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Wratil PR, Le Thi TG, Osterman A, Badell I, Huber M, Zhelyazkova A, Wichert SP, Litwin A, Hörmansdorfer S, Strobl F, Grote V, Jebrini T, Török HP, Hornung V, Choukér A, Koletzko B, Adorjan K, Koletzko S, Keppler OT. Dietary habits, traveling and the living situation potentially influence the susceptibility to SARS-CoV-2 infection: results from healthcare workers participating in the RisCoin Study. Infection 2024; 52:1425-1437. [PMID: 38436913 PMCID: PMC11289231 DOI: 10.1007/s15010-024-02201-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/25/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE To explore occupational and non-occupational risk and protective factors for the coronavirus disease 2019 (COVID-19) in healthcare workers (HCWs). METHODS Serum specimens and questionnaire data were obtained between October 7 and December 16, 2021 from COVID-19-vaccinated HCWs at a quaternary care hospital in Munich, Germany, and were analyzed in the RisCoin Study. RESULTS Of 3,696 participants evaluated, 6.6% have had COVID-19 at least once. Multivariate logistic regression analysis identified working in patient care occupations (7.3% had COVID-19, 95% CI 6.4-8.3, Pr = 0.0002), especially as nurses, to be a potential occupation-related COVID-19 risk factor. Non-occupational factors significantly associated with high rates of the disease were contacts to COVID-19 cases in the community (12.8% had COVID-19, 95% CI 10.3-15.8, Pr < 0.0001), being obese (9.9% had COVID-19, 95% CI 7.1-13.5, Pr = 0.0014), and frequent traveling abroad (9.4% had COVID-19, 95% CI 7.1-12.3, Pr = 0.0088). On the contrary, receiving the basic COVID-19 immunization early during the pandemic (5.9% had COVID-19, 95% CI 5.1-6.8, Pr < 0.0001), regular smoking (3.6% had COVID-19, 95% CI 2.1-6.0, Pr = 0.0088), living with the elderly (3.0% had COVID-19, 95% CI 1.0-8.0, Pr = 0.0475), and frequent consumption of ready-to-eat meals (2.6% had COVID-19, 95% CI 1.1-5.4, Pr = 0.0045) were non-occupational factors potentially protecting study participants against COVID-19. CONCLUSION The newly discovered associations between the living situation, traveling as well as dietary habits and altered COVID-19 risk can potentially help refine containment measures and, furthermore, contribute to new mechanistic insights that may aid the protection of risk groups and vulnerable individuals.
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Affiliation(s)
- Paul R Wratil
- Max von Pettenkofer Institute and Gene Center, Virology, National Reference Center for Retroviruses, LMU Munich, Pettenkoferstr. 9a, 80336, Munich, Germany
- German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Thu Giang Le Thi
- Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospital, LMU Munich, Lindwurmstraße 4, 80337, Munich, Germany
| | - Andreas Osterman
- Max von Pettenkofer Institute and Gene Center, Virology, National Reference Center for Retroviruses, LMU Munich, Pettenkoferstr. 9a, 80336, Munich, Germany
| | - Irina Badell
- Max von Pettenkofer Institute and Gene Center, Virology, National Reference Center for Retroviruses, LMU Munich, Pettenkoferstr. 9a, 80336, Munich, Germany
| | - Melanie Huber
- Max von Pettenkofer Institute and Gene Center, Virology, National Reference Center for Retroviruses, LMU Munich, Pettenkoferstr. 9a, 80336, Munich, Germany
| | - Ana Zhelyazkova
- Institut für Notfallmedizin und Medizinmanagement (INM), LMU University Hospital, LMU Munich, Munich, Germany
| | - Sven P Wichert
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Nussbaumstraße 7, 80336, Munich, Germany
| | - Anna Litwin
- Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospital, LMU Munich, Lindwurmstraße 4, 80337, Munich, Germany
| | | | - Frances Strobl
- Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospital, LMU Munich, Lindwurmstraße 4, 80337, Munich, Germany
| | - Veit Grote
- Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospital, LMU Munich, Lindwurmstraße 4, 80337, Munich, Germany
| | - Tarek Jebrini
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Nussbaumstraße 7, 80336, Munich, Germany
| | - Helga P Török
- Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Veit Hornung
- Gene Center and Department of Biochemistry, LMU Munich, Munich, Germany
| | - Alexander Choukér
- Department of Anesthesiology, Laboratory of Translational Research Stress and Immunity, LMU University Hospital, LMU Munich, Munich, Germany
| | - Berthold Koletzko
- Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospital, LMU Munich, Lindwurmstraße 4, 80337, Munich, Germany
| | - Kristina Adorjan
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Nussbaumstraße 7, 80336, Munich, Germany.
- Institute of Psychiatric Phenomics and Genomics (IPPG), LMU University Hospital, LMU Munich, Munich, Germany.
- Center for International Health (CIH), LMU Munich, Munich, Germany.
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
| | - Sibylle Koletzko
- Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospital, LMU Munich, Lindwurmstraße 4, 80337, Munich, Germany.
- Department of Pediatrics, Gastroenterology and Nutrition, School of Medicine Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland.
| | - Oliver T Keppler
- Max von Pettenkofer Institute and Gene Center, Virology, National Reference Center for Retroviruses, LMU Munich, Pettenkoferstr. 9a, 80336, Munich, Germany.
- German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany.
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2
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Kang SY, Kim YJ, Cho HJ. COVID-19 Outcome and Tobacco Product Use: Case-Control and Retrospective Cohort Studies Using Nationwide Samples. J Korean Med Sci 2024; 39:e103. [PMID: 38529574 DOI: 10.3346/jkms.2024.39.e103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/14/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Conflicting evidence exists regarding the association between smoking and the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We investigated the association between combustible cigarette (CC) smoking, noncombustible tobacco product (NCTP) use, and the use of any tobacco product with various coronavirus disease 2019 (COVID-19) outcomes. METHODS A case-control study was conducted using the Korea Disease Control and Prevention Agency-COVID19-National Health Insurance Service (NHIS) cohort. A retrospective cohort study was conducted using 12,571,698 individuals from the NHIS cohort. Logistic regression evaluated the association between CC smoking, NCTP use, and use of any tobacco product with SARS-CoV-2 infection. Poisson regression evaluated the association between these forms of tobacco product use and COVID-19-related hospitalization and mortality. RESULTS In the case-control study, we identified 30,878 cases of SARS-CoV-2 infection. The odds ratios (95% confidence intervals [CIs]) for SARS-CoV-2 infection were lower among current CC smokers (0.51, 0.48-0.54), current- and former-NCTP users (0.80, 0.74-0.88; 0.82, 0.74-0.91), and current users of any tobacco product (0.52, 0.49-0.55) relative to never user controls. In retrospective cohort study, we identified 16,521 COVID-19-related hospitalization and 362 COVID-19-related deaths. The relative risks (95% CIs) for COVID-19-related hospitalization were lower among current CC smokers (0.51, 0.48-0.54) and current users of any tobacco product (0.53, 0.50-0.56) relative to never user controls. There was no association between the use of tobacco product and COVID-19-related mortality. CONCLUSION Current CC smokers and current users of any tobacco product showed reduced risk of SARS-CoV-2 infection and COVID-19-related hospitalization. It remains uncertain whether these relationships are causal.
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Affiliation(s)
- Seo Young Kang
- Department of Family Medicine, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, Korea
| | - Ye-Jee Kim
- Department of Clinical Epidemiology and Biostatics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hong-Jun Cho
- Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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3
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Leong DP, Loeb M, Mony PK, Rangarajan S, Mushtaha M, Miller MS, Dias M, Yegorov S, V M, Telci Caklili O, Temizhan A, Szuba A, Abat MEM, Mat-Nasir N, Diaz ML, Khansaheb H, Lopez-Jaramillo P, Duong M, Teo KK, Poirier P, Oliveira G, Avezum Á, Yusuf S. Risk factors for recognized and unrecognized SARS-CoV-2 infection: a seroepidemiologic analysis of the Prospective Urban Rural Epidemiology (PURE) study. Microbiol Spectr 2024; 12:e0149223. [PMID: 38214526 PMCID: PMC10845948 DOI: 10.1128/spectrum.01492-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 10/26/2023] [Indexed: 01/13/2024] Open
Abstract
There are limited data on individual risk factors for SARS-CoV-2 infection (including unrecognized infection). In this seroepidemiologic substudy of an ongoing prospective cohort study of community-dwelling adults, participants were thoroughly characterized pre-pandemic. The SARS-CoV-2 infection was ascertained by serology. Among 8,719 participants from 11 high-, middle-, and low-income countries, 3,009 (35%) were seropositive for SARS-CoV-2. Characteristics independently associated with seropositivity were younger age (odds ratio, OR; 95% confidence interval, CI, per five-year increase: 0.95; 0.91-0.98) and body mass index >25 kg/m2 (OR, 95% CI: 1.16, 1.01-1.34). Smoking (as compared with never smoking, OR, 95% CI: 0.83, 0.70-0.97) and COVID-19 vaccination (OR, 95% CI: 0.70, 0.60-0.82) were associated with a reduced risk of seropositivity. Among seropositive participants, 83% were unaware of having been infected with SARS-CoV-2. Seropositivity and a lack of awareness of infection were more common in lower-income countries. The COVID-19 vaccination reduces the risk of SARS-CoV-2 infection (including recognized and unrecognized infections). Overweight or obesity is an independent risk factor for SARS-CoV-2 infection. Infection and lack of infection awareness are more common in lower-income countries.IMPORTANCEIn this large, international study, evidence of SARS-CoV-2 infection was obtained by testing blood specimens from 8,719 community-dwelling adults from 11 countries. The key findings are that (i) the large majority (83%) of community-dwelling adults from several high-, middle-, and low-income countries with blood test evidence of SARS-CoV-2 infection were unaware of this infection-especially in lower-income countries; and (ii) overweight/obesity predisposes to SARS-CoV-2 infection, while COVID-19 vaccination is associated with a reduced risk of SARS-CoV-2 infection. These observations are not attributable to other individual characteristics, highlighting the importance of the COVID-19 vaccination to prevent not only severe infection but possibly any infection. Further research is needed to understand the mechanisms by which overweight/obesity might increase the risk of SARS-CoV-2 infection.
