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Lat Am J Clin Sci Med Technol. 2020 Apr;2:25-27.
Received: March 27th, 2020.
Accepted: March 27th, 2020.
Published: April 3rd, 2020.
Views: 2032
Downloads: 25
| 1. | Bedford J, Enria D, Giesecke J, Heymann DL, Ihekweazu C, Kobinger G, et al. COVID-19: towards controlling of a pandemic. Lancet [Internet]. 2020 Mar 28 [cited 2020 Mar 30];395(10229):1015–8]. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0140673620306735 |
| 2. | Cai H. Sex difference and smoking predisposition in patients with COVID-19. Lancet Respir Med [Internet]. 2020 Mar [cited 2020 Mar 30];0(0) [Epub ahead of print: pii: S2213-600(20)30117-X.] Available from: https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30117-X/fulltext |
| 3. | Brake SJ, Barnsley K, Lu W, McAlinden KD, Eapen MS, Sohal SS. Smoking Upregulates Angioten-sin-Converting Enzyme-2 Receptor: A Potential Adhesion Site for Novel Coronavirus SARS-CoV-2 (Covid-19). J Clin Med. 2020 Mar 20;9(3):841. Available from: https://www.mdpi.com/2077-0383/9/3/841 |
| 4. | World Health Organization (WHO). WHO global report on trends in prevalence of tobacco smoking 2000-2025. Second edition. [Internet]. 2018. p. 120. Available from: https://apps.who.int/iris/handle/10665/272694 |
| 5. | Liu W, Tao Z-W, Lei W, Ming-Li Y, Kui L, Ling Z, et al. Analysis of factors associated with disease outcomes in hospitalized patients with 2019 novel coronavirus disease. Chin Med J (Engl). 2020 Feb;1. [Epub ahead of print] Available from: https://www.ncbi.nlm.nih.gov/pubmed/32118640 |
0000-0001-5656-4153)a; Maria A. Montoya-Giraldo (0000-0002-3756-0074)a; Jefferson A. Buendia (0000-0003-2404-6612)a.aCIEMTO: Drug and Poison Information and Research Center, Integrated Laboratory of Specialized Medicine (LIME), Universidad de Antioquia, Colombia.
Corresponding Author: , . Telephone number: ; e-mail: andres.zuluaga@udea.edu.co
Sir,
The ongoing outbreak of coronavirus disease 2019 has become a challenge for researchers and health systems.1 Recently, Cai commented on Lancet Respiratory Medicine that COVID-19 prevalence is dependent, among other variables, on sex and smoking.2 Brake3 demonstrated that smoking upregulates the expression of Angiotensin-Converting Enzyme-2 (ACE2) receptor in type-2 pneumocytes of smokers with COPD, increasing the ability of this coronavirus to infect the human cells. The e-cigarettes and heat-not-burn (HNB) devices (e.g.& JUUL) also have been involved with the ACE2 overexpression and higher prevalence of viral respiratory infections (e.g.& influenza).
Unbelievably, the smoking status is uncommonly reported in COVID-19 cases hampering our ability to establish any association between this potential risk factor with the disease. A rapid review of PubMed using search terms as smoke, epidemiology, prevalence, COVID-19, coronavirus, 2019-nCoV retrieved zero articles to date. Whether& smoking rates are related to the COVID-19 remains unknown. Thus, we searched into the World Bank Open Data (https://data.worldbank.org/indicator/SH.PRV.SMOK) and the WHO global report on tobacco smoking4 that the total population per country, number of people >65 years old, prevalence of smoking (including new devices) of the top 25 countries on the COVID-19 list.
A Pearson’s correlation matrix was performed (Table 1), a strong uphill correlation was observed between the total number of COVID-19 with the total population in each country (r=0×68), the population living with >65 years old (r=0×74), and the number of smokers (r=0×69). After this exploratory analysis, a linear regression model using OLS was fitted to the dataset (Graphic 1). An empirical linear relationship (R2= 0×97) was observed between the population older than 65 years old, the number of smokers and the total number of confirmed COVID cases in the top 25 countries.
Therefore, a lower progression of COVID-19 could be expected in demographics with lower tobacco use (e.g.& Colombia), if isolation, quarantine and other measures are extensively used1. Obviously, other confounding factors may explain this relationship, but this hypothesis may be a starting point for exploration in current surveillance databases and to clarify the true magnitude and direction of this association.
