We saw a similar phenomenon recently with the drug hydroxychloroquine, where supplies ran out for those who needed them after politicians proclaimed it as a cure for COVID-19. The smoke from autumn burn-offs could make coronavirus symptoms worse. Normally it would be months between submission and publication – but in this case the researchers completed their observations and had the research published online within the same month.Īn unintended consequence of the early release of research is that it may provoke undue community hope or belief in unproven treatments.įrench authorities had to limit sales of nicotine treatments to avoid stockpiling after this study was published. We must acknowledge this research has been conducted at “pandemic speed”, much faster than usual research time frames. Taken together, although there appears to be an association between smoking and COVID-19 in these hospital-based samples, there’s no evidence of a causal relationship – that is, that smoking prevents COVID-19.ĭrug use may increase the risk of coronavirus. COVID-19 patients may be more likely to deny smoking when asked about their smoking status in hospital, wanting to be seen by medical professionals as doing the right thing.Īnd data collection may have been incomplete for behavioural questions in busy hospitals overwhelmed by COVID-19 cases.įinally, it’s important to note this paper has not yet been peer-reviewed. Second is what we call “social desirability bias”. We can identify several biases in the study. But they were classified as non-daily smokers in the study. Some may have given up smoking very recently in response to the WHO declaring smoking as a risk factor for COVID-19. For example, health-care workers and those with existing chronic conditions were disproportionately represented in the inpatient sample – both of these groups usually show lower prevalence of current smoking.įurther, around 60% of the hospitalised patients in the study were ex-smokers (similar to the national prevalence). The hospital patients may be less likely to be daily smokers than the general population. These counterintuitive results may be due to several biases, so let’s explore some alternative explanations.įirst is what we call “selection bias”. The researchers are now planning to test their hypothesis in a randomised trial involving nicotine patches though the trial is still awaiting approval from French health authorities. The researchers have proposed nicotine attaches to the ACE2 receptors, thereby preventing the virus from attaching and potentially reducing the amount of virus that can get into a person’s lung cells. SARS-CoV-2, the virus that causes COVID-19, gains entry into human cells by latching onto protein receptors called ACE2, which are found on certain cells’ surfaces. The authors of the French study suggest the mechanism behind the protective effects of smoking could be found in nicotine. Why do more men die from coronavirus than women? The finding of lower rates of smokers among COVID-19 cases has been more recently described elsewhere, in a rapid review of 28 studies on smoking in COVID-19 patients from various countries. Some 25.4% reportedly smoked daily in 2018.Ĭurrent smokers have a very much lower probability of developing symptomatic or severe SARS-CoV-2 infection as compared to the general population. This was only a fraction of the prevalence seen in the general French population. The study found 4.4% of inpatients and 5.3% of outpatients with COVID-19 were smokers, after adjusting for differences in age and sex. The researchers compared smoking rates in both groups with smoking rates in the general French population. Among other data collected, participants were asked whether they were current smokers. There were two groups included in the study – 343 inpatients treated for COVID-19 from February 28 to March 30, and 139 outpatients treated from March 23 to April 9. This type of research design can’t prove the exposure causes the outcome – only that there may be an association. This study was a cross-sectional survey where the researchers assessed the exposure (smoking) and the outcome (COVID-19) at the same time. But a recent paper which examined smoking rates among COVID-19 patients in a French hospital hypothesised smoking might make people less susceptible to COVID-19 infection.
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