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Affiliation(s)
- Darryl P. Leong
- The Population Health Research Institute, McMaster University, Hamilton, Canada
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Mark Loeb
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Prem K. Mony
- Division of Epidemiology and Population Health, St. John’s Research Institute, St. John’s Medical College, Bangalore, India
| | - Sumathy Rangarajan
- The Population Health Research Institute, McMaster University, Hamilton, Canada
| | - Maha Mushtaha
- The Population Health Research Institute, McMaster University, Hamilton, Canada
| | - Matthew S. Miller
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Canada
| | - Mary Dias
- Department of Microbiology and Infectious Diseases, St. John’s Medical College, Bangalore, India
| | - Sergey Yegorov
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Canada
| | - Mamatha V
- Department of Microbiology and Infectious Diseases, St. John’s Medical College, Bangalore, India
| | - Ozge Telci Caklili
- Department of Endocrinology and Metabolism, Istanbul University, Istanbul, Turkey
| | - Ahmet Temizhan
- Cardiology Department, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Andrzej Szuba
- Department of Angiology, Hypertension and Diabetology, Wroclaw Medical University, Wroclaw, Poland
| | - Marc Evans M. Abat
- Department of Medicine, Philippine General Hospital, Manila, Philippines
| | - Nafiza Mat-Nasir
- Department of Primary Care Medicine, Universiti Teknologi MARA (UiTM), Petaling Jaya, Malaysia
| | - Maria Luz Diaz
- Estudios Clinicos Latinamérica (ECLA), Instituto Cardiovascular de Rosario, Rosario, Argentina
| | | | | | - MyLinh Duong
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Koon K. Teo
- The Population Health Research Institute, McMaster University, Hamilton, Canada
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Paul Poirier
- Faculté de pharmacie, Université Laval, Québec, Canada
| | | | | | - Salim Yusuf
- The Population Health Research Institute, McMaster University, Hamilton, Canada
- Department of Medicine, McMaster University, Hamilton, Canada
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4
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Rosner BM, Falkenhorst G, Kumpf I, Enßle M, Hicketier A, Dörre A, Stark K, Wilking H. Case-control study of behavioural and societal risk factors for sporadic SARS-CoV-2 infections, Germany, 2020-2021 (CoViRiS study). Epidemiol Infect 2024; 152:e16. [PMID: 38220467 PMCID: PMC10894885 DOI: 10.1017/s0950268824000050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 01/16/2024] Open
Abstract
During the COVID-19 pandemic in Germany, a variety of societal activities were restricted to minimize direct personal interactions and, consequently, reduce SARS-CoV-2 transmission. The aim of the CoViRiS study was to investigate whether certain behaviours and societal factors were associated with the risk of sporadic symptomatic SARS-CoV-2 infections. Adult COVID-19 cases and frequency-matched population controls were interviewed by telephone regarding activities that involved contact with other people during the 10 days before illness onset (cases) or before the interview (controls). Associations between activities and symptomatic SARS-CoV-2 infection were analysed using logistic regression models adjusted for potential confounding variables. Data of 859 cases and 1 971 controls were available for analysis. The risk of symptomatic SARS-CoV-2 infection was lower for individuals who worked from home (adjusted odds ratio (aOR) 0.5; 95% confidence interval (CI) 0.3-0.6). Working in a health care setting was associated with a higher risk (aOR: 1.5; 95% CI: 1.1-2.1) as were private indoor contacts, personal contacts that involved shaking hands or hugging, and overnight travelling within Germany. Our results are in line with some of the public health recommendations aimed at reducing interpersonal contacts during the COVID-19 pandemic.
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Affiliation(s)
- Bettina M Rosner
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Gerhard Falkenhorst
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Isabella Kumpf
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Maren Enßle
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Andreas Hicketier
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Achim Dörre
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Klaus Stark
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Hendrik Wilking
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
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5
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Toh TH, Qi YY, Yong SM, Lee JSY, Liyana NF, See RYH, Teh JH, Toh AZ, Naing L, Dahian K, Liew JW, Mose CN, Yong MZQ, Ling NJ, Chua DWS, Ling WW, Thirunavukkarasu N, Suhaili MR, Xia JL, Clemens J, Wang XY. Effectiveness of vero cell inactivated vaccine against severe acute respiratory infections (SARI) in Sibu, Malaysia: A retrospective test-negative design. Hum Vaccin Immunother 2023; 19:2167438. [PMID: 36705277 PMCID: PMC10012932 DOI: 10.1080/21645515.2023.2167438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
The effectiveness of the vero cell inactivated vaccine (CoronaVac®) against severe acute respiratory infection (SARI) caused by SARS-CoV-2 in the real world was assessed. A matched test-negative case-control design was employed using the web-based national information system, as well as the hospitalization dataset in Sibu Hospital. Vaccine effectiveness was measured by conditional logistic regression with adjustment for gender, underlying comorbidity, smoking status, and education level. Between 15 March and 30 September 2021, 838 eligible SARI patients were identified from the hospitalization records. Vaccine effectiveness was 42.4% (95% confidence interval [CI]: -28.3 to 74.1) for partial vaccination (after receiving the first dose to 14 days after receiving the second dose), and 76.5% (95% CI: 45.6 to 89.8) for complete vaccination (at 15 days or more after receiving the second dose). This analysis indicated that two doses of CoronaVac® vaccine provided efficacious protection against SARI caused by SARS-CoV-2 in the short term. However, the duration of protection, and performance against new variants need to be studied continuously.
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Affiliation(s)
- Teck-Hock Toh
- Clinical Research Centre, Sibu Hospital, Ministry of Health Malaysia, Sibu, Malaysia.,Faculty of Medicine, SEGi University, Kota Damansara, Malaysia
| | - Yang-Yang Qi
- Shanghai Institute of Infectious Disease and Biosecurity, Shanghai, China.,Key Laboratory of Medical Molecular Virology of MoE & MoH, and Institutes of Biomedical Sciences, Shanghai Medical College, Fudan University, Shanghai, China
| | - Sook-Min Yong
- Clinical Research Centre, Sibu Hospital, Ministry of Health Malaysia, Sibu, Malaysia
| | - Jeffrey Soon-Yit Lee
- Clinical Research Centre, Sibu Hospital, Ministry of Health Malaysia, Sibu, Malaysia
| | - Nur Fatin Liyana
- Clinical Research Centre, Sibu Hospital, Ministry of Health Malaysia, Sibu, Malaysia
| | | | - Jo-Hun Teh
- Divisional Health Office, Ministry of Health Malaysia, Sibu, Malaysia
| | - Aw-Zien Toh
- Clinical Research Centre, Sibu Hospital, Ministry of Health Malaysia, Sibu, Malaysia
| | - Lin Naing
- PAPRSB Institute of Health Sciences, University Brunei Darussalam, Bandar Seri Begawan, Brunei Darussalam
| | - Kamilah Dahian
- Clinical Research Centre, Sibu Hospital, Ministry of Health Malaysia, Sibu, Malaysia
| | - Jun-Wei Liew
- Medical Department, Sibu Hospital, Ministry of Health Malaysia, Sibu, Malaysia
| | - Caisha Nivenia Mose
- Emergency & Trauma Department, Sibu Hospital, Ministry of Health Malaysia, Sibu, Malaysia
| | - Malvina Zi-Qing Yong
- Clinical Research Centre, Sibu Hospital, Ministry of Health Malaysia, Sibu, Malaysia
| | - Ngiik-Jing Ling
- Clinical Research Centre, Sibu Hospital, Ministry of Health Malaysia, Sibu, Malaysia
| | - Diana Wang-Sing Chua
- Clinical Research Centre, Sibu Hospital, Ministry of Health Malaysia, Sibu, Malaysia
| | - Wee-Wei Ling
- Emergency & Trauma Department, Sibu Hospital, Ministry of Health Malaysia, Sibu, Malaysia
| | | | | | | | | | - Xuan-Yi Wang
- Shanghai Institute of Infectious Disease and Biosecurity, Shanghai, China.,Key Laboratory of Medical Molecular Virology of MoE & MoH, and Institutes of Biomedical Sciences, Shanghai Medical College, Fudan University, Shanghai, China.,Children's Hospital, Fudan University, Shanghai, China
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6
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Papadopoulos KI, Papadopoulou A, Aw TC. Live to die another day: novel insights may explain the pathophysiology behind smoker's paradox in SARS-CoV-2 infection. Mol Cell Biochem 2023; 478:2517-2526. [PMID: 36867341 PMCID: PMC9983545 DOI: 10.1007/s11010-023-04681-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 02/17/2023] [Indexed: 03/04/2023]
Abstract
The severe acute respiratory coronavirus 2 (SARS-CoV-2) infection demonstrates a highly variable and unpredictable course. Several reports have claimed a smoker's paradox in coronavirus disease 2019 (COVID-19), in line with previous suggestions that smoking is associated with better survival after acute myocardial infarction and appears protective in preeclampsia. Several plausible physiological explanations exist accounting for the paradoxical observation of smoking engendering protection against SARS-CoV-2 infection. In this review, we delineate novel mechanisms whereby smoking habits and smokers' genetic polymorphism status affecting various nitric oxide (NO) pathways (endothelial NO synthase, cytochrome P450 (CYP450), erythropoietin receptor (EPOR); β-common receptor (βcR)), along with tobacco smoke modulation of microRNA-155 and aryl-hydrocarbon receptor (AHR) effects, may be important determinators of SARS-CoV-2 infection and COVID-19 course. While transient NO bioavailability increase and beneficial immunoregulatory modulations through the above-mentioned pathways using exogenous, endogenous, genetic and/or therapeutic modalities may have direct and specific, viricidal SARS-CoV-2 effects, employing tobacco smoke inhalation to achieve protection equals self-harm. Tobacco smoking remains the leading cause of death, illness, and impoverishment.
