
Low incidence of daily active tobacco smoking in patients with symptomatic C19 - xbmcuser
https://www.qeios.com/read/article/574
======
rossdavidh
Hypothesis: if you have any pre-existing lung conditions, you are more likely
to quit smoking. In other words, if you're the sort with pre-existing
conditions that make you more likely to be hospitalized if you get Covid-19,
then you would be more likely to have quit smoking (or died before now if you
didn't).

Still an interesting result, but not, needless to say, a reason to start
smoking.

~~~
snikeris
I find it interesting that smoking itself isn't a pre-existing condition that
makes you more likely to be hospitalized if you get Covid-19.

~~~
justizin
engaging in a risk factor is not a condition.

~~~
zxexz
Depends on what you mean as a "condition". In a medical record, smoking status
is often stored as a top-level value tied directly to the patient, and also
often coded into their condition list[0]. In the FHIR standard, a physician's
observation of a patient's smoking history is usually represented with an
observation resource, but often will be "upgraded" to a condition resource[1].

But, yeah, from a non-healthcare data standpoint, what a "condition" is really
just depends on your definition.

[0]
[https://www.icd10data.com/ICD10CM/Codes/F01-F99/F10-F19/F17-...](https://www.icd10data.com/ICD10CM/Codes/F01-F99/F10-F19/F17-/F17.210)

[1]
[https://www.hl7.org/fhir/condition.html](https://www.hl7.org/fhir/condition.html)

------
LatteLazy
This paper is terrible. There are errors in the abstract. It uses percentage
of percentages to make results look important. It relies on self reporting
when people are strongly encouraged to misreport. It excludes groups
arbitrarily (no ICU patients, no one treated by certain departments). Its all
about 1 hospital for a few weeks in one part of France.

Its like a test paper to teach people to spot errors and weaknesses in papers.

~~~
ebg13
> _Its all about 1 hospital for a few weeks in one part of France._

We already have similar results from hospitals all over China. This is gravy.

Read the "smoking history" section of Table 1.
[https://www.nejm.org/doi/full/10.1056/NEJMoa2002032](https://www.nejm.org/doi/full/10.1056/NEJMoa2002032)
and compare it to smoking rates in China over the past several decades.

~~~
LatteLazy
We don't have any data for China. None of their numbers are reliable, they
make them up. This is one of the biggest issues in this pandemic: we don't
know shit partly because China insist on lying...

~~~
ebg13
"...and therefore they have a strong undeclared interest in making it look
like smoking inversely correlates with infection."

Citation needed.

~~~
LatteLazy
Did you reply to the wrong comment? I only know they're making number up,
that's well documented...

Citation for the fairness of Chinese numbers:

[https://foreignpolicy.com/2020/04/01/china-coronavirus-
offic...](https://foreignpolicy.com/2020/04/01/china-coronavirus-official-
figures-underreporting-pandemic-response-xi-jinping/)

Also:

[https://www.theguardian.com/world/2020/apr/17/china-
denies-c...](https://www.theguardian.com/world/2020/apr/17/china-denies-cover-
up-as-wuhan-coronavirus-deaths-revised-up-50)

~~~
stareatgoats
Interesting support for your claims. Not saying they are wrong, but a
classified US intelligence report doesn't really carry much weight either
(link 1).

Link 2 is about the latest revision of the death toll in Wuhan. Now, you must
think the current US death toll is totally accurate. Will you claim that the
US makes things up when those figures are revised (which they will be) too?

------
snikeris
Interesting, they hypothesize that nicotine is responsible:

> There are however, sufficient scientific data to suggest that smoking
> protection is likely to be mediated by nicotine. SARS-CoV2 is known to use
> the angiotensin converting enzyme 2 (ACE2) receptor for cell entry[14-16],
> and there is evidence that nicotine modulates ACE2 expression[17]which could
> in turn modulate the nicotinic acetyl choline receptor (manuscript
> submitted).

~~~
vernie
So start taking nicotine lozenges as a prophylactic?

~~~
downerending
This might be a joke, but I'm "addicted" to nicotine gum (and don't otherwise
smoke). I probably caught the virus early on, and it wasn't particularly bad
for me (even compared to typical flu).

That's not even really a single data point, but I'm curious to see how this
pans out.

~~~
SketchySeaBeast
> I probably caught the virus early on, and it wasn't particularly bad for me
> (even compared to typical flu).

Do you have reason to believe that, or were you sick in January/February and
just kind of assume that was it, even though we were at the height of regular
cold and flu season?

~~~
downerending
Just circumstantial. I was knocked down with something I self-diagnosed as
"walking pneumonia", which turned out to be the thing a lot of these cases
were diagnosed as before the virus was widely known. Several days after a
flight. Main symptom was lots of coughing and some fever. Felt better after
7-10 days, but coughed frequently for several more weeks. Not really the aches
of flu, nor any nasal/sinus symptoms--just totally wiped out.

Until we have antibody tests, no way to know. And I'm locked down hard--not
assuming anything.

------
gregwebs
It would make sense if smoking (the oxidants from smoke) kills the virus.
However, once the infection actually progresses it is clear that smokers are
worse off.

[https://chrismasterjohnphd.com/covid-19/covid-19-and-the-
smo...](https://chrismasterjohnphd.com/covid-19/covid-19-and-the-smoking-
paradox)

~~~
raverbashing
Actually in the article there's a different proposed explanation related to
nicotine and its withdraw when in an hospital setting.

~~~
gregwebs
The nicotine explanation in the article discussion isn't actually studied, it
is just pure speculation (which is fine, mine is as well). But there's no
explanation why there's fewer smokers even though smokers have more ACE2
receptors. That's table stakes for having a hypothesis on this.

