Exposure to SHS is an established causal risk factor for cardiovascular disease (CVD) and chronic lung disease (17) and may also be a risk factor for COVID-19 severity, either by contributing to the development of these underlying conditions or by triggering inflammation and upregulation of angiotensin-converting enzyme 2 (ACE-2) receptors, which facilitate the entry of COVID-19 into cells (5). This evidence concerns the gene ACE2 and COVID-19.