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Affiliation(s)
- K. I. Papadopoulos
- THAI StemLife, 566/3 Soi Ramkhamhaeng 39 (Thepleela 1), Prachaouthit Rd., Wangthonglang, Wangthonglang, 10310 Bangkok Thailand
| | - A. Papadopoulou
- Occupational and Environmental Health Services, Feelgood Lund, Ideon Science Park, Scheelevägen 17, 223 63 Lund, Sweden
| | - T. C. Aw
- Department of Laboratory Medicine, Changi General Hospital, 2 Simei Street 3, Singapore, 529889 Singapore
- Department of Medicine, National University of Singapore, Singapore, 119228 Singapore
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7
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Young‐Wolff KC, Ray GT, Alexeeff SE, Benowitz N, Adams SR, Does MB, Goler N, Ansley D, Conway A, Avalos LA. Association of cannabis use during pregnancy with severe acute respiratory syndrome coronavirus 2 infection: a retrospective cohort study. Addiction 2023; 118:317-326. [PMID: 36189777 PMCID: PMC9812868 DOI: 10.1111/add.16056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 09/12/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND AIMS Cannabis use is increasingly common among pregnant individuals and might be a risk factor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We aimed to test whether prenatal cannabis use is associated with increased risk of SARS-CoV-2 infection during pregnancy. DESIGN This is a retrospective cohort study. SETTING The study was conducted in California, USA. PARTICIPANTS A total of 58 114 pregnancies (with outcomes from 5 March 2020 to 30 September 2021) among 57 287 unique pregnant women aged 14-54 years who were screened for prenatal substance use, enrolled in Kaiser Permanente Northern California (KPNC) (a health-care system) and had not tested positive for COVID-19 prior to pregnancy onset. MEASUREMENTS We utilized data from the KPNC electronic health record. Cannabis use status (current, recently quit and non-user) was based on universal screenings during prenatal care (including urine toxicology testing and self-reported use on a self-administered questionnaire). SARS-CoV-2 infection [based on polymerase chain reaction (PCR) tests] was estimated in time-to-event analyses using Cox proportional hazard regression models adjusting for covariates. Secondary analyses examined differences in (a) SARS-CoV-2 testing rates and (b) SARS-CoV-2 infection rates among those tested. FINDINGS We observed 348 810 person-months of follow-up time in our cohort with 41 064 SARS-CoV-2 PCR tests and 6% (n = 2414) of tests being positive. At the start of follow-up, 7% of pregnant individuals had current use, 12% had recently quit and 81% did not use cannabis. Adjusting for covariates, current use was associated with lower rates of SARS-CoV-2 infection [adjusted hazard ratio (aHR) = 0.60, 95% confidence interval (CI) = 0.49-0.74 than non-use. Those who had recently quit did not differ from non-cannabis users in infection rates (aHR = 0.96, 95% CI = 0.86-1.08). Sensitivity analyses among patients who received a SARS-CoV-2 test also found lower odds of infection associated with current versus no cannabis use (aOR = 0.76, CI = 0.61-0.93). CONCLUSIONS Current cannabis use appears to be associated with a reduced risk of SARS-CoV-2 infection among pregnant individuals.
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Affiliation(s)
- Kelly C. Young‐Wolff
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCAUSA,Department of Psychiatry and Behavioral SciencesUniversity of California, San FranciscoSan FranciscoCAUSA
| | - G. Thomas Ray
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCAUSA
| | | | - Neal Benowitz
- Research Program in Clinical Pharmacology, Division of Cardiology, Department of Medicine and Center for Tobacco Control Research and EducationUniversity of California, San FranciscoSan FranciscoCAUSA
| | - Sara R. Adams
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCAUSA
| | - Monique B. Does
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCAUSA
| | - Nancy Goler
- Regional OfficesKaiser Permanente Northern CaliforniaOaklandCAUSA
| | - Deborah Ansley
- Regional OfficesKaiser Permanente Northern CaliforniaOaklandCAUSA
| | - Amy Conway
- Regional OfficesKaiser Permanente Northern CaliforniaOaklandCAUSA
| | - Lyndsay A. Avalos
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCAUSA
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8
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Young-Wolff KC, Slama N, Alexeeff SE, Sakoda LC, Fogelberg R, Myers LC, Campbell CI, Adams AS, Prochaska JJ. Tobacco Smoking and Risk of SARS-CoV-2 Infection and Disease Severity Among Adults in an Integrated Healthcare System in California. Nicotine Tob Res 2023; 25:211-220. [PMID: 35368066 PMCID: PMC9825324 DOI: 10.1093/ntr/ntac090] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 02/18/2022] [Accepted: 03/31/2022] [Indexed: 01/12/2023]
Abstract
INTRODUCTION The relationship between tobacco smoking status and SARS-CoV-2 infection and coronavirus disease 2019 (COVID-19) severity is highly debated. We conducted a retrospective cohort study of >2.4 million adults in a large healthcare system to evaluate whether smoking is associated with SARS-CoV-2 infection and disease severity. AIMS AND METHODS This retrospective cohort study of 2,427,293 adults in KPNC from March 5, 2020 (baseline) to December 31, 2020 (pre-vaccine) included smoking status (current, former, never), socio-demographics, and comorbidities from the electronic health record. SARS-CoV-2 infection (identified by a positive PCR test) and COVID-19 severity (hospitalization, ICU admission or death ≤ 30 days of COVID-19 diagnosis) were estimated in time-to-event analyses using Cox proportional hazard regression models adjusting for covariates. Secondary analyses examined COVID-19 severity among patients with COVID-19 using logistic regression. RESULTS During the study, 44,270 patients had SARS-CoV-2 infection. Current smoking was associated with lower adjusted rates of SARS-CoV-2 infection (aHR = 0.64 95% CI: 0.61-0.67), COVID-19-related hospitalization (aHR = 0.48 95% CI: 0.40-0.58), ICU admission (aHR = 0.62 95% CI: 0.42-0.87), and death (aHR = 0.52 95% CI: 0.27-0.89) than never-smoking. Former smoking was associated with a lower adjusted rate of SARS-CoV-2 infection (aHR = 0.96 95% CI: 0.94-0.99) and higher adjusted rates of hospitalization (aHR = 1.10 95% CI: 1.03-1.08) and death (aHR = 1.32 95% CI: 1.11-1.56) than never-smoking. Logistic regression analyses among patients with COVID-19 found lower odds of hospitalization for current versus never-smoking and higher odds of hospitalization and death for former versus never-smoking. CONCLUSIONS In the largest US study to date on smoking and COVID-19, current and former smoking showed lower risk of SARS-CoV-2 infection than never-smoking, while a history of smoking was associated with higher risk of severe COVID-19. IMPLICATIONS In this cohort study of 2.4 million adults, adjusting for socio-demographics and medical comorbidities, current tobacco smoking was associated with a lower risk of both SARS-CoV-2 infection and severe COVID-19 illness compared to never-smoking. A history of smoking was associated with a slightly lower risk of SARS-CoV-2 infection and a modestly higher risk of severe COVID-19 illness compared to never-smoking. The lower observed COVID-19 risk for current versus never-smoking deserves further investigation. Results support prioritizing individuals with smoking-related comorbidities for vaccine outreach and treatments as they become available.
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Affiliation(s)
- Kelly C Young-Wolff
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
| | - Natalie Slama
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Stacey E Alexeeff
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Lori C Sakoda
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Renee Fogelberg
- Richmond Medical Center, Kaiser Permanente Northern California, Richmond, CA, USA
| | - Laura C Myers
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Cynthia I Campbell
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
| | - Alyce S Adams
- Stanford Cancer Institute, Stanford University, Stanford, CA, USA
| | - Judith J Prochaska
- Stanford Prevention Research Center, Stanford University, Stanford, CA, USA
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Rodriguez-Miguelez P, Heefner A, Carbone S. Recognizing risk factors associated with poor outcomes among patients with COVID-19. Prog Cardiovasc Dis 2023; 76:3-11. [PMID: 36693489 PMCID: PMC9862711 DOI: 10.1016/j.pcad.2023.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 01/18/2023] [Indexed: 01/22/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has affected >610 million people globally, exerting major social, economic, and health impacts. Despite the large number of global casualities and severe symptomatology associated with COVID-19, a large number of individuals remain at elevated risk of infection and severe outcomes related to poor lifestyle behaviors and/or associated comorbidities. Beyond the well-known social distance and masking policies, maintaining an active lifestyle, minimizing the consumption of tobacco products, and maintaining an adequate nutrition status are some of the key factors that, in an affordable and accessible way, have the potential to improve health and minimize COVID-19 impact. In addition, bringing awareness of the higher risks and poor prognosis of COVID-19 when other conditions are present seems to be essential to protect those individuals with the highest risks.
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Affiliation(s)
- Paula Rodriguez-Miguelez
- Department of Kinesiology and Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, Richmond, VA, United States of America; Division of Pulmonary and Critical Care, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, United States of America.
| | - Allison Heefner
- Department of Kinesiology and Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, Richmond, VA, United States of America; Virginia Commonwealth University School of Medicine, Richmond, VA, United States of America
| | - Salvatore Carbone
- Department of Kinesiology and Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, Richmond, VA, United States of America; VCU Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, United States of America
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Günther F, Einhauser S, Peterhoff D, Wiegrebe S, Niller HH, Beileke S, Steininger P, Burkhardt R, Küchenhoff H, Gefeller O, Überla K, Heid IM, Wagner R. Higher Infection Risk among Health Care Workers and Lower Risk among Smokers Persistent across SARS-CoV-2 Waves-Longitudinal Results from the Population-Based TiKoCo Seroprevalence Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16996. [PMID: 36554876 PMCID: PMC9779618 DOI: 10.3390/ijerph192416996] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/09/2022] [Accepted: 12/15/2022] [Indexed: 06/17/2023]
Abstract
SARS-CoV-2 seroprevalence was reported as substantially increased in medical personnel and decreased in smokers after the first wave in spring 2020, including in our population-based Tirschenreuth Study (TiKoCo). However, it is unclear whether these associations were limited to the early pandemic and whether the decrease in smokers was due to reduced infection or antibody response. We evaluated the association of occupation and smoking with period-specific seropositivity: for the first wave until July 2020 (baseline, BL), the low infection period in summer (follow-up 1, FU1, November 2020), and the second/third wave (FU2, April 2021). We measured binding antibodies directed to SARS-CoV-2 nucleoprotein (N), viral spike protein (S), and neutralizing antibodies at BL, FU1, and FU2. Previous infection, vaccination, smoking, and occupation were assessed by questionnaires. The 4181 participants (3513/3374 at FU1/FU2) included 6.5% medical personnel and 20.4% current smokers. At all three timepoints, new seropositivity was higher in medical personnel with ORs = 1.99 (95%-CI = 1.36-2.93), 1.41 (0.29-6.80), and 3.17 (1.92-5.24) at BL, FU1, and FU2, respectively, and nearly halved among current smokers with ORs = 0.47 (95%-CI = 0.33-0.66), 0.40 (0.09-1.81), and 0.56 (0.33-0.94). Current smokers compared to never-smokers had similar antibody levels after infection or vaccination and reduced odds of a positive SARS-CoV-2 result among tested. Our data suggest that decreased seroprevalence among smokers results from fewer infections rather than reduced antibody response. The persistently higher infection risk of medical staff across infection waves, despite improved means of protection over time, underscores the burden for health care personnel.
