LAUSR

Dear Editor, A meta-analysis done by Guo that was published in Tobacco Induced Diseases, reported a pooled odds ratio of 2.20, concluding that active smoking is significantly associated with the risk of severe COVID-19. Another current meta-analysis reported greater odds of COVID-19 progression among smokers compared to never smokers. Most of the studies in these meta-analyses were from China and focused only on cigarette smoking. Here, we describe characteristics of tobacco use among 193 confirmed COVID-19 patients who were interviewed during their hospitalization from 15 March to 15 April 2020, in the Imam-Khomeini Hospital of Ardabil University of Medical Sciences (ArUMS) in Iran. The protocol was approved by the Institutional Review Board of Ardabil University of Medical Sciences (Approval ID: IR.ARUMS.REC.1399.044) and verbal informed consent was obtained from the patients. All patients tested positive for SARS-CoV-2 by nasopharyngeal swabs using real-time reverse-transcription-polymerase-chain-reaction (rRTPCR) assay; they were at least 18 years old and willing to participate in an approximately 5-min interview. Interviews were administrated in the first two days of hospitalization to collect information regarding demographics, COVID-19-associated symptoms, and use of tobacco products including waterpipe (WP, hookah), cigarettes, and e-cigarettes. As shown in Table 1, 15 (7.8%) and 14 (7.3%) of the patients reported current (past-month) WP or cigarette use, respectively. No patients were dual WP/cigarette or e-cigarette users. Of the 14 cigarette smokers, 2 had cardiovascular disease (CVD), 1 chronic respiratory illness, 1 diabetes, 2 other conditions (e.g. kidney illness or rheumatoid arthritis), and 4 reported having >1 chronic condition. Among 15 WP smokers, 3 reported having CVD, 1 other condition, and 2 having >1 chronic condition. The average time between the onset of symptoms and hospitalization was approximately 4 days for WP smokers, 3 days for cigarette smokers, and 5 days for neversmokers. More than half (n=8) of cigarette smokers and 40% (n=6) of WP smokers reported their COVID-19 symptoms as severe compared to 22% (n=36) of never-smokers. In line with a previous report, the most common COVID-19 symptoms were fever and dry cough, which did not differ significantly between smokers (cigarettes or WP) and never-smokers. However, shortness of breath was reported more frequently by cigarette smokers compared to never-smokers and WP smokers. Body pain was reported more frequently among WP smokers compared to cigarette smokers and never-smokers. AFFILIATION 1 Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, United States 2 Department of Internal Medicine, Pulmonary Division, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran 3 Department of Kinesiology, College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, United States 4 Division of Social and Behavioral Sciences, School of Public Health, The University of Memphis, Memphis, United States 5 Public Health Department, School of Health, Ardabil University of Medical Sciences, Ardabil, Iran 6 Environmental Health Department, School of Health, Ardabil University of Medical Sciences, Ardabil, Iran 7 Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran 8 Nursing and Midwifery, Social Determinants of Health Research Center, Ardabil University of Medical Sciences, Ardabil, Iran