www.medrxiv.org/content/10.1101/2020.04.23.20076042v1
16/

UK (adult smoking rate was 14.7% in 2018)

Large study: Of 5,564 deaths, 7% were smokers.

https://www.medrxiv.org/content/10.1101/2020.05.06.20092999v1.full.pdf">https://www.medrxiv.org/content/1...
17/

Italy (adult smoking rate was 23.7% in 2016)

Of 441 hospitalized patients, 4.8% were smokers.

https://www.medrxiv.org/content/10.1101/2020.05.05.20092015v1.full.pdf">https://www.medrxiv.org/content/1...
18/

Spain

170 patients diagnosed with Covid-19

"A negative association was observed between tobacco consumption (0.52 95%CI 0.27-0.98) and the use of electronic cigarettes (0.45 95%CI 0.28-0.71) and SARS-CoV-2 infection." https://www.jmir.org/preprint/19949?fbclid=IwAR3gavGTaIw_URTvVOYSaalGESkuMREAt9QGFmn7ebWLYhOf0L1CtTOznzU">https://www.jmir.org/preprint/...
Association of SARS-CoV-2 infection to smoking and e-cigarettes

Background: The coronavirus disease 2019 (COVID-19) is spreading worldwide. Several factors have been studied in relation to SARS-CoV-2 infection. One of the factors that has been related and in...

https://www.jmir.org/preprint/19949?fbclid=IwAR3gavGTaIw_URTvVOYSaalGESkuMREAt9QGFmn7ebWLYhOf0L1CtTOznzU
19/

This isn& #39;t new evidence, but it& #39;s the peer-reviewed version of the systematic review & meta-analysis of 13 Chinese studies linked above.

https://link.springer.com/epdf/10.1007/s11739-020-02355-7?sharing_token=9aNfxYYmI9m0a0AEOqO4hve4RwlQNchNByi7wbcMAY6Um969fwMRMGkG7soSlel82g6JjjI30pnhpaXi7InCRG8S9pXibOijaUcVNRdyaIKy0Yh1AHq9ot2KL40oGM5pY2LpPIe2o_JKCQpUGq-GlP3BgJln3oSmdSwNJQotTV4%3D">https://link.springer.com/epdf/10.1...
20/

New York City, USA (adult smoking rate was 13.4% in 2017)

Of 393 hospitalized patients, 5.1% were current smokers

(There might be some overlap between this study & the study in the first tweet of this thread) https://www.nejm.org/doi/full/10.1056/NEJMc2010419">https://www.nejm.org/doi/full/...
Clinical Characteristics of Covid-19 in New York City | NEJM

Correspondence from The New England Journal of Medicine — Clinical Characteristics of Covid-19 in New York City

https://www.nejm.org/doi/full/10.1056/NEJMc2010419
21/

Switzerland (adult smoking rate was 27.1% in 2017)

Of 200 hospitalized patients, 4.5% were smokers.

https://www.medrxiv.org/content/10.1101/2020.05.11.20097741v1.full.pdf">https://www.medrxiv.org/content/1...
22/

Mexico (adult smoking rate was 17.6% in 2016)

Of 10,544 cases, 8.96% were smokers.

https://www.medrxiv.org/content/10.1101/2020.05.11.20098145v1.full.pdf">https://www.medrxiv.org/content/1...
23/

Kuwait (adult smoking rate was 22.5% in 2015)

Of 1,096 hospitalized cases, 4% were smokers.

Note: sample was 81% male. Male smoking rate in Kuwait was 43% in 2018.

https://www.medrxiv.org/content/10.1101/2020.05.09.20096495v1.full.pdf">https://www.medrxiv.org/content/1...
24/

China (adult smoking rate was 26.6% in 2018)

Of 202 hospitalized patients, 7.9% had a history of smoking. https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0008280">https://journals.plos.org/plosntds/...
Clinical findings of patients with coronavirus disease 2019 in Jiangsu province, China: A retrosp...

Author summary We reported the epidemiology, clinical laboratory, radiological characteristics, treatment, and clinical outcomes of 202 confirmed cases of COVID-19 in 8 hospitals from 8 cities of...

https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0008280
25/

3,799 patients in the UK

Smokers were half as likely as non-smokers to test positive for COVID-19

https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30371-6/fulltext">https://www.thelancet.com/journals/...
26/

China (adult smoking rate was 26.6% in 2018)

Of 121 hospitalized patients, 5% were smokers.

https://www.medrxiv.org/content/10.1101/2020.05.12.20099739v1.full.pdf">https://www.medrxiv.org/content/1...
27/

Hong Kong (adult smoking rate was 10% in 2017)

Small study: of 37 hospitalized patients, 2 were current smokers (5.9%) https://www.preprints.org/manuscript/202005.0285/v1">https://www.preprints.org/manuscrip...
Clinical, Laboratory, and Radiological Features Indicative of Novel Coronavirus Disease (COVID-19)...