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Affiliation(s)
- Felix Günther
- Department of Mathematics, Stockholm University, Albanovägen 28, 11419 Stockholm, Sweden
| | - Sebastian Einhauser
- Institute of Medical Microbiology and Hygiene, Molecular Microbiology (Virology), University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - David Peterhoff
- Institute of Medical Microbiology and Hygiene, Molecular Microbiology (Virology), University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
- Institute of Clinical Microbiology and Hygiene, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Simon Wiegrebe
- Department of Genetic Epidemiology, University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
- Statistical Consulting Unit StaBLab, Department of Statistics, LMU Munich, Geschwister-Scholl-Platz 1, 80539 Munich, Germany
| | - Hans Helmut Niller
- Institute of Medical Microbiology and Hygiene, Molecular Microbiology (Virology), University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Stephanie Beileke
- Institute of Clinical and Molecular Virology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schlossgarten 4, 91054 Erlangen, Germany
| | - Philipp Steininger
- Institute of Clinical and Molecular Virology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schlossgarten 4, 91054 Erlangen, Germany
| | - Ralph Burkhardt
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Helmut Küchenhoff
- Statistical Consulting Unit StaBLab, Department of Statistics, LMU Munich, Geschwister-Scholl-Platz 1, 80539 Munich, Germany
| | - Olaf Gefeller
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Waldstr. 6, 91054 Erlangen, Germany
| | - Klaus Überla
- Institute of Clinical and Molecular Virology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schlossgarten 4, 91054 Erlangen, Germany
| | - Iris M. Heid
- Department of Genetic Epidemiology, University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Ralf Wagner
- Institute of Medical Microbiology and Hygiene, Molecular Microbiology (Virology), University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
- Institute of Clinical Microbiology and Hygiene, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
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Ansari N, Nisar MI, Khalid F, Mehmood U, Usmani AA, Shaheen F, Hotwani A, Begum K, Barkat A, Yoshida S, Manu AA, Sazawal S, Baqui AH, Bahl R, Jehan F. Prevalence and risk factors of Severe Acute Respiratory Syndrome Coronavirus 2 infection in women and children in peri-urban communities in Pakistan: A prospective cohort study. J Glob Health 2022; 12:05055. [PMID: 36527274 PMCID: PMC9757617 DOI: 10.7189/jogh.12.95955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Population-based seroepidemiological surveys provide accurate estimates of disease burden. We compare the COVID-19 prevalence estimates from two serial serological surveys and the associated risk factors among women and children in a peri-urban area of Karachi, Pakistan. Methods The AMANHI-COVID-19 study enrolled women and children between November 2020 and March 2021. Blood samples were collected from March to June 2021 (baseline) and September to December 2021 (follow-up) to test for anti-SARS-CoV-2 antibodies using ROCHE Elecsys®. Participants were visited or called weekly during the study for recording symptoms of COVID-19. We report the proportion of participants with anti-SARS-CoV-2 antibodies and symptoms in each survey and describe infection risk factors using step-wise binomial regression analysis. Results The adjusted seroprevalence among women was 45.3% (95% confidence interval (CI) = 42.6-47.9) and 82.3% (95% CI = 79.9-84.4) at baseline and follow-up survey, respectively. Among children, it was 18.4% (95% CI = 16.1-20.7) and 57.4% (95% CI = 54.3-60.3) at baseline and follow-up, respectively. Of the women who were previously seronegative, 404 (74.4%) tested positive at the follow-up survey, as did 365 (50.4%) previously seronegative children. There was a high proportion of asymptomatic infection. At baseline, being poorest and lacking access to safe drinking water lowered the risk of infection for both women (risk ratio (RR) = 0.8, 95% CI = 0.7-0.9 and RR = 1.2, 95% CI = 1.1-1.4, respectively) and children (RR = 0.7, 95% CI = 0.5-1.0 and RR = 1.4, 95% CI = 1.0-1.8, respectively). At the follow-up survey, the risk of infection was lower for underweight women and children (RR = 0.4, 95% CI = 0.3-0.7 and RR = 0.7, 95% CI = 0.5-0.8, respectively) and for women in the 30-39 years age group and children who were 24-36 months of age (RR = 0.6, 95% CI = 0.4-0.9 and RR = 0.7, 95% CI = 0.5-0.9, respectively). In both surveys, paternal employment was an important predictor of seropositivity among children (RR = 0.7, 95% CI = 0.6-0.9 and RR = 0.8, 95% CI = 0.7-1.0, respectively). Conclusion There was a high rate of seroconversion among women and children. Infection was generally mild. Parental education plays an important role in protection of children from COVID-19.
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Affiliation(s)
- Nadia Ansari
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi
| | - Muhammad I Nisar
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi
| | - Farah Khalid
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi
| | - Usma Mehmood
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi
| | - Asra A Usmani
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi
| | - Fariha Shaheen
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi
| | - Aneeta Hotwani
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi
| | - Kehkashan Begum
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi
| | - Amina Barkat
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi
| | - Sachiyo Yoshida
- Department for Maternal, Child, Adolescents and Ageing Health, World Health Organization, Geneva, Switzerland
| | - Alexander A Manu
- Department of Epidemiology and Disease Control, University of Ghana School of Public Health, Legon, Accra, Ghana
| | - Sunil Sazawal
- Center for Public Health Kinetics, Global Division, LGL Vinoba Puri, Lajpat Nagar II, New Delhi, India
- Public Health Laboratory-IDC, Chake Chake, Pemba, Tanzania
| | - Abdullah H Baqui
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Rajiv Bahl
- Department for Maternal, Child, Adolescents and Ageing Health, World Health Organization, Geneva, Switzerland
| | - Fyezah Jehan
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi
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12
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Meynard JB, de Laval F, Texier G, Gorgé O, Degui H, Pommier de Santi V. [Management of the COVID-19 epidemic in the carrier battle group (January-April 2020) by the Armed Forces Epidemiology and Public Health Center]. BULLETIN DE L'ACADEMIE NATIONALE DE MEDECINE 2022; 206:997-1010. [PMID: 35879932 PMCID: PMC9301959 DOI: 10.1016/j.banm.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objectives Faced with the COVID-19 epidemic that occurred within the naval air group and the nuclear aircraft carrier Charles de Gaulle, the French Armed Forces Epidemiology and Public Health Center (CESPA) carried out an investigation (January - April 2020) whose objectives were: to identify the possible routes of introduction of the virus ; to describe the characteristics of the epidemic and to describe and model the dynamics of the epidemic's spread. Methods A telephone survey was conducted. The biological diagnoses were transmitted by the medical antennas. A time/place/population analysis was carried out, as well as the description of the clinical pictures with their exposure factors. The instantaneous reproduction rate Rt of the epidemic was modeled. A spatial analysis of the epidemic on board was carried out. Forty-three viral genomes were sequenced and compared to the reference bases. Results 0f 1767 sailors, 1568 (89%) participated in the telephone survey and 1064 (67.9%) were confirmed cases. Four patient profiles have been described: asymptomatic (13.0%); non-specific symptomatic (8.1%); specific symptomatic (76.3%); severe cases (2.6%). In univariate and multivariate analysis, age, overweight and obesity were significantly associated with the risk of having a severe form. Smoking was a protective factor. The evolution kinetics of Rt was in favor of an introduction of the virus at the end of February with a reintroduction during the stopover in Brest. Analysis of viral genomes ruled out introduction and spread of a single strain. Conclusion Despite the control measures taken, an epidemic occurred. The often pauci-symptomatic clinical pictures resulted in a delay in identification. CESPA was able to carry out this epidemiological investigation within a highly constrained timeframe, showing all the interest of its integrated public health model.
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Affiliation(s)
- J-B Meynard
- Direction de la formation, de la recherche et de l'innovation du service de santé des armées, Val-de-Grâce, 1, place Alphonse Laveran, 75005 Paris, France
- UMR 1252-sciences économiques et sociales de la santé et traitement de l'information médicale, SESSTIM, Inserm/IRD/Aix-Marseille université, faculté de médecine, 27, boulevard Jean Moulin, 13385 Marseille cedex 5, France
- École du Val-de-Grâce, Val-de-Grâce, 1, place Alphonse Laveran, 75005 Paris, France
| | - F de Laval
- UMR 1252-sciences économiques et sociales de la santé et traitement de l'information médicale, SESSTIM, Inserm/IRD/Aix-Marseille université, faculté de médecine, 27, boulevard Jean Moulin, 13385 Marseille cedex 5, France
- Centre d'épidémiologie et de santé publique des armées, base de défense Marseille Aubagne - 111, avenue de la Corse BP40026, 13568 Marseille cedex 02, France
| | - G Texier
- École du Val-de-Grâce, Val-de-Grâce, 1, place Alphonse Laveran, 75005 Paris, France
- Centre d'épidémiologie et de santé publique des armées, base de défense Marseille Aubagne - 111, avenue de la Corse BP40026, 13568 Marseille cedex 02, France
- UMR 257-Vecteurs, infections tropicales et méditerranéennes-VITROME-IRD/SSA/AP-HM/Aix-Marseille université, 19-21, boulevard Jean Moulin, 13005 Marseille, France
| | - O Gorgé
- Institut de recherche biomédicale des armées, 1, place du général Valérie André BP 73, 91223 Brétigny-sur-Orge, France
| | - H Degui
- Centre d'épidémiologie et de santé publique des armées, base de défense Marseille Aubagne - 111, avenue de la Corse BP40026, 13568 Marseille cedex 02, France
| | - V Pommier de Santi
- Centre d'épidémiologie et de santé publique des armées, base de défense Marseille Aubagne - 111, avenue de la Corse BP40026, 13568 Marseille cedex 02, France
- UMR 257-Vecteurs, infections tropicales et méditerranéennes-VITROME-IRD/SSA/AP-HM/Aix-Marseille université, 19-21, boulevard Jean Moulin, 13005 Marseille, France
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Hoballah A, El Haidari R, Badran R, Jaber A, Mansour S, Abou-Abbas L. Smoking status and SARS-CoV-2 infection severity among Lebanese adults: a cross-sectional study. BMC Infect Dis 2022; 22:746. [PMID: 36153476 PMCID: PMC9509589 DOI: 10.1186/s12879-022-07728-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 09/14/2022] [Indexed: 01/08/2023] Open
Abstract
Background A paradoxical hypothesis about the effect of smoking on patients infected with severe acute respiratory syndrom 2 (SARS-CoV-2) infection still exists. Furthermore, gender-discrepancy in the impact of smoking on COVID-19 severity was given little attention. Thus, the aims of the present study were to evaluate the prevalence of smoking and the COVID-19 infection severity in a sample of adult patients diagnosed with COVID-19 and to explore the relationship between smoking status and SARS-CoV-2 infection severity in the overall sample and stratified by gender. Methods A retrospective analytical study was conducted on patients diagnosed with COVID-19 cases between December, 2020 and April, 2021 from three leading laboratories in Lebanon. Sociodemographic characteristics, smoking status and clinical symptoms were collected. Multinomial logistic regression analysis was used to explore the relationship between smoking status and SARS-CoV-2 infection severity. Results A total of 901 confirmed COVID-19 cases participated in the study, 50.8% were females. The mean age of patients was 38.4 years (SD = 15.3). Of the total sample, 521(57.8%) were current smokers. Regarding infection severity, 14.8% were asymptomatic, 69.9% had mild symptoms, while 15.3% had severe infection. In the overall sample, smoking status, smoking types and dose–response were not significantly associated with infection severity. Upon stratifying the entire sample by gender, no association was found between all the considered variables with infection severity among females. However, a significant association was found among male with mild infection compared to their asymptomatic counterparts (OR = 1.78 95% CI (1.01–3.13)). Waterpipe smoking was found to be associated with infection severity among male with mild infection (OR 2.64 (95% CI 1.32–5.27)) and severe infection 2.79, 95% CI (1.19–6.53) compared to their asymptomatic counterparts. Conclusion Our fundings highlight sex differences in the association between tobacco smoking and COVID-19 severity. Current tobacco smoking was not associated with SARS-CoV-2 infection severity among female patients, however, tobacco smoking, particularly waterpipe, was found to be associated with infection severity among male. Thus, the battle against smoking should continue by assisting smokers to successfully and permanently quit.
