The role of novel nicotine-containing products on SARS-CoV-2 infection and COVID-19 progression
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Laboratory of Lifestyle Research, Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
Marco Scala
Laboratory of Lifestyle Research, Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
Publication date: 2023-04-25
Tob. Prev. Cessation 2023;9(Supplement):A127
Because of the alleged protective effect of nicotine on SARS-CoV-2 infection driven by the relatively low smoking prevalence among COVID-19 patients, some researchers, often linked with the tobacco industry, speculated that e-cigarettes (e-cigs) containing nicotine could lower the risk of SARS-CoV-2 infection.

Material and Methods:
We conducted a systematic literature review (updated to June 2022) on all the studies providing data on the link between e-cig and heated tobacco product (HTP) use, and COVID-19 incidence and progression, using the main scientific databases (i.e., PubMed/MEDLINE and Web of Science).

Starting from 422 non-duplicate publications, we found 14 original publications, including 10 on SARS-CoV-2 infection, 4 on hospitalization, 3 on severity and 1 on mortality. Ten studies provided data on the risk of SARS-CoV-2 infection for current/ever e-cig users vs. never/non-users: none of them found a significant decreased risk of SARS-CoV-2 infection among e-cig users, while four studies found a significant increased risk for (exclusive or dual) e-cig users. Three studies showed that e-cig users had more frequent and persistent COVID-19 symptoms. A recent large cohort study did not find any relationship between e-cig use and COVID-19 progression. A couple of cross-sectional studies investigated the association between HTP use and COVID-19 incidence, finding no significant association.

The growing evidence on the role of e-cig on COVID-19 incidence, shows that, if any, e-cig use is associated with an increased risk of SARS-CoV-2 infection when compared to non-use. E-cig use might increase the risk of severe forms of COVID-19, but the studies on this topic are few and conflicting. No significant association was found in the few studies on the association between HTP use and COVID-19.

The authors have no conflicts of interest to declare.