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A prospective trial, identifying smokers and non-smokers now, and following them in the future to see if they acquire COVID-19 and their outcomes would be the definitive way to attempt to establish causation. Galiatsatos explained that he and his colleagues in the School of Medicine and the School of Public Health at Johns Hopkins have been working on a massive systematic review of all the publications put out [on the subject] so far, and based on their analysis, he said, weve found that those who smoke are more likely to suffer more severe symptoms of COVID-19. The finding isnt surprising, he said, because its what weve known all along: People who smoke tend to have worse outcomes from infection. Jeffery Drope, the scientific vice president of economic and health policy research for the American Cancer Society (ACS), has arrived at the same conclusion