COVID and smoking (also, a little review of H1N1)
It seems counter-intuitive, but it may be that smoking confers some sort of benefit regarding COVID:
French researchers want coronavirus patients to wear nicotine patches to study whether it helps prevent or control the disease.
Their review of more than 480 patients with COVID-19 at a large hospital found about 5% of the people to be daily smokers, according to an article on Qeios. An estimated 25% of the French population smoke daily, the researchers said…
The findings are similar to data from China published last month in the New England Journal of Medicine, AFP reported. Out of 1,000 people infected in China, about 12.6% were smokers compared with about 26% in the general population, according to the news outlet.
On reading that, it occurred to me that older people have significantly lower rates of smoking than younger and middle-aged people. Older people also are more likely to have co-morbidities that have caused them to stop smoking, and they are more likely to be the very serious cases that require hospitalization and ICU care and might lead to death.
However, going to what I think must be the actual study (which I always prefer to do if I can find it, because newspaper reports tend to leave out a lot of important information), I noticed that the researchers did correct for age and for sex. So age is not the reason for the lower rates of smoking found.
There were two groups in the study, inpatients and outpatients. Both were compared for rates of smoking to the average French population (adjusted for age and sex):
Eligible patients were those with a confirmed diagnosis of COVID-19 at the APHP Pitié- Salpêtrière Hospital, Paris, France, either hospitalized in medical wards of medicine, but not in ICUs (inpatients) or having consulted for this infection in the infectious disease department and who did not require hospital care until the end of the acute infectious episode (outpatients).
You can see that two other groups were not studied: asymptomatic patients, and those in the ICU. So the study didn’t deal with the mildest or the most severe cases, but it did compare the rates of smoking in mildly symptomatic and somewhat severe (hospitalized) cases to each other and to the ordinary French population in terms of present smoking behavior. The milder and more severe hospital groups both resembled each other, and both featured a great deal less smoking than the matched population. The inpatients in the study tended to be older and to have more co-morbidities, and the listed co-morbidities for the inpatients seemed significantly lower than I’ve read for other studies: hypertension (41.4%), diabetes (27.7%), obesity (14.4%). This could possibly have some significance for the results.
The researchers also write:
…[T]hese studies included mostly hospitalized patients, and the low rate of current smokers may be related to high rate of patients with comorbidities (smokers having been advised to quit) and thus to COVID-19 severity. This could therefore introduce a confusion bias…
…SARS-CoV2 is known to use the angiotensin converting enzyme 2 (ACE2) receptor for cell entry, and there is evidence that nicotine modulates ACE2 expression]which could in turn modulate the nicotinic acetyl choline receptor…
Our findings should be interpreted cautiously and we are aware of its limitations. First, the study was performed in 2020 and the results were compared to data obtained from the French general population’s smoking rate in 2018. However, it is very unlikely that a dramatic decrease in tobacco use may have occurred in France since mid 2018. The SIRs were estimated with the assumption that the studied population who lives in a limited area around a Parisian hospital has the same smoking habits as the general French population. Actually, smoking rates differ across socio-professional categories, and therefore may differ across geographic areas. It should also be noted that in the present study, healthcare workers were over-represented in the outpatient group, due to systematic testing at their work place when they become symptomatic, but not in the inpatient group (data not shown). It is, however, very unlikely that the very low SIRs that were estimated both for the out- and inpatient groups are the result of the study setting. Under or over-reporting of smoking status may also be a concern for studies on smoking habits.
The elimination of ICU patients may be a significant flaw in the study. For example, there’s this:
…[A] study of more than 1,000 patients in China, published in the New England Journal of Medicine, found that smokers with COVID-19 were more likely to require intensive medical interventions than those who didn’t smoke. In the study, 12.3% of current smokers were admitted to an ICU, were placed on a ventilator or died, as compared with only 4.7% of nonsmokers.