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Gosadi IM, Abulqusim EM, Atiah AI, Ageeli BH, Alhazmi DA, Hamzi MA, Somaily SY. Assessment of COVID-19 Symptoms Distribution According to Tobacco Products Consumption and Khat Chewing: A Potential Antinociceptive Role of Nicotine Among COVID-19 Patients. Int J Gen Med 2022; 15:7299-7309. [PMID: 36133912 PMCID: PMC9484568 DOI: 10.2147/ijgm.s379592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 09/08/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Ibrahim M Gosadi
- Department of Family and Community Medicine, Faculty of Medicine, Jazan University, Jazan, 82621, Saudi Arabia
- Correspondence: Ibrahim M Gosadi, Faculty of Medicine, Jazan University, P.O. Box: 2349, Jazan, 82621, Saudi Arabia, Tel +966562137711, Email
| | | | | | - Bander H Ageeli
- Faculty of Medicine, Jazan University, Jazan, 82621, Saudi Arabia
| | - Doa’a A Alhazmi
- Faculty of Medicine, Jazan University, Jazan, 82621, Saudi Arabia
| | - Marwah A Hamzi
- Faculty of Medicine, Jazan University, Jazan, 82621, Saudi Arabia
| | - Sara Y Somaily
- Faculty of Medicine, Jazan University, Jazan, 82621, Saudi Arabia
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Le Guen CL, Muir KC, Simons M, Coffman DL, Soans RS. The Impact of Smoking Status and Smoking-Related Comorbidities on Coronavirus Disease 2019 Patient Outcomes: A Causal Mediation Analysis. Nicotine Tob Res 2022; 25:331-338. [PMID: 35952390 PMCID: PMC9384707 DOI: 10.1093/ntr/ntac193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 06/21/2022] [Accepted: 08/09/2022] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Smoking history is a known risk factor for significant chronic diseases as well as pulmonary infections; however, the impact of smoking status on coronavirus disease 2019 (COVID-19) outcomes has not been conclusively characterized. This study aims to evaluate the association of smoking status on COVID-19 outcomes, and to explore the mechanism by which smoking and smoking-related comorbidities relate to COVID-19 outcomes. AIMS AND METHODS Patients admitted with SARS-CoV-2 infection from November 2020 through January 2021 were included in this study. Causal mediation models investigating the associations between smoking status and the outcomes of mortality, intensive care unit (ICU) admission, advanced respiratory support, mechanical ventilation, ICU length of stay, and hospital length of stay, through mediation via smoking-related comorbidities, were examined. RESULTS Active smokers did not experience worse COVID-19 outcomes once hospitalized. Former smokers had a higher odds of mortality (total effect OR 1.59, 95% CI 1.07 to 2.38, p = .01; indirect effect OR 1.45, 95% CI 1.09 to 1.93, p < .001), and advanced respiratory support (total effect OR 1.31, 95% CI 1.04 to 1.67, p = .02; indirect effect OR 1.26, 95% CI 1.03 to 1.54, p = .02), which were mediated by smoking-related comorbidities. While there was a nonsignificant increase in the total effect for mechanical ventilation, smoking-related comorbidities were significant mediators for their increased need (total effect OR 1.40, 95% CI 0.92 to 2.14, p = .13; indirect effect OR 1.47, 95% CI 1.10 to 1.87, p < .001). CONCLUSIONS Although active smokers did not experience worse COVID-19 outcomes compared to never smokers, these results should be interpreted with caution. Compared to never smokers, former smokers had greater odds of mortality, advanced respiratory support, and mechanical ventilation which was significantly mediated through smoking-related comorbidities. IMPLICATIONS Previous studies have linked smoking status with worse COVID-19 outcomes, and have inferred that smoking-related comorbidities may play a role in these findings. This causal mediation analysis provides statistical evidence supporting this hypothesis, clarifying the risk that smoking-related comorbidities impart on COVID-19 outcomes in those with a smoking history.
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Affiliation(s)
- Claire L Le Guen
- Corresponding author information: Claire Le Guen, MD Temple University Hospital 3401 North Broad Street Parkinson Pavilion 4th Floor Suite 410, Philadelphia, PA 19140 Ph: +001 267-858-9932
| | | | | | - Donna L Coffman
- Department of Biostatistics and Epidemiology, Temple University
| | - Rohit S Soans
- Lewis Katz School of Medicine, Temple University,Department of Bariatric and Minimally Invasive Surgery, Temple University Hospital
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de Laval F, Chaudet H, Gorgé O, Marchi J, Lacrosse C, Dia A, Marbac V, Mmadi Mrenda B, Texier G, Letois F, Chapus C, Sarilar V, Tournier JN, Levasseur A, Cobola J, Nolent F, Dutasta F, Janvier F, Meynard JB, Pommier de Santi V. Investigation of a COVID-19 outbreak on the Charles de Gaulle aircraft carrier, March to April 2020: a retrospective cohort study. EURO SURVEILLANCE : BULLETIN EUROPEEN SUR LES MALADIES TRANSMISSIBLES = EUROPEAN COMMUNICABLE DISEASE BULLETIN 2022; 27. [PMID: 35620999 PMCID: PMC9137271 DOI: 10.2807/1560-7917.es.2022.27.21.2100612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background SARS-CoV-2 emergence was a threat for armed forces. A COVID-19 outbreak occurred on the French aircraft carrier Charles de Gaulle from mid-March to mid-April 2020. Aim To understand how the virus was introduced, circulated then stopped circulation, risk factors for infection and severity, and effectiveness of preventive measures. Methods We considered the entire crew as a cohort and collected personal, clinical, biological, and epidemiological data. We performed viral genome sequencing and searched for SARS-CoV-2 in the environment. Results The attack rate was 65% (1,148/1,767); 1,568 (89%) were included. The male:female ratio was 6.9, and median age was 29 years (IQR: 24–36). We examined four clinical profiles: asymptomatic (13.0%), non-specific symptomatic (8.1%), specific symptomatic (76.3%), and severe (i.e. requiring oxygen therapy, 2.6%). Active smoking was not associated with severe COVID-19; age and obesity were risk factors. The instantaneous reproduction rate (Rt) and viral sequencing suggested several introductions of the virus with 4 of 5 introduced strains from within France, with an acceleration of Rt when lifting preventive measures. Physical distancing prevented infection (adjusted OR: 0.55; 95% CI: 0.40–0.76). Transmission may have stopped when the proportion of infected personnel was large enough to prevent circulation (65%; 95% CI: 62–68). Conclusion Non-specific clinical pictures of COVID-19 delayed detection of the outbreak. The lack of an isolation ward made it difficult to manage transmission; the outbreak spread until a protective threshold was reached. Physical distancing was effective when applied. Early surveillance with adapted prevention measures should prevent such an outbreak.
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Affiliation(s)
- Franck de Laval
- French Armed Forces Center for Epidemiology and Public Health (CESPA), Marseille, France.,Aix-Marseille University, INSERM, IRD, SESSTIM (Economic and Social Sciences, Health Systems, and Medical Informatics), Marseille, France
| | - Hervé Chaudet
- French Armed Forces Center for Epidemiology and Public Health (CESPA), Marseille, France.,Aix-Marseille University, IRD, AP-HM, SSA (French Military Health Service), VITROME, Marseille, France.,University Hospital Institute Méditerranée Infection, Marseille, France
| | - Olivier Gorgé
- French Armed Forces Biomedical Research Institute (IRBA), Brétigny-sur-Orge, France
| | - Joffrey Marchi
- French Armed Forces Center for Epidemiology and Public Health (CESPA), Marseille, France
| | - Constance Lacrosse
- French Armed Forces Center for Epidemiology and Public Health (CESPA), Marseille, France
| | - Aissata Dia
- French Armed Forces Center for Epidemiology and Public Health (CESPA), Marseille, France
| | | | - Bakridine Mmadi Mrenda
- French Armed Forces Center for Epidemiology and Public Health (CESPA), Marseille, France
| | - Gaëtan Texier
- French Armed Forces Center for Epidemiology and Public Health (CESPA), Marseille, France.,Aix-Marseille University, IRD, AP-HM, SSA (French Military Health Service), VITROME, Marseille, France
| | - Flavie Letois
- French Armed Forces Center for Epidemiology and Public Health (CESPA), Marseille, France
| | - Charles Chapus
- French Armed Forces Biomedical Research Institute (IRBA), Brétigny-sur-Orge, France
| | - Véronique Sarilar
- French Armed Forces Biomedical Research Institute (IRBA), Brétigny-sur-Orge, France
| | | | - Anthony Levasseur
- University Hospital Institute Méditerranée Infection, Marseille, France.,Aix Marseille University, IRD, AP-HM, MEPHI, Marseille, France
| | | | - Flora Nolent
- French Armed Forces Biomedical Research Institute (IRBA), Brétigny-sur-Orge, France
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- PA-CDG COVID-19 investigation group members are listed under Collaborators
| | - Jean-Baptiste Meynard
- French Armed Forces Center for Epidemiology and Public Health (CESPA), Marseille, France.,Aix-Marseille University, INSERM, IRD, SESSTIM (Economic and Social Sciences, Health Systems, and Medical Informatics), Marseille, France
| | - Vincent Pommier de Santi
- French Armed Forces Center for Epidemiology and Public Health (CESPA), Marseille, France.,Aix-Marseille University, IRD, AP-HM, SSA (French Military Health Service), VITROME, Marseille, France
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17
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The association between tobacco use and COVID-19 in Qatar. Prev Med Rep 2022; 28:101832. [PMID: 35607613 PMCID: PMC9116971 DOI: 10.1016/j.pmedr.2022.101832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 05/12/2022] [Accepted: 05/15/2022] [Indexed: 01/08/2023] Open
Abstract
Tobacco smoking prevalence in the total sample was only 11.0% Smokeless tobacco users may be at an increased risk for severe disease. Smoking was not associated with an increased risk of greater disease severity. Increased age and co-morbidities were the most important risk factors for severity. Considering limitations, COVID-19 severity may be affected by other factors.
