Smoking increases the risk of COVID-19 positivity, while Never-smoking reduces the risk

Introduction Does smoking decrease the risk of testing positive for COVID-19 because the never-smokers (84%) prevalence is high and the current-smokers prevalence is low among COVID-19 positive patients? [1][1],[2][2],[3][3],[4][4],[5][5],[6][6] We sought to determine whether never smoking increases the risk of COVID-19 positivity among the 50 to 69-year old patients because they are more likely to test positive for COVID-19.[7][7] Method We conducted a retrospective chart review of COVID-19 Polymerase chain reaction, in-hospital tested ≥18-year-old patients. A Poisson regression analysis stratified into never-smokers and history of smoking (current + former smokers) was conducted. Results 277 COVID-19 negative and 117 COVID-19 positive patients’ charts with a never-smokers prevalence of 42.32% and 54% respectively were analyzed. The never-smokers prevalence was 54%, 20-39-years; 61 %, 40 -49-years; 41%, 50 – 69-years; and 43%, 70 – 100-years. The 40-49-year-old current and former smokers were more likely to test positive for COVID-19 [1.309 (1.047 - 1.635)], unlike the 40-49-year-old never-smokers [0.976 (0.890-1.071)] who had a lower risk. Regardless of their smoking status, males [1.084(1.021 - 1.151)] and the 50-69-year-old patients [1.082 (1.014 -1.154)] were more likely to test positive for COVID-19, while end stage renal disease [0.908(0.843-0.978)] and non-COVID-19 respiratory viral illness [0.907 (0.863 - 0.953)] patients had a lower risk of COVID-19 positivity. Heart failure [0.907 (0.830 - 0.991)], chronic obstructive pulmonary disease (COPD) [0.842 (0.745 - 0.952)] and Parkinson’s disease [0.823 (0.708 - 0.957)] never-smokers were less likely to test positive for COVID-19. Conclusion This is the first study to show that smoking increases the risk of COVID-19 positivity among the 40-49-year-old patients, while not smoking reduces the risk of COVID-19 positivity among the heart failure, COPD and Parkinson’s disease patients. This study emphasizes that COVID-19 positivity risk is not reduced by smoking and not increased by not smoking. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement No funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The PeaceHealth institutional review board (IRB) approved the study and waived the written informed consent requirement. IRB # 1689210-1 All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes all the data is available in the manuscript and in the supplementary files [1]: #ref-1 [2]: #ref-2 [3]: #ref-3 [4]: #ref-4 [5]: #ref-5 [6]: #ref-6 [7]: #ref-17