We urgently need more data, while the healthcare authorities should increase the surveillance of the smoking status in diagnosed COVID-19 patients, and promoting stopping tobacco use during the pandemic. Notably, in Chinese patients diagnosed with COVID-19, the odds of disease progression and death were 14 times higher among smokers compared to non-smokers.5
| Table 1. Interval and frequency of ages of patients with RA who received rituximab. | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|
PrEVTOB>15 | CANCDEATHTOB2016 (%) | POPTOT2020 | POP>65LIV | SMOKEPrEV+Ecig | TOTCOVID | DEATHSCOVID | SERIOUSCOVID | 1.0 | ||
| PrEVTOB>15 | 1.00 | 0.29 | 0.04 | 0.08 | 0.10 | 0.17 | 0.07 | 0.32 | 0.5 | |
| CANCDEATHTOB2016 (%) | 0.29 | 1.00 | -0.14 | -0.07 | -0.10 | 2.33×10-3 | -0.10 | 0.11 | ||
| POPTOT2020 | 0.04 | -0.14 | 1.00 | 0.99 | 1.00 | 0.68 | 0.36 | 0.23 | ||
| 0 | ||||||||||
| POP>65LIV | 0.08 | -0.07 | 0.99 | 1.00 | 0.99 | 0.74 | 0.39 | 0.30 | ||
| SMOKEPrEV+Ecig | 0.10 | -0.10 | 1.0 | 0.99 | 1.00 | 0.69 | 0.36 | 0.25 | -0.5 | |
| TOTCOVID | 0.17 | 2.33×10-3 | 0.68 | 0.74 | 0.69 | 1.00 | 0.82 | 0.74 | ||
| DEATHSCOVID | 0.07 | -0.10 | 0.36 | 0.39 | 0.36 | 0.82 | 1.00 | 0.84 | 0 | |
| SERIOUSCOVID | 0.32 | 0.11 | 0.23 | 0.30 | 0.25 | 0.74 | 0.84 | 1.00 | ||
| Abbrevations: prevalence of tobacco use in >15 years old (PrEVTOB >15), cancer death for tobacco use in 2016 (CANCDEATHTOB2016), total population in each country (POPTOT 2020), population living with >65 years old (POP>65LIV), estimate of total of smokers using cigarettes, e-cigarettes and heat-not-burn devices (SMOKERSPrEV+Ecig), total of cases with COVID-19 (TOTCOVID), deaths related to COVID-19 (DEATHSCOVID) and serious cases (SERIOUSCOVID) by March 24th, 2020. | ||||||||||
Dr. Montoya-Giraldo& reports personal fees from Amgen and Novartis,& outside the submitted work.
Dr. Zuluaga reports personal fees from Amgen, Sanofi-Genzyme, Merck, Janssen, Celltrion, Pfizer, and Novartis, outside the submitted work.
Dr. Buendia has nothing to disclose.
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Latin American Journal of Clinical Sciences and Medical Technology,Continuous Publication • Responsible Editor: Gilberto Castañeda Hernández • Reservation of Exclusive Use Rights: 04-2019-062013242000-203; ISSN: 2683-2291; both granted by Instituto Nacional del Derecho de Autor. • Responsible for the last update of this issue, Web Master Hunahpú Velázquez Martínez.
Calle Profesor Miguel Serrano #8, Col. Del Valle, Alcaldía Benito Juárez, CP 03100, Ciudad de México, México. Telephone number: 55 5405 1396 • Last modified on August 28th, 2026.
All Rights Reserved® 2019
Continuous Publication • Responsible Editor: Gilberto Castañeda Hernández • Reservation of Exclusive Use Rights: 04-2019-062013242000-203; ISSN: 2683-2291; both granted by Instituto Nacional del Derecho de Autor. • Responsible for the last update of this issue, Web Master Hunahpú Velázquez Martínez.
Calle Profesor Miguel Serrano #8, Col. Del Valle, Alcaldía Benito Juárez, CP 03100, Ciudad de México, México. Telephone number: 55 5405 1396 • Last modified on August 28th, 2026.
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