(1) Background: It is unclear whether the reported presenting clinical features of coronavirus disease 2019 (COVID-19) are useful in identifying high-risk patients for early testing and isolation in...

https://www.preprints.org/manuscript/202005.0285/v1
28/

China (adult smoking rate was 26.6% in 2018)

Of 285 hospitalized patients, 11% had a history of smoking.

https://www.researchsquare.com/article/rs-27390/v1">https://www.researchsquare.com/article/r...
29/

China (adult smoking rate was 26.6% in 2018)

Of 208 hospitalized patients, 5.8% were smokers

https://www.researchsquare.com/article/rs-23842/v1">https://www.researchsquare.com/article/r...
30/

China (adult smoking rate was 26.6% in 2018)

Of 220 hospitalized patients, 12.8% had a history of smoking. This one includes smoking index data. Smoking index number is cigarettes per day x years smoked.

https://www.researchsquare.com/article/rs-26776/v1">https://www.researchsquare.com/article/r...
31/

China (adult smoking rate was 26.6% in 2018)

Of 134 hospitalized patients, 10.4% were smokers.

https://www.researchsquare.com/article/rs-26416/v1">https://www.researchsquare.com/article/r...
32/

China (adult smoking rate was 26.6% in 2018)

Of 142 hospitalized patients, 9.1% were smokers

https://www.researchsquare.com/article/rs-23614/v1">https://www.researchsquare.com/article/r...
33/

Very small study from China

"Based on the expression of ACE2 in smoking individuals, it is inferred that long-term smoking might be a risk factor for 2019-nCoV, and in this study, We showed the evidence against that finding."

https://www.researchsquare.com/article/rs-24743/v1">https://www.researchsquare.com/article/r...
34/

China (adult smoking rate was 26.6% in 2018)

Reported: "There were more smokers (8.84% vs 1.36%, P = 0.006)...in the severe group than in the mild group."

Not mentioned: 5.1% of the 292 hospitalized patients had a history of smoking.

https://www.researchsquare.com/article/rs-23272/v1">https://www.researchsquare.com/article/r...
35/

New Mexico USA (adult smoking rate was 17.5% in 2017)

An outlier. Of 50 hospitalized patients, 48% were smokers. It& #39;s not clear whether current smokers or people with a history of smoking were counted.

https://www.medrxiv.org/content/10.1101/2020.05.15.20094284v1.full.pdf">https://www.medrxiv.org/content/1...
36/

China (adult smoking rate was 26.6% in 2018)

Of 101 hospitalized medical staff, 4 were smokers.

https://www.researchsquare.com/article/rs-28753/v1">https://www.researchsquare.com/article/r...
37/

Spain (adult smoking rate was 24% in 2019)

Of 54 patients with inflammatory rheumatic disease who were hospitalized with Covid-19, 5.56% were smokers.

https://www.medrxiv.org/content/10.1101/2020.05.14.20101584v1.full.pdf">https://www.medrxiv.org/content/1...
38/

France (adult daily smoking rate was 27% in 2017)

Of 108 cancer patients who tested positive, 19% were active smokers.

https://www.medrxiv.org/content/10.1101/2020.05.14.20101576v1.full.pdf">https://www.medrxiv.org/content/1...
39/

London, UK (adult smoking rate was 13.9% in 2018)

Of 75 cancer patients who tested positive, 9.3% were current smokers.

https://www.medrxiv.org/content/10.1101/2020.05.12.20094219v1.full.pdf">https://www.medrxiv.org/content/1...
40/

North Carolina, USA (adult smoking rate was 17.4% in 2019)

Of 86 hospitalized patients, 3.5% were current or former smokers.

https://www.medrxiv.org/content/10.1101/2020.05.14.20099234v1.full.pdf">https://www.medrxiv.org/content/1...
41/

China (adult smoking rate was 26.6% in 2018)

Of 145 hospitalized patients, 10.3% had a history of smoking.

This is a peer-reviewed article that appears to use the same data as the preprint in tweet 32, but the numbers are slightly different. https://link.springer.com/article/10.1007/s15010-020-01432-5?utm_source=sn">https://link.springer.com/article/1...
Clinical characteristics of 145 patients with corona virus disease 201

The aim of this study was to investigate the clinical characteristics of Corona Virus Disease 2019 in Taizhou, China. A single center retrospective observational study was performed between Jan 1,...

https://link.springer.com/article/10.1007/s15010-020-01432-5?utm_source=sn
42/

China (adult smoking rate was 26.6% in 2018)

Of 125 hospitalized patients, 12.8% had a history of smoking https://www.sciencedirect.com/science/article/pii/S1201971220302034">https://www.sciencedirect.com/science/a...
Epidemiological and clinical features of 125 Hospitalized Patients with COVID-19 in Fuyang, Anhui,...

To investigate the epidemiological and clinical features of patients with COVID-19 in Anhui province of China.In this descriptive study, we obtained e


https://www.sciencedirect.com/science/article/pii/S1201971220302034
43/

China (adult smoking rate was 26.6% in 2018)

Of 73 hospitalized patients, 10.9% had a history of smoking https://www.sciencedirect.com/science/article/pii/S1043661820311294">https://www.sciencedirect.com/science/a...
Epidemiological and clinical characteristics analysis of COVID-19 in the surrounding areas of...