The effects of smoking on COVID-19 are controversial. Some studies show no link between smoking and severe COVID-19, whereas others demonstrate a significant link. This cross-sectional study aims to determine the prevalence of tobacco use among COVID-19 patients, examine the relationship between tobacco use and hospitalized COVID-19 (non-severe and severe), and quantify its risk factors. A random sample of 7430 COVID-19 patients diagnosed between 27 February-30 May 2020 in Qatar were recruited over the telephone to complete an interviewer-administered questionnaire. The prevalence of tobacco smoking in the total sample was 11.0%, with 12.6% among those quarantined, 5.7% among hospitalized patients, and 2.5% among patients with severe COVID-19. Smokeless tobacco and e-cigarette use were reported by 3.2% and 0.6% of the total sample, respectively. We found a significant lower risk for hospitalization and severity of COVID-19 among current tobacco smokers (p < 0.001) relative to non-smokers (never and ex-smokers). Risk factors significantly related to an increased risk of being hospitalized with COVID-19 were older age (aged 55 + ), being male, non-Qatari, and those with heart disease, hypertension, diabetes, asthma, cancer, and chronic renal disease. Smokeless tobacco use, older age (aged 55 + ), being male, non-Qatari, previously diagnosed with heart disease and diabetes were significant risk factors for severe COVID-19. Our data suggests that only smokeless tobacco users may be at an increased risk for severe disease, yet this requires further investigation as other studies have reported smoking to be associated with an increased risk of greater disease severity.
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Domènech-Montoliu S, Puig-Barberà J, Pac-Sa MR, Vidal-Utrillas P, Latorre-Poveda M, Del Rio-González A, Ferrando-Rubert S, Ferrer-Abad G, Sánchez-Urbano M, Aparisi-Esteve L, Badenes-Marques G, Cervera-Ferrer B, Clerig-Arnau U, Dols-Bernad C, Fontal-Carcel M, Gomez-Lanas L, Jovani-Sales D, León-Domingo MC, Llopico-Vilanova MD, Moros-Blasco M, Notari-Rodríguez C, Ruíz-Puig R, Valls-López S, Arnedo-Pena A. Complications Post-COVID-19 and Risk Factors among Patients after Six Months of a SARS-CoV-2 Infection: A Population-Based Prospective Cohort Study. EPIDEMIOLOGIA 2022; 3:49-67. [PMID: 36417267 PMCID: PMC9620887 DOI: 10.3390/epidemiologia3010006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/12/2022] [Accepted: 02/07/2022] [Indexed: 12/14/2022] Open
Abstract
In October 2020, we conducted a population-based prospective cohort study to determine post-COVID-19 complications, recovery, return to usual health, and associated risk factors in 536 cases of COVID-19 outbreak in Borriana (Spain) by administering an epidemiological questionnaire via phone interviews. A total of 484 patients participated (90.3%), age mean 37.2 ± 17.1 years, and 301 females (62.2%). Mild illness was the most common COVID-19 manifestation. After six months, 160 patients (33.1%) suffered at least one complication post-COVID-19, and 47 (29.4%) of them sought medical assistance. The most frequent persistent symptoms were hair loss, fatigue, loss of smell or taste, and headache. Risk factors associated with a complication were female sex (adjusted relative risk, [aRR] = 1.93 95% confidence interval [CI] 1.41-2.65), age 35 years and above (aRR = 1.50 95% CI 1.14-1.99), B blood group (aRR = 1.51 95% CI 1.04-2.16), current smoker (RR = 1.61 95% CI 1.02-2.54), and at least a COVID-19 exposure (aRR = 2.13 95% CI 1.11-4.09). Male sex, age younger than 35 years, and low COVID-19 exposures were associated with better recovery and return to usual health. A third of patients presented persistent symptoms compatible with the long-COVID-19 syndrome. In conclusion, an active medical follow-up of post-COVID-19 patients must be implemented.
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Affiliation(s)
- Salvador Domènech-Montoliu
- Emergency Service Hospital de la Plana, 12540 Villarreal, Castellon, Spain; (S.D.-M.); (M.L.-P.); (M.S.-U.); (G.B.-M.); (B.C.-F.); (U.C.-A.); (L.G.-L.); (D.J.-S.); (M.D.L.-V.); (C.N.-R.); (R.R.-P.); (S.V.-L.)
| | | | | | - Paula Vidal-Utrillas
- Health Centers I and II, 12530 Borriana, Castellon, Spain; (P.V.-U.); (A.D.R.-G.); (S.F.-R.); (G.F.-A.); (M.M.-B.)
| | - Marta Latorre-Poveda
- Emergency Service Hospital de la Plana, 12540 Villarreal, Castellon, Spain; (S.D.-M.); (M.L.-P.); (M.S.-U.); (G.B.-M.); (B.C.-F.); (U.C.-A.); (L.G.-L.); (D.J.-S.); (M.D.L.-V.); (C.N.-R.); (R.R.-P.); (S.V.-L.)
| | - Alba Del Rio-González
- Health Centers I and II, 12530 Borriana, Castellon, Spain; (P.V.-U.); (A.D.R.-G.); (S.F.-R.); (G.F.-A.); (M.M.-B.)
| | - Sara Ferrando-Rubert
- Health Centers I and II, 12530 Borriana, Castellon, Spain; (P.V.-U.); (A.D.R.-G.); (S.F.-R.); (G.F.-A.); (M.M.-B.)
| | - Gema Ferrer-Abad
- Health Centers I and II, 12530 Borriana, Castellon, Spain; (P.V.-U.); (A.D.R.-G.); (S.F.-R.); (G.F.-A.); (M.M.-B.)
| | - Manuel Sánchez-Urbano
- Emergency Service Hospital de la Plana, 12540 Villarreal, Castellon, Spain; (S.D.-M.); (M.L.-P.); (M.S.-U.); (G.B.-M.); (B.C.-F.); (U.C.-A.); (L.G.-L.); (D.J.-S.); (M.D.L.-V.); (C.N.-R.); (R.R.-P.); (S.V.-L.)
| | | | - Gema Badenes-Marques
- Emergency Service Hospital de la Plana, 12540 Villarreal, Castellon, Spain; (S.D.-M.); (M.L.-P.); (M.S.-U.); (G.B.-M.); (B.C.-F.); (U.C.-A.); (L.G.-L.); (D.J.-S.); (M.D.L.-V.); (C.N.-R.); (R.R.-P.); (S.V.-L.)
| | - Belen Cervera-Ferrer
- Emergency Service Hospital de la Plana, 12540 Villarreal, Castellon, Spain; (S.D.-M.); (M.L.-P.); (M.S.-U.); (G.B.-M.); (B.C.-F.); (U.C.-A.); (L.G.-L.); (D.J.-S.); (M.D.L.-V.); (C.N.-R.); (R.R.-P.); (S.V.-L.)
| | - Ursula Clerig-Arnau
- Emergency Service Hospital de la Plana, 12540 Villarreal, Castellon, Spain; (S.D.-M.); (M.L.-P.); (M.S.-U.); (G.B.-M.); (B.C.-F.); (U.C.-A.); (L.G.-L.); (D.J.-S.); (M.D.L.-V.); (C.N.-R.); (R.R.-P.); (S.V.-L.)
| | | | | | - Lorna Gomez-Lanas
- Emergency Service Hospital de la Plana, 12540 Villarreal, Castellon, Spain; (S.D.-M.); (M.L.-P.); (M.S.-U.); (G.B.-M.); (B.C.-F.); (U.C.-A.); (L.G.-L.); (D.J.-S.); (M.D.L.-V.); (C.N.-R.); (R.R.-P.); (S.V.-L.)
| | - David Jovani-Sales
- Emergency Service Hospital de la Plana, 12540 Villarreal, Castellon, Spain; (S.D.-M.); (M.L.-P.); (M.S.-U.); (G.B.-M.); (B.C.-F.); (U.C.-A.); (L.G.-L.); (D.J.-S.); (M.D.L.-V.); (C.N.-R.); (R.R.-P.); (S.V.-L.)
| | | | - Maria Dolores Llopico-Vilanova
- Emergency Service Hospital de la Plana, 12540 Villarreal, Castellon, Spain; (S.D.-M.); (M.L.-P.); (M.S.-U.); (G.B.-M.); (B.C.-F.); (U.C.-A.); (L.G.-L.); (D.J.-S.); (M.D.L.-V.); (C.N.-R.); (R.R.-P.); (S.V.-L.)
| | - Mercedes Moros-Blasco
- Health Centers I and II, 12530 Borriana, Castellon, Spain; (P.V.-U.); (A.D.R.-G.); (S.F.-R.); (G.F.-A.); (M.M.-B.)
| | - Cristina Notari-Rodríguez
- Emergency Service Hospital de la Plana, 12540 Villarreal, Castellon, Spain; (S.D.-M.); (M.L.-P.); (M.S.-U.); (G.B.-M.); (B.C.-F.); (U.C.-A.); (L.G.-L.); (D.J.-S.); (M.D.L.-V.); (C.N.-R.); (R.R.-P.); (S.V.-L.)
| | - Raquel Ruíz-Puig
- Emergency Service Hospital de la Plana, 12540 Villarreal, Castellon, Spain; (S.D.-M.); (M.L.-P.); (M.S.-U.); (G.B.-M.); (B.C.-F.); (U.C.-A.); (L.G.-L.); (D.J.-S.); (M.D.L.-V.); (C.N.-R.); (R.R.-P.); (S.V.-L.)
| | - Sonia Valls-López
- Emergency Service Hospital de la Plana, 12540 Villarreal, Castellon, Spain; (S.D.-M.); (M.L.-P.); (M.S.-U.); (G.B.-M.); (B.C.-F.); (U.C.-A.); (L.G.-L.); (D.J.-S.); (M.D.L.-V.); (C.N.-R.); (R.R.-P.); (S.V.-L.)
| | - Alberto Arnedo-Pena
- Public Health Center, 12003 Castelló de la Plana, Castellon, Spain;
- Department of Health Science, Public University Navarra, 31006 Pamplona, Navarra, Spain
- Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
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19
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Adorni F, Jesuthasan N, Perdixi E, Sojic A, Giacomelli A, Noale M, Trevisan C, Franchini M, Pieroni S, Cori L, Mastroianni CM, Bianchi F, Antonelli-Incalzi R, Maggi S, Galli M, Prinelli F. Epidemiology of SARS-CoV-2 Infection in Italy Using Real-World Data: Methodology and Cohort Description of the Second Phase of Web-Based EPICOVID19 Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:1274. [PMID: 35162295 PMCID: PMC8835202 DOI: 10.3390/ijerph19031274] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/16/2022] [Accepted: 01/19/2022] [Indexed: 12/29/2022]
Abstract
Digital technologies have been extensively employed in response to the SARS-CoV-2 pandemic worldwide. This study describes the methodology of the two-phase internet-based EPICOVID19 survey, and the characteristics of the adult volunteer respondents who lived in Italy during the first (April-May 2020) and the second wave (January-February 2021) of the epidemic. Validated scales and ad hoc questionnaires were used to collect socio-demographic, medical and behavioural characteristics, as well as information on COVID-19. Among those who provided email addresses during phase I (105,355), 41,473 participated in phase II (mean age 50.7 years ± 13.5 SD, 60.6% females). After a median follow-up of ten months, 52.8% had undergone nasopharyngeal swab (NPS) testing and 13.2% had a positive result. More than 40% had undergone serological test (ST) and 11.9% were positive. Out of the 2073 participants with at least one positive ST, 72.8% had only negative results from NPS or never performed it. These results indicate that a large fraction of individuals remained undiagnosed, possibly contributing to the spread of the virus in the community. Participatory online surveys offer a unique opportunity to collect relevant data at individual level from large samples during confinement.
