Assessment of COVID-19 Symptoms Distribution According to Tobacco Products Consumption and Khat Chewing: A Potential Antinociceptive Role of Nicotine Among COVID-19 Patients

Purpose: To assess the distribution of COVID-19 symptoms according to the consumption of tobacco products and khat chewing among samples of Saudi Arabian individuals. Methods: This retrospective cohort study was conducted in the Jazan region of Saudi Arabia. Data was collected online via a self-administered questionnaire. The questionnaire measured demographic variables, COVID-19 symptoms and vaccination, comorbidities history, tobacco product consumption, and khat chewing. In addition, logistic regression was performed to assess the association between the clinical presentation of COVID-19 with tobacco product consumption and khat chewing. Results: A total of 1026 subjects were recruited. The mean age of the participants was 31 years, and more than half were male (53%). Among the reported tobacco product consumption, hookah smoking was more frequently reported as a currently consumed tobacco product (14.3%), followed by cigarette smoking (11.5%) and chewing tobacco (3.8%). Thirteen percent (134) were khat chewers at the time of recruitment. The odds of reporting five symptoms or more were higher among patients who have never been tobacco product consumers (OR: 1.6, 95% CI: 1.15-2.35) while accounting for khat chewing, age, vaccination status, and history of comorbidities. Nonetheless, the difference in symptom distribution with khat chewing status was not statistically significant. Conclusion: The findings of the current investigation suggest the presence of a potential impact of nicotine toxicity in masking pain among the subjects infected with COVID-19. Therefore, it is possible to hypothesize that, with the potential masking effect of nicotine, infected smokers may be less likely to suffer from the symptoms and seek official healthcare services, including diagnostic services. Keywords: COVID-19, tobacco, khat, Jazan, Saudi Arabia