Systematic review of the prevalence of current smoking among hospitalized COVID-19 patients in China: could nicotine be
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CE - LETTER TO THE EDITOR
Systematic review of the prevalence of current smoking among hospitalized COVID‑19 patients in China: could nicotine be a therapeutic option? Reply Konstantinos Farsalinos1,2 · Anastasia Barbouni2 · Raymond Niaura3 Received: 17 July 2020 / Accepted: 20 July 2020 © Società Italiana di Medicina Interna (SIMI) 2020
Dear editor, We would like to thank Dr. Takagi [1] for his comments and the interesting analysis of the association between COVID19 incidence and smoking prevalence in Japanese prefectures. In this response, we clarify some possible misunderstandings related to the current research on the link between smoking and COVID-19. Our systematic review and meta-analysis examined the prevalence of smoking among hospitalized COVID-19 patients only [2]. Our findings cannot be interpreted as smoking reducing the risk of being infected with SARSCoV-2 and developing COVID-19. In fact, we emphasized that no conclusion can be drawn about the prevalence of current smoking among patients with less severe COVID19 that would not require hospitalization. While we suggested that nicotine is unlikely to have direct antiviral activity and, thus, is not expected to act as chemoprophylaxis, recent studies suggest that smokers may be less likely to be diagnosed with COVID-19 [3], while an inverse association between national smoking rates and COVID-19 mortality was reported [4]. These findings may not be in agreement with the report by Dr. Takagi but, in any case, the overall incidence of COVID-19 (including mild forms of the disease) should be clearly differentiated from severe The article belongs to COVID 19. * Konstantinos Farsalinos [email protected] 1
Department of Pharmacy, University of Patras, Rio, Greece
2
School of Public Health, Department of Public and Community Health, University of West Attica, Athens, Greece
3
Departments of Social and Behavioral Science and Epidemiology, College of Global Public Health, New York University, New York City, USA
COVID-19 that requires hospitalization. Additionally, the lower than expected prevalence of smoking among hospitalized COVID-19 patients is not contradictory to the reported higher odds for adverse outcome in hospitalized smokers compared to non-smokers. In our most recent systematic review and meta-analysis of 30 studies, we reported both an unexpectedly low prevalence of smoking among hospitalized COVID-19 patients and higher odds for adverse outcome in hospitalized smokers [5]. In reality, the evidence suggests that any association between smoking and disease outcome cannot not be generalized to the whole population of smokers but should refer specifically to the seemingly low proportion of smokers who develop severe COVID-19 necessitating hospitalization. One potential explanation for the adverse outcome among hospitalized smokers is that they experience abrupt nicotine cessation from the moment they are admitted to the hospital (unless they are given nicotine replacement therapies). As a result, these patients will be deprived
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