A curious observation during the ongoing pandemic is the remarkably low proportion of smokers amongst hospitalized COVID-19 patients. Data from China suggests smokers account for only 6.5% of such patients despite a high smoking rate (26.6 %) in the general population. 1,2 Similarly, the Center for Disease Control and Prevention (CDC) found only 1.3% of 7,162 Covid-positive hospitalized Americans were smokers against a national smoking prevalence of 14%. 3 Could nicotine have a protective effect against COVID19, or are these disproportionately low figures due to varying definitions and inaccurate reporting of smoking status amidst an emerging and overwhelming epidemic? Patients might be too sick or fearful to provide an honest or coherent report of tobacco use. Doctors may be too busy to take a detailed history. Smoking is more prevalent among lower socioeconomic classes where affordable access to hospital care might be an issue.