It will be a long time before we understand this disease. I don’t think that makes it so very different from a whole lot of other diseases, either. For example, do really understand why H1N1 killed mostly people under 65? The hypothesis was that older people had been exposed previously to a similar virus, but in an admittedly quick search I can’t find any proof of that. One reason we (the public, that is) are not still puzzling over the details of H1N1 infection is that although the H1N1 virus killed a lot people, it didn’t kill quite as many as feared. And then, a vaccine was developed and has been incorporated into regular flu shots). But this was the toll in the pandemic’s first year:
Few young people had any existing immunity (as detected by antibody response) to the (H1N1)pdm09 virus, but nearly one-third of people over 60 years old had antibodies against this virus, likely from exposure to an older H1N1 virus earlier in their lives. Since the (H1N1)pdm09 virus was very different from circulating H1N1 viruses, vaccination with seasonal flu vaccines offered little cross-protection against (H1N1)pdm09 virus infection. While a monovalent (H1N1)pdm09 vaccine was produced, it was not available in large quantities until late November—after the peak of illness during the second wave had come and gone in the United States. From April 12, 2009 to April 10, 2010, CDC estimated there were 60.8 million cases (range: 43.3-89.3 million), 274,304 hospitalizations (range: 195,086-402,719), and 12,469 deaths (range: 8868-18,306) in the United States due to the (H1N1)pdm09 virus.
Additionally, CDC estimated that 151,700-575,400 people worldwide died from (H1N1)pdm09 virus infection during the first year the virus circulated.** Globally, 80 percent of (H1N1)pdm09 virus-related deaths were estimated to have occurred in people younger than 65 years of age. This differs greatly from typical seasonal influenza epidemics, during which about 70 percent to 90 percent of deaths are estimated to occur in people 65 years and older…
On August 10, 2010, WHO declared an end to the global 2009 H1N1 influenza pandemic. However, (H1N1)pdm09 virus continues to circulate as a seasonal flu virus, and cause illness, hospitalization, and deaths worldwide every year.
Also, Obama was president in 2009-2010, which made the press far less likely to criticize our H1N1 response or blow the situation up.
Because there is an inverse correlation between smoking and obesity? I have long thought that the reduction in smoking is at least one reason for the increase in obesity in the US over the past few decades.
“Also, Obama was president in 2009-2010, which made the press far less likely to criticize our H1N1 response or blow the situation up.”
It drove the probability to zero.
FOAF:
I meant to mention that and forgot. Thanks for reminding me.
I didn’t see anywhere that the researchers adjusted for weight. I did notice, however – you can see it in the post – that the comorbidities such as obesity seemed rather low in this study. So it doesn’t appear that the non-smokers who were studied (and most were non-smokers) were especially obese at all. A rate of 14.4 for obesity in the inpatients seems quite low to me, and these were predominantly non-smokers. I’ve gotten a variety of obesity figures for France, but they tend to be slightly higher than that 14.4 figure (see this, for example).
So I don’t think lower rates of obesity in smokers had much or anything to do with this study.
FOAF: Press was also less likely to criticize smokers when Obama was President.
Smokers in China? There are a lot of men who smoke in China. However, the air is so polluted in China, (and I’ve seen Wuhan’s air described as the worst in all of China) that nearly everyone is ingesting quite load of pollutants everyday. Smoking does a ;lot of bad things to your health – COPD, high blood pressure, cancer, and such. Just breathing in China does the same.
This virus is mysterious. Why do some people barely notice they’ve got it? Why do some healthy people get very ill? (Pace Sharon W’s husband, Doug) That old people with comorbidities get very ill and die is not surprising. But some of that population actually get well. Here in my area we had a 92 year old woman recover who has cardiac disease and who had just had a stroke. What happened there? Statistics show, that in my area, 55% of those who are over 80 recover. It’s not necessarily an automatic death sentence, but the odds are not great.
Is this a disease that’s mostly passed by contact with surfaces? It appears so, unless you are in the area of an infected person who coughs, sneezes, or breathes on you. They say the masks are to protect others should you happen to be asymptomatic. Yet it’s hard to get your head around that. It feels like the mask should be a protection for you from others.
Here in WA we now have a doctor, who is also a member of Congress (D, of course), speaking out and saying she will not go in a restaurant, hair dressers, or on an airplane unless the employees have all been tested as uninfected with the virus. WTF? That implies testing all employees in service businesses every five days. Can.Not.Be.Done at this time or maybe ever. How do we overcome that kind of fear?
I took my car in for service yesterday. The dealer has gone all out to make things sterile. Employees all wearing masks and gloves. Very little interaction between you and them. The waiting area with chairs widely separated, and a woman constantly cleaning surfaces. All well and good, except for one man. No mask and coughing occasionally. I gave him a very wide berth. The dealer told me they cleaned and disinfected the interior of my car. Okay. No harm in me doing the same when I got home. Not like I don’t have the time.
There is a possibility for a tool to disinfect public spaces, airplanes, and other transportation. It’s called far infra red lighting. Described here:
https://www.webmd.com/cold-and-flu/news/20180212/can-uv-light-be-used-to-kill-airborne-flu-virus-#1
If the virus is still with us next fall, this might help pave a way forward.
