Introduction:
The highly infectious coronavirus disease 2019 (COVID-19) has now rapidly spread around the world. This meta-analysis was strictly focused on the influence of smoking history on the severe and critical outcomes on people with COVID-19 pneumonia.
Methods:
A systematic literature search was conducted in eight online databases before 1 February 2021. All studies meeting our selection criteria were included and evaluated. Stata 14.0 software was used to analyze the data.
Results:
A total of 109 articles involving 517,020 patients were included in this meta-analysis. A statistically significant association was discovered between smoking history and COVID-19 severity, the pooled OR was 1.55 (95%CI: 1.41-1.71). Smoking was significantly associated with the risk of admission to intensive care unit (ICU) (OR=1.73, 95%CI: 1.36-2.19), increased mortality (OR=1.58, 95%CI: 1.38-1.81), and critical diseases composite endpoints (OR=1.61, 95%CI: 1.35-1.93), whereas there was no relationship with mechanical ventilation. The pooled prevalence of smoking using the random effects model (REM) was 15% (95%CI: 14%-16%). Meta-regression analysis showed that age (
P=
0.004), hypertension (
P
=0.007), diabetes (
P
=0.029), chronic obstructive pulmonary disease (COPD) (
P
=0.001) were covariates that affect the association.
Conclusions:
Smoking was associated with severe or critical outcomes and increased the risk of admission to ICU and mortality in COVID-19 patients, but not associated with mechanical ventilation. This association was more significant for former smokers than in current smokers. Current smokers also had a higher risk of developing severe COVID-19 compared with non-smokers. More detailed data, which are representative for more counties, are needed to confirm these preliminary findings.
Before institution of universal patient surveillance, patients detected outside the isolation ward over a 6-month period (January-June 2020) spent an average of 16.5 hours (N = 32; SD, 9.76) in the general ward prior to isolation, with 68 inpatient close contacts identified; 1 inpatient's close contact subsequently tested positive within the incubation period. 8,9 During the universal surveillance period, asymptomatic inpatients spent an average of 2 hours (N = 5; SD, 1.87) prior to isolation, a difference that was statistically significant (−14.6; 95% CI, −23.5 to −5.6; P = .002). In total, 26 inpatient close contacts were identified and placed under quarantine; none tested positive.In conclusion, institution of RRT for all HCWs as well as universal screening for COVID-19 in all inpatients during a 6-week period of increased transmission in the surrounding community detected additional asymptomatic cases among HCWs and inpatients. Although the yield of testing was not high, earlier detection of asymptomatic inpatient cases allowed for faster isolation, limiting potential exposure. No clusters of COVID-19 infections were seeded among staff or patients during a period of heightened risk. Although RRT and universal screening for all inpatients is resource intensive (Fig. 1c), there may be a role for such measures during increased community transmission, given that healthcare institutions are inextricably intertwined with their neighboring communities.
A 54-year-old woman was admitted to the general medical floor after undergoing percutaneous nephrolithotomy via the supracostal approach. On postprocedure day 1, she developed low-grade fever, dry cough, shortness of breath, and palpitations.
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