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Our COVID-19 results extend recent MR studies showing adverse effects of smoking on COVID-19 risk by accounting for highly comorbid alcohol consumption, cannabis use, and SUDs, which when combined with reports suggesting smoking intensifies the severity of COVID-19 symptoms 33,34 , the risk for being admitted to an intensive care unit or requiring ventilation 34 , and recent transcriptomics-based work showing that smoking may increase the expression of angiotensin converting enzyme 2 ( ACE2 ), the putative receptor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (the virus that causes COVID-19) 35 , suggests smoking may be an important modifiable risk factor for COVID-19 risk

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