Better yet, would be a treatment that renders the sickness as no worse than a cold, with few complications. That would certainly blunt the fear. and allow a return to full normal.
J.J.
No surprise that a Democrat member of congress from WA could be so irresponsible in spreading fear, I guess they elected a coward as well as a Democrat. Maybe she should consider resigning to protect herself?
It would be bizarre to discover a nicotine patch helps the cure, when the CDC has been busy telling us how awful vaping is — that is, nicotine without the tar.
do really understand why H1N1 killed mostly people under 65?
USUALLY…
the conditions that kill older do so by wearing down immunity and something else gets them.. [they lost mitochondria]
the conditions that kill the younger, are the ones whose immunity over reacts, and so they die of fluids and the over reacting to the pathogen
the conditions that kill the children, tend to overwhelm systems not yet developed or programmed well enough to resist…
A quick check on the CDC website and it shows that there are still many people who test positive for H1N1 every year (tens of thousands), even though a vaccine has been available for over 10 years. I’m not sure how the people hiding under their beds until a vaccine arrives feel about this. I don’t think anyone has mentioned it, probably not worth worrying folks over, I guess.
om, it was Dr. Kim Schrier that made that remark. She was elected to Dave Reichert’s old seat from the 8th district in 2018. We sure as heck don’t need that kind of fear inducing remarks. I hope she’s not helping advise Sleepy Jay. If so, I see more protests and maybe outright rebellion coming.
Dwayne:
An awful lot of people don’t get flu shots.
I bet after this the rate will go up.
J.J.: The main factors of a drastic difference between age cohorts in the number of serious cases are not comorbidities, but the exponential plunge of T-limphocytes numbers with age. This virus is new, so nobody has a ready immunity to it. But acquiring the antibodies response to a new antigen is mediated by T-cells. They are abundant in babies and infants, but their numbers plunge with age rather drastically, and since incubational period for this virus is so long, by the time the virus has enough numbers to produce symptoms, the antibody response to the virus is already mature enough to prevent virus replication in the body of infected person. All this happen on condition that there are lots of T-cells to kickstart the antibody response. That is why there are so many asymptomatic cases among children and young adults. Alas, amongst elderly this is not so.
As my martial sensei of 43 years would say; case by case, everyone’s fate is determined by ki (spirit), shin (mind), tai (body/will). This I think is true, but he forgot the fourth element, namely love.
everyone’s fate is determined by ki (spirit), shin (mind), tai (body/will).
they broke my spirit, played with my mind, and my body cant beat the crap out of them to get them to make up their minds to hire me without a higher degree i dont have because i started too long ago…
this is too good to not put up almost whole:
Several governors are beginning to engage in opening their states. Good. They should wait no further. As each day goes by, we learn more and more about the coronavirus and its effects, and the facts lead toward getting adults back to work and children back to school. We suggest a focus away from the blare and glare of raw death tolls and worst-case scenarios. Instead let’s look at less-alarming truths that are generally being ignored by a media more invested in shock and frenzy. Perhaps we should start with these:
The first numbers we heard were that the coronavirus would kill up to 2.2 million Americans. This dire prediction was the first out of the box and it stuck in too many minds, struck too much fear, and still lingers.
The correction came late in March, as we were told to expect between 100,000 and 240,000 deaths in the U.S. But the death toll estimates keep coming in lower and lower. We are being told this is because of mitigation and distancing orders. Forgotten is that those six-figure numbers included and factored in mitigation and social distancing orders. That is, experts and government officials now tell us our numbers are lower because we are doing what they told us to do, but social distancing was always part and parcel of their high predictions.
The same model used to predict 100,000 or more deaths now tells us to expect something closer to 60,000 deaths. Now, some health departments are artificially inflating their numbers. New York City’s Health Department is now counting “probable” COVID-19 deaths. As Dr. Deborah Birx put it, unlike other countries, “We’ve taken a very liberal approach to mortality . . . if someone dies with COVID-19, we are counting that as a COVID-19 death.”
The per capita infection and death rates and dates of lockdown in various states confirm our questioning of not only one-lockdown-fits-all policies, but also the effectiveness of lockdowns themselves. Lockdowns don’t appear to be highly correlated with infection and death rates. Look at the timing. California, our largest state by far, locked down only three days before New York. Per capita, California’s infection rate is 6% that of New York’s, and its death rate is 4%. Florida, also more populous than New York, locked down almost two weeks after New York. Per capita, Florida’s infection rate is 9% that of New York’s, and it has had 4% of its death rate. Ohio locked down one day after New York, and yet Ohio’s death rate is only 5% that of New York’s. Missouri locked down more than two weeks after New York, but its infection rate is 7% of New York’s, and it has 4% the death rate. The rest of the country is not New York.
