(P-508) COVID-19 Symptom Severity Among Smokers: Insights from a Direct-to-community Registry

Background: There is mixed evidence on the association between smoking and COVID-19 risk, presentation and outcomes. Some studies suggest that cigarette smoke reduces the number of ACE2 receptors in the lung tissue, resulting in lowered infection risk. Other studies highlight that the compromised lung function in smokers may result in higher risk for severe symptoms.

Objectives: To describe symptom presentation among smokers compared to non-smokers enrolled in a direct-to-community COVID-19 registry.

Methods: Social media outlets were used to enroll adult volunteers who believed they had been exposed to or tested positive for COVID-19 (www.helpstopCOVID19.com). Respondents reported demographics, medical history and medication use at enrollment, and COVID-19 test results and symptoms (including severity) periodically over 90 days. This analysis included those reporting a positive COVID-19 test result within 14 days of enrollment. Symptom presentation and severity were described by self-reported smoking status.

Results: A total of n=2,923 COVID-19 positive individuals were included in this analysis, n=387 smokers and n=2,536 non-smokers. The average age was 40 years (SD: 12.3) with 83% female. Smokers were more likely than non-smokers to be male (23% vs 16%), report lung disease (18.6% vs 9.9%), and less likely to have a 4-year college degree or more (18.8% vs 42.7%). In both groups, the most commonly reported symptoms were fatigue (70%), cough and nasal congestion (60%), and decreased sense of smell or taste (>50%). Notably, smokers were more likely to report symptoms of depression (17.3% vs 11.1%) and anxiety (26.3% vs 20.0%). There were modest differences between smokers and non-smokers in reported aches and pains (54.5% vs 50.8%), decreased sense of smell (53.7% vs 50.2%), shortness of breath (36.4% vs 32.1%), chest pain (22.2% vs 18.4%) and vomiting (10.6% vs 6.9). Smokers were more likely than non-smokers to report the symptoms to be moderate of severe for aches and pains (67.2% vs 61.2%), cough (46.7% vs 39.0%), nausea (50.5% vs 41.4%), vomiting (61.1% vs 38.1%).

Conclusions: In this direct-to-community COVID-19 registry, among participants who tested positive for COVID-19, smokers had similar symptoms as non-smokers, but reported experiencing more depression and anxiety and were more likely to report their symptoms as moderate or severe. This potential increased severity among both respiratory and non-respiratory symptoms may be correlated with worse outcomes and requires further focus.