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Affiliation(s)
- Fulvio Adorni
- National Research Council, Institute of Biomedical Technologies, Via Fratelli Cervi 93, 20054 Segrate, Italy; (N.J.); (E.P.); (A.S.); (F.P.)
| | - Nithiya Jesuthasan
- National Research Council, Institute of Biomedical Technologies, Via Fratelli Cervi 93, 20054 Segrate, Italy; (N.J.); (E.P.); (A.S.); (F.P.)
| | - Elena Perdixi
- National Research Council, Institute of Biomedical Technologies, Via Fratelli Cervi 93, 20054 Segrate, Italy; (N.J.); (E.P.); (A.S.); (F.P.)
| | - Aleksandra Sojic
- National Research Council, Institute of Biomedical Technologies, Via Fratelli Cervi 93, 20054 Segrate, Italy; (N.J.); (E.P.); (A.S.); (F.P.)
| | - Andrea Giacomelli
- Infectious Diseases Unit, Department of Biomedical and Clinical Sciences L. Sacco, Università di Milano, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (A.G.); (M.G.)
| | - Marianna Noale
- National Research Council, Neuroscience Institute, Aging Branch, Via Vincenzo Maria Gallucci 16, 35128 Padova, Italy; (M.N.); (S.M.)
| | - Caterina Trevisan
- Geriatric Unit, Department of Medicine (DIMED), University of Padova, Via Giustiniani 2, 35128 Padova, Italy;
- Department of Medical Sciences, University of Ferrara, Via Aldo Moro 8, Cona, 44124 Ferrara, Italy
| | - Michela Franchini
- National Research Council, Institute of Clinical Physiology, Via G. Moruzzi 1, 56124 Pisa, Italy; (M.F.); (S.P.); (L.C.); (F.B.)
| | - Stefania Pieroni
- National Research Council, Institute of Clinical Physiology, Via G. Moruzzi 1, 56124 Pisa, Italy; (M.F.); (S.P.); (L.C.); (F.B.)
| | - Liliana Cori
- National Research Council, Institute of Clinical Physiology, Via G. Moruzzi 1, 56124 Pisa, Italy; (M.F.); (S.P.); (L.C.); (F.B.)
| | - Claudio Maria Mastroianni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy;
| | - Fabrizio Bianchi
- National Research Council, Institute of Clinical Physiology, Via G. Moruzzi 1, 56124 Pisa, Italy; (M.F.); (S.P.); (L.C.); (F.B.)
| | | | - Stefania Maggi
- National Research Council, Neuroscience Institute, Aging Branch, Via Vincenzo Maria Gallucci 16, 35128 Padova, Italy; (M.N.); (S.M.)
| | - Massimo Galli
- Infectious Diseases Unit, Department of Biomedical and Clinical Sciences L. Sacco, Università di Milano, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (A.G.); (M.G.)
| | - Federica Prinelli
- National Research Council, Institute of Biomedical Technologies, Via Fratelli Cervi 93, 20054 Segrate, Italy; (N.J.); (E.P.); (A.S.); (F.P.)
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20
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Recio-Vivas AM, Font-Jiménez I, Mansilla-Domínguez JM, Belzunegui-Eraso A, Díaz-Pérez D, Lorenzo-Allegue L, Peña-Otero D. Fear and Attitude towards SARS-CoV-2 (COVID-19) Infection in Spanish Population during the Period of Confinement. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020834. [PMID: 35055656 PMCID: PMC8775959 DOI: 10.3390/ijerph19020834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/08/2022] [Accepted: 01/10/2022] [Indexed: 12/12/2022]
Abstract
In January 2020, the WHO classified SARS-CoV-2 infection as a public health emergency and it was declared a pandemic on 11 March 2020. The media warned about the danger of infection, fuelling the population’s fear of the new situation and increasing the perception of risk. This fear can cause behaviour that will determine the course of the pandemic and, therefore, the purpose of this study was to analyse the fear of infection from COVID-19 among the Spanish population during the state of emergency. A cross-sectional, descriptive observational study was conducted with 16,372 participants. Data on sociodemographic factors, health factors, risk perception and fear were collected through an online survey. Level of fear is associated with older age, a lower level of education, having a person infected with SARS-CoV-2 in the immediate surroundings and living with and belonging to the most socioeconomically vulnerable group of people. Risk perception is associated with increased preventive behaviour. This paper provides relevant information for the public health sector since it contributes first-hand knowledge of population data that is highly useful in terms of prevention. Understanding the experiences of people in this pandemic helps to create more effective future intervention strategies in terms of planning and management for crisis situations.
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Affiliation(s)
- Ana María Recio-Vivas
- Department of Nursing, Faculty of Biomedical and Health Science, Universidad Europea de Madrid, 28670 Madrid, Spain; (A.M.R.-V.); (I.F.-J.); (L.L.-A.)
| | - Isabel Font-Jiménez
- Department of Nursing, Faculty of Biomedical and Health Science, Universidad Europea de Madrid, 28670 Madrid, Spain; (A.M.R.-V.); (I.F.-J.); (L.L.-A.)
| | - José Miguel Mansilla-Domínguez
- Department of Nursing, Faculty of Biomedical and Health Science, Universidad Europea de Madrid, 28670 Madrid, Spain; (A.M.R.-V.); (I.F.-J.); (L.L.-A.)
- Correspondence:
| | - Angel Belzunegui-Eraso
- Medical Anthropology Research Centre, Department of Quantitative Methods at the Faculty of Nursing, Rovira i Virgili University, 43002 Tarragona, Spain;
| | - David Díaz-Pérez
- Respiratory Nursing Department at SEPAR, Respiratory Nurse at the Pneumology and Thoracic Surgery Service of the Hospital Universitario Nuestra Señora de Candelaria (Tenerife), 38010 Santa Cruz, Spain;
| | - Laura Lorenzo-Allegue
- Department of Nursing, Faculty of Biomedical and Health Science, Universidad Europea de Madrid, 28670 Madrid, Spain; (A.M.R.-V.); (I.F.-J.); (L.L.-A.)
| | - David Peña-Otero
- Respiratory Nursing Department at SEPAR, Nurse Member of the IDIVAL and IiSGM Research Institutes, 28007 Madrid, Spain;
- Hospital de Sierrallana, Cantabrian Health Service, 39300 Torrelavega, Spain
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21
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Nyman AL, Spears CA, Churchill V, Do VV, Henderson KC, Massey ZB, Reynolds RM, Huang J. Associations between COVID-19 risk perceptions and smoking and quitting behavior among U.S. adults. Addict Behav Rep 2021; 14:100394. [PMID: 34869823 PMCID: PMC8626346 DOI: 10.1016/j.abrep.2021.100394] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 01/02/2023] Open
Abstract
Smokers are more likely to think smoking increases risk of COVID-19 severity than susceptibility. Perceiving risk of COVID-19 severity is associated with readiness to quit and quit attempts. Perceiving risk of COVID-19 severity is also linked with both smoking increases and decreases. Greater psychological distress is associated with changes in smoking and quitting behavior.
Objectives The COVID-19 pandemic may impact cigarette smokers’ behaviors. Among smokers, perceptions about the risks of contracting COVID-19 and the severity of COVID-19 illness likely vary, and perceptions may be associated with individual smoking behavior. Our study measured smokers’ perceptions of COVID-19 risks and their association with smoking and quitting outcomes. Methods A sample of 1,223 U.S. adult cigarette smokers participated in an online survey in October-November 2020 to assess their COVID-19-related risk perceptions and changes in smoking, readiness to quit, and quit attempts during the COVID-19 pandemic. Results More smokers believed smoking could increase the severity of COVID-19 (43.6%, 95% CI: 40.1, 47.3) than believed smoking makes them more susceptible to COVID-19 (20.0%, 95% CI: 17.2, 23.0.). While there were no associations between perceptions of COVID-19 susceptibility and smoking behaviors or intentions, perceptions of greater smoking-related COVID-19 severity were associated with both higher likelihood of smoking increases (aOR: 2.16, 95% CI: 1.19, 3.93) and greater readiness to quit smoking (aOR: 1.65, 95% CI: 1.18, 2.30). Greater perceptions of general COVID-19 severity were associated with higher likelihood of smoking reductions (aOR: 1.12, 95% CI: 1.02, 1.22), greater readiness to quit smoking (aOR: 1.14, 95% CI: 1.07, 1.22), and higher likelihood of making a quit attempt (aOR: 1.12, 95% CI: 1.04, 1.22). Conclusions Smokers’ perceptions about COVID-19 severity are related to their smoking behavior and likelihood of making a quit attempt. Providing smokers with accurate information on the relationship between smoking and the severity of COVID-19 may alter smoking behaviors.
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Affiliation(s)
- Amy L Nyman
- Georgia State University, School of Public Health, USA
| | - Claire A Spears
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, USA
| | | | - Vuong V Do
- Georgia State University, School of Public Health, USA
| | - Katherine C Henderson
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, USA
| | - Zachary B Massey
- Strategic Communication, School of Journalism, University of Missouri, USA
| | | | - Jidong Huang
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, USA
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22
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Trevisan C, Pedone C, Maggi S, Noale M, Di Bari M, Sojic A, Molinaro S, Giacomelli A, Bianchi F, Tavio M, Rusconi S, Pagani G, Galli M, Prinelli F, Adorni F, Antonelli Incalzi R. Accessibility to SARS-CoV-2 swab test during the Covid-19 pandemic: Did age make the difference? Health Policy 2021; 125:1580-1586. [PMID: 34649753 PMCID: PMC8492891 DOI: 10.1016/j.healthpol.2021.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 09/27/2021] [Accepted: 10/03/2021] [Indexed: 12/23/2022]
Abstract
Although COVID-19 affects older people more severely, health policies during the first wave of the pandemic often prioritized younger individuals. We investigated whether age had influenced the access to a diagnostic test for SARS-CoV-2 infection and whether clinical complexity and healthcare resources availability could have impacted such differences. This work included 126,741 Italian participants in the EPICOVID19 web-based survey, who reported having had contacts with known/suspected COVID-19 cases (epidemiological criterion) and/or COVID-19-like signs/symptoms (clinical criterion) from February to June 2020. Data on sociodemographic, medical history and access to SARS-CoV-2 nasopharyngeal swab (NPS) were collected. Logistic regressions estimated the probability of accessing NPS as a function of age and the possible modifying effect of chronic diseases' number and residential areas in such association. A total of 6136 (4.8%) participants had undergone an NPS. Older participants had lower NPS frequencies than the younger ones when reporting epidemiological (14.9% vs. 8.8%) or both epidemiological and clinical criteria (17.5% vs. 13.7%). After adjustment for potential confounders, including epidemiological and clinical criteria, the chance of NPS access decreased by 29% (OR=0.71, 95%CI:0.63-0.79) in older vs. younger individuals. Such disparity was accentuated in areas with greater healthcare resources. In conclusion, in the first wave of the pandemic, age may have affected the access to COVID-19 diagnostic testing, disadvantaging older people.
