key: cord-0878825-oy1l1b31 authors: Kalan, Mohammad Ebrahimi; Ghobadi, Hassan; Taleb, Ziyad Ben; Ward, Kenneth D.; Adham, Davoud; Matin, Somaieh; Fazlzadeh, Mehdi; Narimani, Sajjad title: Descriptive characteristics of hospitalized adult smokers and never-smokers with COVID-19 date: 2020-05-28 journal: Tob Induc Dis DOI: 10.18332/tid/122759 sha: f041ae8af4e66c326f295bd18505a2738b33907a doc_id: 878825 cord_uid: oy1l1b31 nan Three out of the five deaths occurred among WP smokers with the remaining two deaths among neversmokers. When interviewed at the beginning of the study, all three WP smokers and 2 never-smokers who later died due to COVID-19 infection reported having chronic conditions. It is suggested that WP smoking be regulated to restrict COVID-19 transmission 4, 5 and several countries accordingly have temporarily shut down WP cafes 4,6 . Berlin et al. 7 highlighted that 'lockdown may be an opportune moment to quit to reduce not only the smoker's health risk but also that of his/her family members'. This recommendation might not be practical, however, in countries like Iran (the epicenter of COVID-19 in the Middle East), where WP smoking is culturally rooted, highly prevalent, and frequently occurs at home 8, 9 . As social distancing restrictions are relaxed, it is critical to provide guidelines (e.g. best cleaning practices, hygiene standards) and increase awareness regarding the risks of sharing WP. Future studies investigating the association between smoking and COVID-19 should consider WP smoking as a potential conduit of infection for this new disease. These studies could answer critical questions about whether smoking WP in a café environment will increase the risk of contracting coronavirus, how café owners must sanitize WP components to reduce the risk of virus transmission, and whether sharing the same WP hose in a home environment between family members or friends increases the risk of suffering from serious symptoms due to COVID-19 illness. The limitations of this study include the self-report of underlying medical conditions, tobacco smoking, and the severity of COVID-19-associated symptoms. Despite these limitations, this descriptive study is among the first to describe the patterns of WP use among COVID-19 patients. Our findings highlight the need for larger scale studies to further investigate the influence of smoking behavior on the severity and the prognosis of COVID-19. Active smoking is associated with severity of coronavirus disease 2019 (COVID-19): An update of a meta-analysis Smoking is Associated with COVID-19 Progression: A Meta-analysis Clinical Characteristics of Coronavirus Disease 2019 in China Hookah smoking and COVID-19: call for action Waterpipe Tobacco Smoking: A Potential Conduit of COVID-19 Coronavirus: Qatar bans shisha in public places to stem outbreak COVID-19 and Smoking Characteristics of Iranian hookah users aged 15 years and older, primary report Waterpipe tobacco smoking: A reality or hidden iceberg for Iranian women We thank all the doctors, nurses, and other people who are working hard on the frontline of battling the COVID-19 pandemic. The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none was reported.