------
baron_harkonnen
I was joking the other day that it would be funny if the reason that Covid19
was less sever in Asian countries was not the high rate of mask usage but the
high rate of smoking!

------
jholdn
It's an interesting data discrepancy - fewer smokers in covid-19 infected
individuals - but it doesn't tell us much. The survival bias is a problem.
They took the smoking status of alive patients, not in the ICU. The results
could indicate the opposite effect. Smokers tend to be in the ICU or die at an
accelerated rate so are under-represented. That said, one would expect
counter-acting effects in such a situation that would make the counter-
intuitive result of fewer smokers meaning it's worse for smokers less likely,
e.g. greater diagnosis rate in smokers due to increased severity, higher rates
of infection in smokers, etc.

I don't think any conclusions can be drawn from this study. It does suggest
that there is value in investigating the impacts of smoking on Covid-19.

------
scandox
There is a story from the Golden Age of Science Fiction called Pandemic by JF
Bone. It postulates a global virus the cure for which in the end turns out to
be smoking tobacco.

And the improbably beautiful nurse marries the curmudgeon who is her boss.

And they put babies in smoke ventilators.

------
LatteLazy
I find it fascinating how willing people are to accept the vital importance of
chemicals not directly related to covid 19 or coronaviruses. People were very
willing to swallow Chloroquine as a "cure" or treatment, but that is (was?)
used for treating malaria (not a virus). Now tobacco smoke is preventative?
And that must be because of nicotine. Not one of 1000s of other chemicals in
the same smoke? And forget that other research found smoking increased the
density of the proteins covid 19 binds to to enter cells (another small study
with unverified results I think).

Jesus people, the solution to this problem will not be as simple as
antimalarials or taking up Cuban cigars. Stop grasping at straws like they are
lifeboats!

~~~
ebg13
This has nothing to do with "accept the vital importance of chemicals" and
everything to do with the fact that we record smoker status when patients
enter hospitals and HOLY COW, LOOK, A TREND IN THE DATA.

> _Now tobacco smoke is preventative?_

Maybe! If you just casually ignore data, you will miss opportunities for
important discovery.

> _And that must be because of nicotine. Not one of 1000s of other chemicals
> in the same smoke?_

That's called a _hypothesis_. Hypotheses are somewhat important for research.

~~~
LatteLazy
Now you're in trouble. You named a hypothesis but the experiment doesn't test
that hypothesis does it? No one checked whether any or all of these people
actually smoked. Weirdly they let them report different levels of smoking but
don't include that data And no one thought to ask about vaping (where there
are far fewer chemicals and you would have a stronger case to pin point
nicotine). Plus they included Chinese data which is mostly made up. And they
excluded random arbitrarily groups (no ICU patients, maybe all the smokers
went straight there?).

A good experiment is one where you learn something. You prove or disprove your
hypothesis.

This paper doesn't mean anything. Like you say, the answer to the question si
"maybe". Maybe nicotine helps, maybe it doesn't. Maybe literally any chemical
helps, maybe it doesn't. Great, thanks for wasting everyone time...

~~~
ebg13
> _You named a hypothesis but the experiment doesn 't test that hypothesis
> does it?_

This paper doesn't claim to be an experiment to test that hypothesis. That's
all you.

This paper claims to be a data record highlighting an interesting trend for
future experimentation.

The hypothesis for cause is in the DISCUSSION section at the end and
references things that we already know about interactions between nicotine,
ACE2, and sars-cov-2.

~~~
LatteLazy
Call it what you like, experiment or report, hypothesis (your word) or trend
(I think this the wrong term but I can't think of abetter one...).

As it is, they have found nothing because they did such a bad job of looking.
Leaving aside that apparently 601% of patients were men (now there is a
concerning trend), they haven't tested nicotine or smokers because their
methods don't differentiate the Corona cases involving those factors from ones
that don't.

Nicotine could kill every user and this study wouldn't find that, nicotine
could make its users immortal and this study wouldn't notice. That's what
makes it bad: they found nothing because they did a bad job of looking.

This is a badly dressed up version of "my aunt smoked and she lived to be 97
so it can't be all bad".

------
gridlockd
Smoking may well have some hormetic effects, being a non-smoker is a risk
factor in a handful diseases.

------
11235813213455
That's maybe because someone who has a "strong enough health" to tolerate
smoking, builds some resistance in the short term. That's in the long term
that smoking is really deadly though

That kind of study would also find out that people doing daily physical
exercise would be much less affected by Covid, etc..

------
billman
Well stick that in your pipe!

------
phillnom
So, smoke em if you got em?

------
drewcoo
It doesn't seem to take the social aspects of smoking into account. In a
sense, smokers were already doing social isolation.

I'd bet that people who scream on street corners are less likely to contract
it than people who spend time quietly on street corners.

~~~
whoisjuan
The study is done with a Covid positive population.

They didn’t study if people who smoked where less likely to get Covid. The
study goal, as I understand it, was to theorize the idea that smoking serves
as some sort of protection leading to less severe symptoms.

Otherwise the study wouldn’t make sense. The study must have clearly accounted
for ratios in the smoking general population against the sample population.
That’s the only way it makes sense.

I’m curious what makes you think that smokers isolated earlier than anyone
else. I don’t think being a smoker makes you more self-aware of your own
health. If anything is quite the contrary.

~~~
gridlockd
The OP does have a point. You cannot control for the social isolation factor
because there is no data on it.

The people who isolate with 100% success never get COVID and thus are missing
from the sample population.

It is also easier to isolate than to give up smoking.