Since December 2019, new COVID-19 outbreaks have occurred and spread around the world. However, the clinical characteristics of patients in other area


https://www.sciencedirect.com/science/article/pii/S1043661820311294
44/

Toronto, Canada (Ontario current smoking rate age 12 and over was 15.2% in 2017)

Of 226 hospitalized patients, 15.9% were current or former smokers https://www.sciencedirect.com/science/article/pii/S1386653220300809">https://www.sciencedirect.com/science/a...
Severity of coronavirus respiratory tract infections in adults admitted to acute care in Toronto,...

The World Health Organization has highlighted the need for improved surveillance and understanding of the health burden imposed by non-influenza RNA r


https://www.sciencedirect.com/science/article/pii/S1386653220300809
45/

New York City, USA (adult smoking rate was 13.4% in 2017)

Of 257 critically ill patients, 13% were current or former smokers https://www.sciencedirect.com/science/article/pii/S0140673620311892">https://www.sciencedirect.com/science/a...
Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York...

Over 40 000 patients with COVID-19 have been hospitalised in New York City (NY, USA) as of April 28, 2020. Data on the epidemiology, clinical course, 


https://www.sciencedirect.com/science/article/pii/S0140673620311892
46/

UK

"...we observed an apparently protective effect, in the tested sub-population, of smoking on the risk of having a positive PCR for SARS-CoV-2 infection (OR [95% CI] 0.73 [0.65 to 0.81]; p=9.49x10-9)..."

No hospitalization data reported.

https://www.medrxiv.org/content/10.1101/2020.05.18.20105288v1.full.pdf">https://www.medrxiv.org/content/1...
47/

China (adult male smoking rate was 50.5% in 2018)

Of 125 male patients with mild symptoms, 65.6% were current smokers.

Notes:
Median age was 35
Patients with severe symptoms were excluded from study

https://www.researchsquare.com/article/rs-29526/v1">https://www.researchsquare.com/article/r...
48/

China (adult smoking rate was 26.6% in 2018)

Of 50 critically ill patients admitted to ICU, 18% were current smokers

https://www.researchsquare.com/article/rs-29681/v1">https://www.researchsquare.com/article/r...
49/

New York City, USA (adult smoking rate was 13.4% in 2017)

Of 5,051 patients diagnosed with Covid-19, 3.6% were current smokers

https://www.medrxiv.org/content/10.1101/2020.05.19.20103036v1.full.pdf">https://www.medrxiv.org/content/1...
50/

Earth (adult smoking rate was ~20% in 2015)

Of 96,032 hospitalized patients, 9.88% were current smokers.

Note: 65.9% of sample was from North America
Europe 17.3%
Asia 7.9%
Africa 4.6%
Australia 0.6% https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31180-6/fulltext">https://www.thelancet.com/journals/...
Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multin...

We were unable to confirm a benefit of hydroxychloroquine or chloroquine, when used alone or with a macrolide, on in-hospital outcomes for COVID-19. Each of these drug regimens was associated with...

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31180-6/fulltext
51/

Monterey County, California, USA (adult smoking rate was 11.7% in 2017)

Of 362 confirmed cases, 4% were current or former smokers

https://www.co.monterey.ca.us/government/departments-a-h/health/diseases/2019-novel-coronavirus-2019-ncov/2019-novel-coronavirus-2019-ncov-local-data">https://www.co.monterey.ca.us/governmen...
52/

China (adult smoking rate was 26.6% in 2018)

Of 307 hospitalized patients, 21.8% had a history of smoking

https://www.researchsquare.com/article/rs-30347/v1">https://www.researchsquare.com/article/r...
53/

China (adult smoking rate was 26.6% in 2018)

Of 201 hospitalized patients, 7.0% had a history of smoking

https://www.researchsquare.com/article/rs-30438/v1">https://www.researchsquare.com/article/r...
54/

Milan, Italy (adult smoking rate was 19% in 2017)

Of 222 hospitalized patients, 11.2% had a "smoke habit"

https://www.researchsquare.com/article/rs-30481/v1">https://www.researchsquare.com/article/r...
55/

Israel (adult smoking rate was 19.1% in 2018)

Of 4,353 people who tested positive, 11.8% were current smokers

https://www.medrxiv.org/content/10.1101/2020.05.07.20091652v2.full.pdf">https://www.medrxiv.org/content/1...
56/

New York City, USA (adult smoking rate was 13.4% in 2017)

Of 1,000 who tested positive, 4.9% were active smokers

Of 850 hospitalized, 4.12% were active smokers

Of 236 in ICU, 4.2% were active smokers

https://www.medrxiv.org/content/10.1101/2020.04.20.20072116v2.full.pdf">https://www.medrxiv.org/content/1...
56a/

There appears to be a considerable amount of overlap between the studies in tweet 56 & tweet 45.
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