What We Know—and Still Need to Learn—About Coronavirus and Nicotine

In response to intriguing data from French scientists showing that smokers are strongly underrepresented among patients with COVID-19 symptoms, French citizens have started to apply nicotine patches to their upper arms.  The practice has become so widespread that it created a run on supplies, prompting the government to limit people to one month’s supply of patches and require that they be purchased at pharmacies rather than online.

Last March, Konstantinos Farsalinos, a physician-researcher at the University of West Attica, was one of the first to observe that smokers were under-represented in Chinese patients with COVID. Farsalinos’ team examined 13 Chinese studies that comprised 5,960 patients hospitalized with COVID-19 and found that the prevalence of current smoking among them was “unexpectedly low” at an average of 6.5 percent, or one-quarter the population smoking prevalence of 26.6 percent.

Data from France are similar. Within a sample of 343 COVID-19 patients in a Parisian hospital, 5.3 percent were daily smokers, far below the nation’s 25.4 percent smoking rate. At a high school in Northern France researchers tested 661 staff and students for presence of SARS-CoV-2 antibodies, an indication of prior exposure to the virus. Among those found positive, 7.2 percent were smokers, over 70 percent below the rate of non-smokers in the sample who tested positive, which was 28.0 percent. 

The pattern is similar in the United States. Data from the Centers for Disease Control show that, out of 7,162 COVID cases reported to the agency, 1.3 percent were smokers, far below the 13.8 percent smoking rate in the general population. A New York City hospital study of 4,103 COVID cases found that current “tobacco users” represented about 5.2 percent of cases needing hospitalization while 13 percent of New Yorkers smoke. Once hospitalized, tobacco users were no more likely than non-users to deteriorate to the point of needing critical care. In another U.S. study of 585 veterans who tested positive for coronavirus, current smokers were under-represented relative to non-smokers by 55 percent. These results suggest a protective effect against the disease itself, not just an amelioration of symptoms following infection. 

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