Coronavirus UK: Smokers with more “bizarre” evidence may be less at risk

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A review of scientific studies added more evidence to the contention that people who smoke may have a lower risk of becoming seriously ill with COVID-19.

University of London academics reviewed 28 articles and found that the proportions of smokers among hospitalized patients were “lower than expected.”

A public health professor said there was “something weird with smoking and the coronavirus” and experts have trouble explaining the link.

One study found that in the UK, the proportion of smokers among patients with COVID-19 was only 5%, a third of the national rate of 14.4%.

Another found in France that the rate was four times lower. In China, a study noted that 3.8% of patients were smokers – despite the fact that more than half of the population smoked cigarettes regularly.

However, when smokers are diagnosed with a virus, they seem more likely to get so sick that they need ventilation, two studies from the review showed.

Researchers admit that hospitals are probably not recording patients’ smoking status correctly, potentially because they are too busy, patients are too sick to respond, or because people lie in their responses.

But they are struggling to bring down mounting evidence suggesting an apparent protective effect from cigarettes, which one expert has today recognized as “bizarre”.

A review of five early studies on the subject last month drew exactly the same conclusions – that smokers can avoid a serious infection, but their prospects are worse if they do.

The University of the College of London reviewed 28 studies and found that smoking rates were lower than expected in COVID-19 patients. The graph shows the smoking rate of each country in relation to the percentage of smokers among COVID-19 patients. The lowest figure was chosen for each country to show the austere comparison found by some studies

The University of the College of London reviewed 28 studies and found that smoking rates were lower than expected in COVID-19 patients. The graph shows the smoking rate of each country in relation to the percentage of smokers among COVID-19 patients. The lowest figure was chosen for each country to show the austere comparison found by some studies

The team is not the first to suggest that smokers can be protected by their habit, after a multitude of studies have identified the unexpected link (stock image)

The team is not the first to suggest that smokers can be protected by their habit, after a multitude of studies have identified the unexpected link (stock image)

Two of the authors of the recent UCL review have received research grants from the smoking cessation lobbies.

Their article was titled “The Association of Smoking Status with SARS-CoV-2 Infection, Hospitalization and Mortality with COVID-19: A Quick Review of Living Evidence” and was published on the site Qeios study sharing web.

David Simons and colleagues reviewed 28 studies involving more than 23,000 people.

Twenty-two of the studies were conducted in China, three in the United States, one in South Korea, one in France, and one was an international study using mainly British data.

Only three of them divided smoking status into three parts – current smokers, former smokers and non-smokers.

The remaining 25 only reported current and former smoking, but questions were asked about the number of people who have never smoked and the number of missing data.

“Despite these uncertainties, compared to national prevalence estimates, current and former smoking rates recorded in the included studies were generally lower than expected,” wrote the study authors.

Data from the United States suggests that smokers appear less likely to test positive for SARS-CoV-2 than non-smokers.

Rather than reflecting the likelihood of getting the virus in the first place, it is more likely to indicate the risk of a person becoming so ill that they need to go to hospital. Most of the countries involved in the studies carried out almost all of their tests in hospitals.

But the researchers noted that smokers were more likely to be tested, perhaps because their symptoms, such as a cough, are more evident due to their habit.

“We therefore warn against any conclusion as to whether smokers are at increased risk of SARS-CoV-2 infection at this early stage,” said the UCL team.

Two high-quality studies have provided no evidence that 657 smokers or former smokers of the virus are at higher risk of being hospitalized.

But among 1,370 people hospitalized in two other studies, smokers were 43% more likely to have their illness become severe than those who had never smoked.

Three studies have reported death rates from COVID-19, but there does not appear to be a noticeable difference between smokers and non-smokers.

However, the studies “did not explicitly indicate non-smoking status,” said the authors. They suggested that the deceased patients may have smoked in the past, but this was not clearly recorded by a doctor.

The authors concluded that there is a lack of evidence that responds at a high level to say with certainty whether smokers are more at risk of getting coronavirus or having poor results.

Data from the United States suggests that smokers appear less likely to test positive for SARS-CoV-2 than non-smokers. But researchers noted that smokers were more likely to be tested - perhaps because their symptoms were more obvious.

Data from the United States suggests that smokers appear less likely to test positive for SARS-CoV-2 than non-smokers. But the researchers noted that smokers were more likely to be tested – perhaps because their symptoms are more obvious.

Three studies have examined hospitalization for COVID-19 by smoking status. An analysis of two of these studies did not provide any evidence that the 657 current or former smokers with the virus were at higher risk of ending up in hospital.

Three studies have examined hospitalization for COVID-19 by smoking status. An analysis of two of these studies found no evidence that the 657 current or former smokers with the virus were at higher risk of ending up in hospital.