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Affiliation(s)
- Caterina Trevisan
- National Research Council-Neuroscience Institute, Aging Branch, Via Vincenzo Maria Gallucci 16, 35128 Padova, Italy; Geriatrics Unit, Department of Medicine (DIMED), University of Padova, Via Giustiniani 2, 35128 Padova, Italy; Geriatric Unit, Department of Medical Sciences, University of Ferrara, Via Aldo Moro 8, 44124 Cona, Ferrara, Italy.
| | - Claudio Pedone
- Unit of Geriatrics, Department of Medicine, Biomedical Campus of Rome, via Alvaro del Portillo, 21, 00128 Rome, Italy
| | - Stefania Maggi
- National Research Council-Neuroscience Institute, Aging Branch, Via Vincenzo Maria Gallucci 16, 35128 Padova, Italy
| | - Marianna Noale
- National Research Council-Neuroscience Institute, Aging Branch, Via Vincenzo Maria Gallucci 16, 35128 Padova, Italy
| | - Mauro Di Bari
- Geriatric Intensive Care Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Viale Peraccini 18, 50139 Florence, Italy
| | - Aleksandra Sojic
- National Research Council-Institute of Biomedical Technologies, Epidemiology Unit, Via Fratelli Cervi 93, 20090 Segrate, Italy
| | - Sabrina Molinaro
- National Research Council-Institute of Clinical Physiology, Epidemiology and Health Research Laboratory, Via G. Moruzzi 1, 56124 Pisa, Italy
| | - Andrea Giacomelli
- Infectious Diseases Unit, Department of Biomedical and Clinical Sciences L. Sacco, Università di Milano, ASST Fatebenefratelli Sacco, 20157 Milan, Italy
| | - Fabrizio Bianchi
- National Research Council-Institute of Clinical Physiology, Department of Environmental Epidemiology and Disease registries, Via G. Moruzzi 1, 56124 Pisa, Italy
| | - Marcello Tavio
- Division of Infectious Diseases, Azienda Ospedaliero Universitaria Ospedali Riuniti, Via Conca, 71, 60020, Ancona, Italy
| | - Stefano Rusconi
- Infectious Diseases Unit, Department of Biomedical and Clinical Sciences L. Sacco, Università di Milano, ASST Fatebenefratelli Sacco, 20157 Milan, Italy
| | - Gabriele Pagani
- Infectious Diseases Unit, Department of Biomedical and Clinical Sciences L. Sacco, Università di Milano, ASST Fatebenefratelli Sacco, 20157 Milan, Italy
| | - Massimo Galli
- Infectious Diseases Unit, Department of Biomedical and Clinical Sciences L. Sacco, Università di Milano, ASST Fatebenefratelli Sacco, 20157 Milan, Italy
| | - Federica Prinelli
- National Research Council-Institute of Biomedical Technologies, Epidemiology Unit, Via Fratelli Cervi 93, 20090 Segrate, Italy
| | - Fulvio Adorni
- National Research Council-Institute of Biomedical Technologies, Epidemiology Unit, Via Fratelli Cervi 93, 20090 Segrate, Italy
| | - Raffaele Antonelli Incalzi
- Unit of Geriatrics, Department of Medicine, Biomedical Campus of Rome, via Alvaro del Portillo, 21, 00128 Rome, Italy
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23
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Scozzari G, Costa C, Migliore E, Coggiola M, Ciccone G, Savio L, Scarmozzino A, Pira E, Cassoni P, Galassi C, Cavallo R. Prevalence, Persistence, and Factors Associated with SARS-CoV-2 IgG Seropositivity in a Large Cohort of Healthcare Workers in a Tertiary Care University Hospital in Northern Italy. Viruses 2021; 13:v13061064. [PMID: 34205134 PMCID: PMC8229066 DOI: 10.3390/v13061064] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/01/2021] [Accepted: 06/02/2021] [Indexed: 02/07/2023] Open
Abstract
This observational study evaluated SARS-CoV-2 IgG seroprevalence and related clinical, demographic, and occupational factors among workers at the largest tertiary care University-Hospital of Northwestern Italy and the University of Turin after the first pandemic wave of March–April 2020. Overall, about 10,000 individuals were tested; seropositive subjects were retested after 5 months to evaluate antibodies waning. Among 8769 hospital workers, seroprevalence was 7.6%, without significant differences related to job profile; among 1185 University workers, 3.3%. Self-reporting of COVID-19 suspected symptoms was significantly associated with positivity (Odds Ratio (OR) 2.07, 95%CI: 1.76–2.44), although 27% of seropositive subjects reported no previous symptom. At multivariable analysis, contacts at work resulted in an increased risk of 69%, or 24% for working in a COVID ward; contacts in the household evidenced the highest risk, up to more than five-fold (OR 5.31, 95%CI: 4.12–6.85). Compared to never smokers, being active smokers was inversely associated with seroprevalence (OR 0.60, 95%CI: 0.48–0.76). After 5 months, 85% of previously positive subjects still tested positive. The frequency of SARS-COV-2 infection among Health Care Workers was comparable with that observed in surveys performed in Northern Italy and Europe after the first pandemic wave. This study confirms that infection frequently occurred as asymptomatic and underlines the importance of household exposure, seroprevalence (OR 0.60, 95%CI: 0.48–0.76).
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Affiliation(s)
- Gitana Scozzari
- Hospital Medical Direction, Ospedale Molinette, University Hospital Città Della Salute e Della Scienza di Torino, 10126 Turin, Italy; (G.S.); (L.S.); (A.S.)
| | - Cristina Costa
- Microbiology and Virology Unit, University Hospital Città Della Salute e Della Scienza di Torino, 10126 Turin, Italy;
- Correspondence: ; Tel.: +39-(11)6335953
| | - Enrica Migliore
- Clinical Epidemiology Unit, University Hospital Città Della Salute e Della Scienza di Torino, 10126 Turin, Italy; (E.M.); (G.C.); (C.G.)
- Cancer Epidemiology Unit, University Hospital Città Della Salute e Della Scienza di Torino, 10126 Turin, Italy
| | - Maurizio Coggiola
- Occupational Medicine Unit, University Hospital Città Della Salute e Della Scienza di Torino, 10126 Turin, Italy; (M.C.); (E.P.)
| | - Giovannino Ciccone
- Clinical Epidemiology Unit, University Hospital Città Della Salute e Della Scienza di Torino, 10126 Turin, Italy; (E.M.); (G.C.); (C.G.)
| | - Luigi Savio
- Hospital Medical Direction, Ospedale Molinette, University Hospital Città Della Salute e Della Scienza di Torino, 10126 Turin, Italy; (G.S.); (L.S.); (A.S.)
| | - Antonio Scarmozzino
- Hospital Medical Direction, Ospedale Molinette, University Hospital Città Della Salute e Della Scienza di Torino, 10126 Turin, Italy; (G.S.); (L.S.); (A.S.)
| | - Enrico Pira
- Occupational Medicine Unit, University Hospital Città Della Salute e Della Scienza di Torino, 10126 Turin, Italy; (M.C.); (E.P.)
| | - Paola Cassoni
- Department of Medical Sciences, Pathology Unit, University of Turin, 10126 Turin, Italy;
| | - Claudia Galassi
- Clinical Epidemiology Unit, University Hospital Città Della Salute e Della Scienza di Torino, 10126 Turin, Italy; (E.M.); (G.C.); (C.G.)
| | - Rossana Cavallo
- Microbiology and Virology Unit, University Hospital Città Della Salute e Della Scienza di Torino, 10126 Turin, Italy;
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24
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Lee SC, Son KJ, Kim DW, Han CH, Choi YJ, Kim SW, Park SC. Smoking and the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Nicotine Tob Res 2021; 23:1787-1792. [PMID: 33891697 PMCID: PMC8135532 DOI: 10.1093/ntr/ntab079] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 04/20/2021] [Indexed: 01/08/2023]
Abstract
Introduction It is unclear whether smokers are more vulnerable to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. This study aimed to evaluate the association between smoking and the risk of SARS-CoV-2 infection. Methods A matched case-control study was conducted using a large nationwide database. The case group included patients with SARS-CoV-2 infection confirmed by the Korea Centers for Disease Control and Prevention, and the control group was randomly sampled from the general Korean population in the National Health Insurance Service database by matching sex, age, and region of residence. Conditional logistic regression models were used to investigate whether the risk of infection with SARS-CoV-2 was affected by smoking status. Results A total of 4,167 patients with SARS-CoV-2 infection and 20,937 matched controls were enrolled. The proportion of ex-smokers and current smokers was 26.6% of the total participants. In multivariate analysis, smoking was not associated with an increased risk of SARS-CoV-2 infection (odds ratio [OR] = 0.56, confidence interval [CI] = 0.50–0.62). When ex-smokers and current smokers were analysed separately, similar results were obtained (current smoker OR = 0.33, CI = 0.28–0.38; ex-smoker OR = 0.81, CI = 0.72–0.91). Conclusions This study showed that smoking may not be associated with an increased risk of SARS-CoV-2 infection. Smoking tends to lower the risk of SARS-CoV-2 infection; however, these findings should be interpreted with caution. Implications It is unclear whether smokers are more vulnerable to coronavirus disease 2019. In this large nationwide study in South Korea, smoking tended to lower the risk of infection with severe acute respiratory syndrome coronavirus 2. However, these findings should be interpreted with caution, and further confirmatory studies are required.
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Affiliation(s)
- Sang Chul Lee
- Division of Pulmonology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Kang Ju Son
- Department of Research and Analysis, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Dong Wook Kim
- Department of Big Data, National Health Insurance Service, Wonju, Republic of Korea
| | - Chang Hoon Han
- Division of Pulmonology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Yoon Jung Choi
- Department of Pathology, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Seong Woo Kim
- Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Seon Cheol Park
- Division of Pulmonology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
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