R. Polosa, Grazia Caci
Internal and Emergency Medicine, 2020
All the world is aware of the Coronavirus pandemic, and as of the 23rd of April 2020 globally 2.629.801 cases had been confirmed, and 183.454 fatalities had occurred (https ://coron aviru s.jhu.edu/map.html). The world is struggling and working to contain the disease and death of this active new virus. On top of the medical toll, the COVID-19 pandemic has resulted in severe economic devastation that has tragic and widespread consequences for human health and suffering. Multiple strategies are necessary to end this pandemic. Some of these actions are supplying all health professionals with personal protective equipment, reorganizing healthcare systems with COVID-19 dedicated high-dependency hospitals/wards, testing new treatments and vaccines, and motivating people to maintain social distancing practices even when the pandemic recedes. In the absence of long-term immunization against SARSCoV-2 or effective therapies for COVID-19, healthcare professionals must have access to clear information that accurately predicts which patients with the virus would go on to develop clinical deterioration of COVID-19 (high-risk populations). A better clinical definition of those at highrisk for severe illness with COVID-19 is vital for effective clinical assessment, risk stratification, resource allocation repositioning, and targeted public health interventions. Some conclusive predictors of the risks for severe illness have been clearly described: the presence of co-morbidities [1], older age [2], breathlessness [3] and lymphopenia [4]. Many other predictors of COVID-19 that result in clinical severity have been proposed, but their validity has been questioned. The difficulty in identifying predictors is not surprising considering that anamnestic and behavioral data might have been collected inaccurately due to the extremely challenging situations at wards/ICUs with work overloads and operating in a persistent state of emergency. Intuitively, one vulnerability to severe illness from COVID-19 would be assumed to be cigarette smoking [8] because it is known to increase the risk of serious respiratory infections [5–7]. But is this in fact true? In this issue of Internal and Emergency Medicine, Farsalinos et al. [9] explore the hypothesis that smokers are at higher risk and unexpectedly found data that point to the opposite and counter-intuitive conclusion that smoking may actually have a protective effect. Their systematic review observed that smoking is vastly protective for hospitalized COVID19 based on the surprisingly low prevalence of smoking in patients hospitalized with COVID-19. While it is possible that the prevalence of smokers in Chinese case series may be underrepresented due to inaccurate recording of their smoking status, similar findings have been now being reported in the US, Germany and in France. The Centers for Disease Control and Prevention (CDC) [10] report an unusually low prevalence of current smoking among COVID-19 cases at 1.3% compared to population smoking prevalence in US of 16.5% [11]. A cross-sectional analysis of 4103 laboratoryconfirmed COVID-19 patients treated at academic hospitals in New York City, demonstrated again a low smoking prevalence of 5.2% [12]. A multivariate analysis performed by the New York researchers showed a significant protective effect against hospitalization among current and former tobacco users (OR = 0.71, 95% CI 0.57–0.87 p = 0.001). Moreover, smoking was not a risk factor for critical disease or death. In Germany, a recent case series of hospitalized COVID-19 patients found a low smoking prevalence of about 6% [13]. The protective association has been also recently observed in France where smoking prevalence reported for various age groups and levels of disease severity roughly average to about 1/5 of the population prevalence [14]. These findings * Riccardo Polosa polosa@unict.it
Cited by 18 publications.
Field of study: Medicine