Are smokers and tobacco users at higher risk of COVID-19 infection?
Tobacco use kills more than 7 million people every year.
Any kind of tobacco use (smoking, chewing or via waterpipes) is harmful to health. Research suggests that people who start tobacco use in their teens and continue for two decades or more, will die 20 to 25 years earlier than those who never start up.
Tobacco has a particularly huge impact on respiratory health. The link between tobacco use and lung cancer, tuberculosis, chronic obstructive pulmonary disease (COPD) and several respiratory has been is well-established. Evidence from other outbreaks caused by viruses from the same family as COVID-19 suggests that tobacco smoking could, directly or indirectly, contribute to an increased risk of infection, poor prognosis and/or mortality for infectious respiratory diseases.
Tobacco use reduces the lung’s capacity to take in oxygen and expel carbon dioxide, and the build-up of mucus, which results in painful coughing and breathing difficulties. This may have implications for smokers, given that smoking is considered to be a risk factor for any lower respiratory tract infection and the virus that causes COVID-19 primarily affects the respiratory system, often causing mild to severe respiratory damage. Given that COVID-19 is a newly identified disease, the link between tobacco smoking and the disease has yet to be established; however, information from China, where COVID-19 originated, shows that people who have cardiovascular and respiratory conditions caused by tobacco use, or otherwise, are at higher risk of developing severe COVID-19 symptoms.
Smokers are likely to be more vulnerable to COVID-19 as the act of smoking means that fingers (and possibly contaminated cigarettes) are in contact with lips which increases the possibility of transmission of virus from hand to mouth. Smokers may also already have lung disease or reduced lung capacity which would greatly increase risk of serious illness.
Smoking products such as water pipes often involve the sharing of mouth pieces and hoses, which could facilitate the transmission of COVID-19 in communal and social settings.
The relation between COVID-19 and cardiovascular health is important because tobacco use and exposure to second-hand smoke are major causes of CVDs. According to the available evidence, the virus that causes COVID-19 (SARS-CoV-2) is from the same family as MERS-CoV and SARS-CoV, both of which have been associated with cardiovascular damage. There is an increased risk of more serious symptoms and death among COVID-19 patients that have underlying cardiovascular diseases (CVDs); in addition, there is evidence that COVID-19 patients that have more severe symptoms often have heart related complications.
A weaker cardiovascular system among COVID-19 patients with a history of tobacco use could make such patients susceptible to severe symptoms, thereby increasing the chance of death.
What about E-Cigarettes?
Electronic nicotine delivery systems (ENDS), of which electronic cigarettes are the most common prototype, are devices that do not burn or use tobacco leaves but instead vaporise a solution the user then inhales. The main constituents of the solution, in addition to nicotine (when present), are propylene glycol, with or without glycerol and flavouring agents. ENDS solutions and emissions contain other chemicals, some of them considered to be toxicants. The nicotine itself is a harmful and addictive ingredient, and affects brain development in youth. E-cigarettes are a threat to health; being associated with injuries and illnesses, such as explosions and fires, throat and mouth infections, coughs, nausea and vomiting. Read about health risks of ENDS here:
The use of waterpipes has both acute and long-term harmful effects on the respiratory and cardiovascular systems, likely increasing the risk of diseases including coronary artery disease and chronic obstructive pulmonary disease.
The communal nature of waterpipe smoking means that a single mouthpiece and hose are often shared between people, especially in social and communal settings that provide ample opportunity for the virus that causes COVID-19 to spread. Additionally, the waterpipe apparatus (including the hose and chamber) itself may contribute to this risk by providing an environment that promotes the survival of microorganisms outside the body. These factors increase the potential for the transmission of infectious diseases between users. Evidence has shown that waterpipe use is associated with an increased risk of transmission of infectious agents such as respiratory viruses, hepatitis C virus, Epstein Barr virus, Herpes Simplex virus, tuberculosis, Heliobacter pylori, and Aspergillus.
What about second-hand smoke?
Second-hand smoke impacts health adversely too. When second-hand smoke contaminates the air, especially in enclosed spaces, it is inhaled by everyone – this exposes both smokers and non-smokers to its harmful effects. Tobacco smoke contains over 4000 known chemicals, many of which are harmful, with at least 40 that cause cancer. It also includes large quantities of carbon monoxide, which hinders the blood’s ability to carry oxygen to vital organs such as the heart and brain, and substances that contribute to heart disease and stroke.
Article 8 of the WHO Framework Convention on Tobacco Control stipulates that all people need to be protected from second-hand smoke through the adoption and implementation of legislative and other measures to provide protection from exposure to tobacco smoke in indoor workplaces, public places and public transport.
Key points of note include:
- There is no safe level of exposure to second-hand smoke.
- Non-smokers, including women and children, have a right to breathe tobacco-free clean air.
- Ventilation or designated smoking-rooms do not offer effective protection.
- All indoor workplaces, public transport, schools and health services should be smoke-free.
- People need to be better informed of the hazards of second-hand smoke to themselves, foetuses, children and other family members.
A good time to Quit!
Tobacco use dramatically increases the risk of many serious health problems. Stopping any form of tobacco use may be especially important at this time to reduce the harm caused by COVID-19. Tobacco users are probably less likely to become infected if they quit because the absence of smoking helps reduce the touching of fingers to the mouth. It is also likely that they would better manage the comorbid conditions if they become infected because quitting tobacco use has an almost immediate positive impact on lung and cardiovascular function and these improvements only increase as time goes on. Faster recovery and milder symptoms also reduce the risk of the transmission of the disease to other people.