A recent Stanford University study reveals the virus is 50-85 times less deadly than initially thought. The infection/mortality rate of COVID-19 is not the 2% to 5% rate others have surmised, wrongly, but one somewhere in the small hundredths-of-a-single-percent range. An even newer study done at the University of Southern California comes to the same conclusion for Los Angeles County.
The closing of our schools is an increasing curiosity. We drastically transfigured over 55 million children’s educational and social lives to protect them from a virus that affects them less than the annual flu. As of this writing, a total of three children have died from the virus in New York City — each of whom had underlying health conditions. Fewer than 10 children have died nationally from COVID-19, although about 80 have died from the flu. The argument that children could spread the new coronavirus to adults is true, but that is true of the flu as well. This has put an additional burden on families, children, and, for our poorest, has ripped millions of them from nutritious meals and trusted adults and institutions.
All perspective was lost. We have needed to hospitalize just over 80,000 people for this illness. The previous two flu seasons in America required nearly half a million hospitalizations. As Dr. Jonathan Geach has written: “Our health care system is now underwhelmed and health care workers are being laid off and furloughed in droves as a result of health care centers having neglected patient care not related to COVID-19 in fear of a COVID-19 surge that failed to materialize on a nationwide basis. This means tens of millions of patients are failing to receive the medical care they need in a timely manner. Almost every hospital outside of the hot spots is empty.” At the Mayo Clinic, as one example, he reports “65% of the hospital beds are empty, as are 75% of the operating rooms.”
Our overreaction to this epidemic will create myriad other health problems. California Rep. Tom McClintock put it well: “How many of the 1.8 million new cancers each year in the United States will go undetected for months because routine screenings and appointments have been postponed? How many heart, kidney, liver, and pulmonary illnesses will fester while people’s lives are on hold? How many suicides or domestic homicides will occur as families watch their livelihoods evaporate before their eyes? How many drug and alcohol deaths can we expect as Americans stew in their homes under police-enforced indefinite home detention orders? How many new cases of obesity-related diabetes and heart disease will emerge as Americans are banished from outdoor recreation and instead spend their idle days within a few steps of the refrigerator?”
If you don’t want to listen to a Republican congressman, how about the United Nations: “The economic hardship experienced by families as a result of the global economic downturn could result in hundreds of thousands of additional child deaths in 2020, reversing the last 2 to 3 years of progress in reducing infant mortality within a single year.”
The political posturing, while predictable, is hypocritical and often one-sided. The Trump administration did not neglect this virus. Instead, Democrats criticized the administration for doing too much and for too little at the same time. The travel ban from China was “xenophobic” in late January, but his declaration of a national emergency in early March was too late. Meanwhile, not one word about this virus was uttered at the February Democratic presidential debate in Las Vegas, even though China was brought up several times in other contexts, such as in trade and defense policy.
As late as Feb. 24, House Speaker Nancy Pelosi was telling people, “We think it’s safe to come to Chinatown and hope others will come.” And, on the last day of February, the principle expert on whom the president relies and the press reveres, Dr. Anthony Fauci, stated: “Right now, at this moment, there is no need to change anything you are doing on a day-by-day basis.”
Almost all of us are interested in the health, safety, and well-being of the American people. The daily death rate should decline dramatically in the next two weeks, and, by the end of the summer, most of this will be in the rear-view mirror. Already, we are being warned that a second wave of the virus will hit us in the autumn. Perhaps, but this is a certainty: There will be a second wave of this crisis that will result from massive unemployment and all the mental and social illnesses and deaths that will come from that and the other policies the lockdowns and shutdowns are bringing.
In short, there will be more pain and hardship — and perhaps more deaths — from the convulsing of our country as a result of the response to the coronavirus than from the coronavirus itself. The governors of our 50 states have real jobs — so do almost all other Americans. They should all be given them back while they still exist.
https://www.realclearpolitics.com/articles/2020/04/23/eight_reasons_to_support_reopening_our_country_143020.html
Maybe off topic
Victor Davis Hanson on Uncommon Knowledge podcast (download link)
https://www.podbean.com/site/EpisodeDownload/PBDA53BECEE25c
Victor Davis Hanson on Coronavirus, California, and the Classical World
2020-04-24