Among the 1,370 people hospitalized in two other studies, smokers were 43% more likely to have progressed than those who had never smoked.

Among the 1,370 people hospitalized in two other studies, smokers were 43% more likely to have progressed than those who had never smoked.

Three studies have reported death rates from COVID-19, but there does not appear to be a noticeable difference between smokers and non-smokers

Three studies have reported death rates from COVID-19, but there does not appear to be a noticeable difference between smokers and non-smokers

WHAT DID THE FIRST FIVE SMOKING STUDIES DO WITH COVID-19 SHOW?

A team of scientists from Harvard University in Boston and the University of Crete in Greece reviewed five of the first studies on the links between smoking and COVID-19 in March.

They found that smokers were at greater risk of complications, but others suggested that they were less likely to be infected in the first place.

In all of the studies, less than 15% of the patients were smokers – a figure that contrasts with the smoking rate in China, which is between 20 and 26% and almost half of the men.

The evidence review, led by Dr. Constantine Vardavas of Harvard, was published in the journal Tobacco Induced Diseases.

Here’s what he found:

STUDY 1

How many people were involved?

78 patients in 3 hospitals in Wuhan, China

How many of them were smokers?

Not clear

Where were the results published?

Chinese medical journal

What did he find?

Patients who progressed to a serious illness had a “significantly” higher number of smokers than patients who improved – 27% versus 3%

STUDY 2

How many people were involved?

1,099 in 552 hospitals across China

How many of them were smokers?

In total, 12.6% (137) were current smokers and 1.9% (21) were former smokers.

Where were the results published?

New England Medical Journal

What did he find?

Of the 173 patients with severe symptoms, 16.9% (29) were current smokers and 5.2% (nine) were former smokers.

In comparison, 11.8% (108) of 926 with milder symptoms were current smokers, and 1.3% (12) were former smokers.

In the group of patients who required mechanical ventilation, intensive care admission or who died, 25.5% were current smokers and 7.6% were former smokers.

This is more than double the proportion of patients who did not require intensive care, of which 11.8% were current smokers and 1.6% were former smokers.

STUDY 3

How many people were involved?

140 in a Wuhan hospital

How many of them were smokers?

6.4% were current smokers (two) or former smokers (seven).

Where were the results published?

Allergy

What did he find?

Of the 58 critically ill patients, 3.4% (two people) were current smokers and 6.9% (four) were former smokers.

In comparison, of the 82 with milder symptoms, none was a current smoker and 3.7% (three) were former smokers.

STUDY 4:

How many people were involved?

191 in two hospitals in Wuhan

How many of them were smokers?

Six percent (11 people) were current smokers

Where were the results published?

The Lancet

What did he find?

Of those who died (54), nine percent (five) were current smokers. Of those who survived, four percent (six people) were smokers.

STUDY 5

How many people were involved?

41 in a hospital in Wuhan

How many of them were smokers?

Seven percent (three people) were current smokers

Where were the results published?

The Lancet

What did he find?

None of the 13 patients who were to be admitted to intensive care was a current smoker. In contrast, 11% (three) of those who did not require intensive care were smokers.

Commenting on the question, Linda Bauld, professor of public health at the University of Edinburgh, said, “Something weird is happening with smoking and coronaviruses.”

She told Good Morning Britain: “We have known for decades that smoking is linked to a higher risk of developing respiratory problems and that people who smoke have poorer outcomes.

“And we still have around seven million smokers in the UK, [the] leading preventable cause of death.

“However, my UCL colleagues … what they have found is that there are surprisingly few smokers in these studies who have developed a coronavirus.

“In a French study, four times more non-smokers contracted the virus and developed COVID-19 than smokers.

“There is a potential biological explanation for this. “

Professor Bauld said the way the virus enters the body could be blocked by the effects of nicotine – the addictive compound found in tobacco.

The coronavirus enters cells inside the body through structures called ACE-2 receptors, which cover the surface of certain cells, including in the airways and lungs.

The number of ACE-2 receptors someone has is thought to vary with genetics, and there is some evidence to suggest that they are higher in smokers.

This could, in theory, expose them to a higher risk of contracting the coronavirus.

However, the virus is known to cause damage to the lungs by decreasing the number of ACE-2 receptors, so the fact that smoking increases them could reverse the effect and prevent damage to the lungs.

On the other hand, other studies show that nicotine reduces the action of the ACE-2 receptor, suggesting that smokers are less likely to get the virus in the first place.

Professor Bauld said: “It is plausible that smokers are less likely to develop the condition potentially because of nicotine. Especially in this UCL review where smokers developed COVID-19, their results are much worse.

