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Previously submitted to: Journal of Medical Internet Research (no longer under consideration since Jun 18, 2020)

Date Submitted: May 7, 2020
Open Peer Review Period: May 7, 2020 - Jun 18, 2020
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Association of SARS-CoV-2 infection to smoking and e-cigarettes

  • Josep M Ramon-Torrell; 
  • Sergio Morchon; 
  • Fernando Aguero; 
  • Cristina Masuet-Aumatell



The coronavirus disease 2019 (COVID-19) is spreading worldwide. Several factors have been studied in relation to SARS-CoV-2 infection. One of the factors that has been related and in an uncertain way has been tobacco consumption. To our knowledge, no studies measuring the association between e-cigarettes and SARS-CoV-2 had been reported.


The aim of this study was to evaluate, through a cross-sectional survey, the current prevalence estimation of SARS-CoV-2 infection among smokers and e-cigarette users.


: A cross-sectional study was carried out using an online questionnaire-based survey between April 6,2020 to April 19, 2020. Participants were males and females enrolled via link from website. We also posted the link in Facebook, Twitter and anti-tobacco, smokers and e-cigarette users forums. For this analysis, only participants residing in Spain were included. To measure the association between infection and independent variables odds ratios (ORs) were calculated for each category by conditional logistic regression and the corresponding 95% confidence intervals (CIs) and adjusted by age and gender.


A total of 3,517 participants were included in the study. Of all the participants, 170 reported a diagnosis of SARS-CoV-2 infection (4.6 % 95% CI 3.9-5.1) of which 35 (0,99 %; 95% CI 0.6-1.06) ), reported a confirmed diagnosis and 135 (3.8 %; 95% CI 2.9-4.01) a clinical diagnosis. Rate of daily smokers of conventional tobacco among all participants was of 12.2 % (14.3 % of males and 9.8 of females). The number of smokers (4.7%) and users of electronic cigarettes (3.9%) among the group with infection was lower than the number of non-smokers (10.2%) (p <.01). A negative association was observed between tobacco consumption (0.52 95%CI 0.27-0.98) and the use of electronic cigarettes (0.45 95%CI 0.28-0.71) and SARS-CoV-2 infection.


The results must be corroborated by analytical studies. In relation to the electronic cigarette, the basis would be similar to those of conventional cigarettes and based on the role of nicotine in the incidence and progression of SAR-CoV-2 infection.


Please cite as:

Ramon-Torrell JM, Morchon S, Aguero F, Masuet-Aumatell C

Association of SARS-CoV-2 infection to smoking and e-cigarettes

JMIR Preprints. 07/05/2020:19949

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