08 May '20 23:53>
The link below is to a cohort study in the UK. The reason for the word "wow" is because of the Cohort size - 17 million. This is high quality data. 40% of the English population were tracked in this. There's some interesting results.
Even correcting for SES non-whites are more at risk from covid-19.
Former smokers are at higher risk HR = 1.25 (95% CI = 1.18-1.33), but current smokers at significantly lower risk of dying of covid-19 although since the hazard ratio of dying of covid-19 is 0.88 (95% CI = 0.79-0.99) and the relative risk of dying of lung cancer something of the order of 100 it's difficult to recommend smoking. Asthma is a risk factor which seems to indicate that the cholinergic agonist theory for nicotine having a protective effect is more likely to be valid - typical drugs for asthma are anti-cholinergics. They found that asthmatics who had recently taken oral corticosteroids had a hazard ratio of 1.25 (95% CI = 1.08-1.44) compared with asthmatics who had not recently taken oral corticosteroids HR = 1.11 (95% CI = 1.02-1.20).
There's good news for people with hypertension as it's not a risk factor, the hazard ratio is 0.95 (95% CI = 0.89-1.01).
Deprivation turns out to be a risk factor independently of the various co-morbidities that they examined - see figure 3.
I think the immediate takeaways for the medical profession are, if a smoker presents with severe Covid-19 give them nicotine replacement. If someone who is taking anti-cholinergic drugs for some reason presents with covid-19 consider dose reduction. If someone is showing signs of cytokine storm then, if it's allowed in medical protocols and not contraindicated, maybe try a cholinergic agonist.
https://www.medrxiv.org/content/10.1101/2020.05.06.20092999v1.full.pdf?fbclid=IwAR2vWByOGj4_4aiyAtz8VNs2ca19D5GaImAOISlI4SA5jdBvj7YfjQvwl90
Even correcting for SES non-whites are more at risk from covid-19.
Former smokers are at higher risk HR = 1.25 (95% CI = 1.18-1.33), but current smokers at significantly lower risk of dying of covid-19 although since the hazard ratio of dying of covid-19 is 0.88 (95% CI = 0.79-0.99) and the relative risk of dying of lung cancer something of the order of 100 it's difficult to recommend smoking. Asthma is a risk factor which seems to indicate that the cholinergic agonist theory for nicotine having a protective effect is more likely to be valid - typical drugs for asthma are anti-cholinergics. They found that asthmatics who had recently taken oral corticosteroids had a hazard ratio of 1.25 (95% CI = 1.08-1.44) compared with asthmatics who had not recently taken oral corticosteroids HR = 1.11 (95% CI = 1.02-1.20).
There's good news for people with hypertension as it's not a risk factor, the hazard ratio is 0.95 (95% CI = 0.89-1.01).
Deprivation turns out to be a risk factor independently of the various co-morbidities that they examined - see figure 3.
I think the immediate takeaways for the medical profession are, if a smoker presents with severe Covid-19 give them nicotine replacement. If someone who is taking anti-cholinergic drugs for some reason presents with covid-19 consider dose reduction. If someone is showing signs of cytokine storm then, if it's allowed in medical protocols and not contraindicated, maybe try a cholinergic agonist.
https://www.medrxiv.org/content/10.1101/2020.05.06.20092999v1.full.pdf?fbclid=IwAR2vWByOGj4_4aiyAtz8VNs2ca19D5GaImAOISlI4SA5jdBvj7YfjQvwl90