Professor François Balloux, a leading infectious disease specialist at University College London, also said there was “strangely strong” evidence that smoking could be protective

What do studies from each country show?

Studies in hospitals in China have shown that 3.8% to 17.6% of COVID-19 patients were current smokers and less than 5% were former smokers.

However, 2018 data shows that more than half of the country’s population is current smokers (50.5% men and 2.1% women).

And almost one in ten of non-smokers in China are former smokers (8.4% of men and 0.8% of women).

In American studies, 1.3-27.2% were current smokers, compared to a smoking prevalence of 13.8% in 2018.

And 2.3 to 30.6% were former smokers, compared to 20.9% of former smokers across the states.

In the South Korean study, 18.5% were current smokers, almost matching the smoking prevalence of 19.3% in 2016.

In the included study from France, 7.1% were current smokers, including 6.1% hospitalized. But much higher smoking rates are recorded in the population – 32%.

But the results are different for former smokers, including 31.4% in France. A much higher number of 59.1% of patients with COVID-19 were former smokers.

In the international study with participants mainly from the UK in hospitals, 5% were current or former smokers.

This compares to a current and former smoking prevalence of 14.4 and 25.8% in England in 2018, “suggesting a lower than expected proportion of current and former smokers in the study included”.

Typically, smokers are at increased risk of infection because the tiny hairs inside the airways and lungs, which help keep pathogens and mucus away, are often damaged by toxic chemicals from the cigarette smoke.

In theory, this would put smokers at a disadvantage if they get a coronavirus, since the disease leaves patients unable to get enough oxygen into the bloodstream due to lung inflammation.

A group of Chinese studies found that the average proportion of coronavirus patients classified as smokers - out of a total of nearly 6,000 people - was only 6.5%. By comparison, more than 26% of the country's population as a whole are smokers

A group of Chinese studies found that the average proportion of coronavirus patients classified as smokers – out of a total of nearly 6,000 people – was only 6.5%. By comparison, more than 26% of the country’s population as a whole are smokers

The largest study that analyzes patient health profiles is published in the New England Journal of Medicine: of the 173 patients with severe symptoms, 16.9% were current smokers and 5.2% had ever smoked. In comparison, among patients with milder symptoms, 11.8% were current smokers and 1.3% were former smokers.

The largest study that analyzes patient health profiles is published in the New England Journal of Medicine: of the 173 patients with severe symptoms, 16.9% were current smokers and 5.2% had ever smoked. In comparison, among patients with milder symptoms, 11.8% were current smokers and 1.3% were former smokers.

Researchers from Wuhan University Zhongnan Hospital concluded that only 1.4% of the 140 hospital patients were smokers

Researchers from Wuhan University Zhongnan Hospital concluded that only 1.4% of the 140 hospital patients were smokers

A study of 41 patients found that none of the 13 patients who were to be admitted to intensive care was a current smoker. In contrast, 11% (three) of those who did not require intensive care were smokers

A study of 41 patients found that none of the 13 patients who were to be admitted to intensive care was a current smoker. In contrast, 11% (three) of those who did not require intensive care were smokers

A study of 140 coronavirus patients found that of the 58 critically ill patients, 3.4% (two people) were current smokers and 6.9% (four) were former smokers. In comparison, of the 82 with milder symptoms, none was a current smoker and 3.7% (three) were former smokers.

A study of 140 coronavirus patients found that of the 58 critically ill patients, 3.4% (two people) were current smokers and 6.9% (four) were former smokers. In comparison, of the 82 with milder symptoms, none was a current smoker and 3.7% (three) were former smokers.

WHAT IS AN ACE-2 RECEIVER AND WHAT SHOULD I DO WITH COVID-19?

ACE-2 receptors are structures on the surface of cells in the lungs and airways that work with an enzyme called ACE (angiotensin converting enzyme) to regulate blood pressure.

Its exact function in the lungs is not well understood, but studies suggest that it protects against lung damage and that its low levels can worsen the impact of viral infections.

Scientists say the coronavirus that causes COVID-19 enters the body through the ACE-2 receptor, to which its shape allows it to cling.

This means that a person with more ACE-2 receptors may be more sensitive to a large viral load – the first infectious dose of a virus – entering their bloodstream.

ACE-2 receptors have a shape that matches the outside of the coronavirus, effectively providing it with a gateway into the bloodstream, scientists say.

ACE-2 receptors have a shape that matches the outside of the coronavirus, effectively providing it with a gateway into the bloodstream, scientists say.

People who have a higher number of ACE-2 receptors than usual may include those with diabetes or high blood pressure because they have genetic defects that make them more productive. New evidence shows that smokers can also produce more.

