Association between cigarette smoking patterns and severity of COVID-19: Findings from a study in 15 private Hospitals in Indonesia.

INTRODUCTION: Indonesia is ranked fourth among countries with the highest smoking rates and has the highest number of male smokers globally. This study aimed to assess the association between cigarette smoking patterns and the severity of COVID-19 among patients in 15 Indonesian hospitals. METHODS: A cross-sectional study was conducted from April to August 2020 using medical records of 490 COVID-19 patients, including the history of their smoking patterns from 15 private referral hospitals in 5 provinces. The severity was defined based on the Guidelines on the Prevention and Control of COVID-19 issued by the Indonesian Ministry of Health, which was indicated by the care provided to patients, namely outpatient, inpatient, and Intensive Care Unit (ICU) services for mild, moderate, and severe symptoms. Smoking patterns were grouped based on adult tobacco use classifications of the Centers for Disease Control and Prevention (CDC). Univariate and bivariate analyses were performed. RESULTS: The results showed that 69.8% of respondents had not smoked cigarettes, 17.1% were active smokers, and 13.1% were former smokers. A significant difference was seen in the number of cigarettes smoked by patients in the ICU, inpatients, and outpatients, among current smokers and passive smokers (p=0.018 and p=0.005, respectively). Furthermore, there was no significant difference in the severity of COVID-19 among current smokers, former smokers, and non-smokers. The time from when smoking was stopped among former smokers was not associated with the severity of COVID-19. CONCLUSIONS: There was no significant difference in COVID-19 severity between groups of smokers. Passive smoking and the number of cigarettes smoked by smokers daily were associated with the severity of COVID-19. Smoke-free policies should be implemented continuously to protect people from the dangers of secondhand smoke.

Significance of Chronic Diseases and Smoking Behavior in the Development of Acute Respiratory Distress Syndrome Among Hospitalized COVID-19 Patients in Indonesia.

Acute respiratory distress syndrome (ARDS) is one of the main causes of high mortality among coronavirus disease 2019 (COVID-19) patients. This study aimed at determining the association between presence of chronic diseases and smoking behaviors with the development of ARDS among hospitalized COVID-19 patients in Indonesia. This study was carried out in 15 Muhammadiyah-'Aisyiyah-affiliated COVID-19 referral hospitals in Indonesia. Four hundred ninety participants who tested positive for the COVID-19 were recruited in this study. Demographic data, history of chronic diseases, and the development of ARDS were retrieved from hospital patient records. Information about the smoking behavior was collected after respondents were discharged from the hospital. Presence of chronic diseases such as diabetes, chronic heart disease, hypertension, and chronic liver diseases were significantly associated with the development of ARDS. In a similar regard, patients who currently smoked had a 5 times greater risk of developing ARDS compared with those who never smoked.

The Impact of Large-scale Social Restrictions on the Incidence of COVID-19 : A Case Study of Four Provinces in Indonesia

The Indonesian government has chosen to implement large-scale social restrictions (Pembatasan Sosial Berskala Besar/PSBB) to minimize the spread of COVID-19. Large-scale social restrictions is a government policy aimed at restricting the internal movement of people in a bid to reduce the spreading of SARS-CoV-2. This study aims at assessing the impact of large-scale social restriction measures on the incidence of COVID-19 cases in the four provinces of Indonesia. Time series analysis was used to describe the trends of COVID-19 case by using surveillance data from the Ministry of Health of Indonesia. Quasi-Poisson regression with an interaction model was used to estimate the incidence rate ratio (IRR). IRR was calculated to compare an incidence rate before and during PSBB implementation. The trend of COVID-19 cases in the provinces of West Java, East Java, Banten, and Jakarta continued to fluctuate. These four provinces continue to experience a significant increase in COVID-19 incidence rate ratio after the first and second PSBB period implementation compared to the time of before PSBB implementation. Lack of proper implementation of the large-scale social restriction led to the PSBB's ineffectiveness in reducing the number of COVID-19 cases in each of the provinces.