However, high levels of ACE-2 receptors can also be protective.

They are thought to be able to protect the lungs during infection, and a 2008 mouse study found that mice that had ACE-2 blocked in their bodies suffered more damage when they were infected. by SARS, which is almost identical to COVID-19.

In the past, smoking has been repeatedly linked to lower than normal ACE-2 receptor levels, which could increase the risk of lung damage from COVID-19.

Research has shown that smokers are at greater risk of developing complications – but others have suggested that they are less likely to be infected in the first place.

This was the conclusion of the first major review of the evidence by a team led by Dr. Constantine Vardavas from Harvard, Greece, published in the journal Tobacco Induced Diseases.

The team reviewed five studies in March and said so far that the evidence that smoking increases the risk of coronavirus is limited, after finding that only 1.4% of hospital patients were smokers.

The panel even admitted that the warnings from health leaders were largely hypothetical, given the known risks of infection from smoking.

A study released earlier this month by scientists from New York and Athens looked at 13 Chinese studies that had registered smoking as a prerequisite and found that the number of smokers out of the entire sample of 5 300 patients was 6.5%.

This is a surprisingly small number in a country where half of the men still smoke.

Another study by the U.S. Centers for Disease Control of more than 7,000 people who tested positive for coronavirus found that only 1.3% of them were smokers – compared to the 14 percent of all Americans the CDC says they smoke.

The study also found that smokers were more likely to end up in the hospital or ICU.

The governments of the United Kingdom and the United States are urging people to quit smoking to protect themselves from the virus as a precaution, while scientists admit there is no clear evidence that cigarettes can make the disease worse.

Recently, world-renowned artist David Hockney wrote a letter to the Daily Mail saying, “I joked that being a smoker in Malibu was like being a non-smoker in Pasadena. They previously had very bad pollution.

“Isn’t it possible that smokers have developed an immune system against this virus? With all these numbers coming out, it’s starting to look like that to me.

The British artist, now 82 years old and living in France, adds “I am serious” and revealed in the past that he had been smoking for more than 60 years but still considered himself in good health.

Meanwhile, a British NHS doctor said today that Prime Minister Boris Johnson was so severely affected by the coronavirus because he was “significantly” overweight.

Consultant cardiologist Dr Aseem Malhotra said there is a tenfold risk of death from the disease – which has so far killed more than 20,000 Britons – if the patients are obese.

He noted that other “thinner” members of cabinet – such as Secretary of Health Matt Hancock – recovered much faster and were not hospitalized.

Other senior government officials and advisers who have recovered from the virus include chief medical officer Chris Whitty, chief counselor Dominic Cummings and Minister of Health Nadine Dorries.

Johnson, 55, has struggled with his weight for a long time and revealed in 2018 that he weighed almost 16 and a half stones, which at 5 feet 9 inches places him in the high-risk category.

Dr. Malhotra said: “It was obviously very disturbing for the whole nation to see our Prime Minister admitted to the hospital with COVID-19.

“Now this is an observation, but it fits the evidence, Boris is unfortunately overweight.

“I used to speak to one of his very senior advisers when he was mayor of London a few years ago, who expressed personal concerns about his weight.”

FIRST AMERICAN DATA SHOWS JUST 1.3 PERCENT CORONAVIRUS PATIENTS ARE SMOKING

Initial data from the United States Centers for Disease Control and Prevention (CDC) showed that only 1.3% of people diagnosed with COVID-19 were classified as smokers.

Out of a sample of 7,162 of the country’s first patients, only 96 were “current smokers”. According to the data, only 22 of the 1,037 hospital patients were smokers, as well as five of the 457 in intensive care.

This is in sharp contrast to CDC statistics which show that 14% of all Americans smoke cigarettes regularly.

It is not clear whether there is a link between smoking and a lower risk of getting or getting sick with a coronavirus, or whether the record of who smokes and who is not is not up to par.

Professor Jamie Brown of University College London, a specialist in tobacco and public health, said he expected it to be the last.

He told MailOnline: “It is really difficult to assess the extent to which smoking has been recorded in an emerging epidemic and many of these people have been too sick to answer or may not have answered completely honestly.

“We know that, overall, smokers tend to come from low-income groups who have more limited access to health care and are more likely to die in the community.”

Data from the Centers for Disease Control and Prevention (CDC) in the United States has shown that of approximately 7,000 COVID-19 patients, former smokers were more likely to be hospitalized or placed in intensive care than current smokers.

Les données des Centers for Disease Control and Prevention (CDC) aux États-Unis ont montré que sur environ 7 000 patients COVID-19, les anciens fumeurs étaient plus susceptibles d’être hospitalisés ou placés en soins intensifs que les fumeurs actuels.

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