Tobacco and COVID-19
World No Tobacco Day is celebrated annually on May 31st in an effort to draw global attention to the tobacco epidemic and the preventable effects of smoking. Empowering people by helping them to understand the harmful effects of tobacco smoking is essential especially during the COVID-19 pandemic since both can have deleterious effects on the respiratory system. This pandemic has been a very stressful time and many people resort to unhealthy ways of coping which includes tobacco smoking.
Does smoking increase your risk of severe COVID- 19 infection?
A study conducted by the National Heart and Lung Institute of the Imperial College in London, concluded that people who smoke are at an increased risk for developing symptomatic COVID-19. Furthermore, the results from this investigation suggests that current smokers who become infected with the virus are twice as likely to require hospitalization and these people tend to report more symptoms compared to non-smokers. This is because “smoking impairs lung function making it harder for the body to fight off coronaviruses and other diseases,” (WHO, 2020). Smoking compromises the equilibrium or balance of the immune system which increases the risk for several immune and autoimmune disorders (CDC, 2014). Tobacco smoking also causes respiratory irritation, decreases lung function and also precipitates issues such as chronic obstructive pulmonary disease (COPD), which includes emphysema and chronic bronchitis (CDC, 2021). When a smoker’s lungs are exposed to any infections that affects the airways, more complications arise because damage to the airways and air sacs decreases oxygen levels to the lungs and throughout the circulatory system and organs. Additionally, damage to the cilia of the lungs also makes it harder for mucus to be cleared from the lungs (Healthline, n.d). These impairments causes smokers to be more likely to get serious lung conditions such as pneumonia and acute respiratory distress syndrome (ARDS).
Are smokers less likely or more likely to become infected with COVID 19?
While studies have suggested that smokers are more likely to become seriously ill with Covid-19, it is unclear as to whether or not smokers are more likely to ‘contract’ the virus. Thus far, it may be fair to say that everyone has an equal chance of becoming infected with the virus based on the fact that the virus is transmitted via person to person contact, mostly through droplets from an infected person. However, the risk and level of exposure varies based on factors such as occupation and lifestyle. Additionally, the severity of the symptoms experienced will also vary based on one’s immune composition and the presence of pre-existing comorbidities. As a result, some people may be at a higher risk of becoming infected based on their level of exposure and the degree to which they observe measures to decrease their risk of infection (such as social distancing, hand washing and mask wearing. Of note, smoking or vaping involves the fingers touching the lips and so this increases the risk of the virus spreading from the hand to the mouth (Web MD, 2021).
Previous studies have found that nicotine exposure worsens pulmonary infections associated with SARS-CoV-2. It has been found that “nicotine exposure induces rapid and long-lasting increases in the gene and protein expression of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) receptor ACE2, which in turn translates into increased competence for SARS-CoV-2 replication and cytopathic effect,” (Maggi et al, 2021). The ACE2 enzyme is a protein present on many cell types and tissues including the lungs, heart, blood vessels, kidneys, liver and gastrointestinal tract. It acts as a ‘doorway’ to allow movement of matter into cells. The spike proteins on the coronavirus binds to the ACE2 receptors prior to entry (Sriram, 2020). Overexpression therefore results in an increased chance of the coronavirus virus entering cells. On the contrary, one recent study has suggested that people who smoke are “less likely to become infected with the coronavirus.” This was a study conducted by London researchers entitled “SARS-CoV-2 antibody prevalence in England following the first peak of the pandemic.” The findings of the study was that smokers had a lower prevalence of SARS-CoV-2 infection when compared to non-smokers. This study was found to have several limitations and it was recommended that more scientific research is needed to support such a claim. In fact, another study that was published by the University of Piraeus and University of Utah, that claimed that smoking reduces the risk of Covid-19 infection was retracted because the authors were found to be supporters of the tobacco industry (Maggi et al, 2021). Despite these minimally supported claims, smoking is bad for your health and it is known and supported by literature that smokers are at an increased risk for severe illness and hospitalization when infected with the Covid-19 virus.
Can I smoke if I have COVID?
Smoking is discouraged in persons who are infected with or recovering from the coronavirus infection. The COVID 19 virus attacks the respiratory system and smoking also causes impairments to the lungs that respiratory system. This results in an increased risk for severe respiratory complications.
Healthy ways of coping with stress instead of smoking:
- Practice relaxation techniques such as resting, taking deep breaths, meditating or engaging in a hobby.
- Identify stress triggers and avoid these triggers as much as possible.
- Exercise regularly as physical activity releases natural hormones that helps to improve mood and decrease stress (Healthline, n.d).
- Stay occupied to avoid the habit. If you have decided to quit, quit the habit abruptly or quit gradually by smoking less each day. You may also consider nicotine replacement therapy such as nicotine patch, gum or lozenges.
- Stay connected to family and friends (a support system) that can support your decision to quit smoking; avoid hanging around people who smoke.
- Try alternative therapies such as acupuncture, magnet therapy, herbs and supplements (such as green tea, St John’s wort, lobelia).
- Seek support from groups such as the National Council on Drug Abuse. You may call the help line at 876-564-HELP (876-564-4357), to access trained counsellors who can assist with managing strong emotions, developing plans for quitting and helping you to stay on track (NCDA, 2021).
By quitting smoking, you will improve your health, the quality and duration of your life, as well as the lives of those around you.
Brealey, S. (2020, October 30). Coronavirus and smoking. Bhf.org.uk; British Heart Foundation. https://www.bhf.org.uk/informationsupport/heart-matters-magazine/news/behind-the-headlines/coronavirus/coronavirus-and-smoking
CDC. (2014). SMOKING AND OVERALL HEALTH. https://www.cdc.gov/tobacco/data_statistics/sgr/50thanniversary/pdfs/fs_smoking_overall_health_508.pdf
CDC. (2021, February 22). Chronic Obstructive Pulmonary Disease (COPD) | CDC. Www.cdc.gov. https://www.cdc.gov/copd/index.html#:~:text=Chronic%20obstructive%20pulmonary%20disease%2C%20 or
Coronavirus and Smoking. (n.d.). WebMD. https://www.webmd.com/lung/covid-19-smoking-vaping#1
Effects of Quitting Smoking on the Body. (n.d.). Healthline. https://www.healthline.com/health/effects-of-quitting-smoking#withdrawal-symptoms
HCC. (n.d.). Jamaica Coalition for Tobacco Control Celebrates its 15th Anniversary. Healthy Caribbean Coalition. Retrieved May 18, 2021, from https://www.healthycaribbean.org/jamaica-coalition-for-tobacco-control-celebrates-its-15th-anniversary/#:~:text=The%20JCTC%20was%20formed%20to
Hopkinson, N. S., Rossi, N., El-Sayed_Moustafa, J., Laverty, A. A., Quint, J. K., Freidin, M., Visconti, A., Murray, B., Modat, M., Ourselin, S., Small, K., Davies, R., Wolf, J., Spector, T. D., Steves, C. J., & Falchi, M. (2021). Current smoking and COVID-19 risk: results from a population symptom app in over 2.4 million people. Thorax, thoraxjnl-2020-216422. https://doi.org/10.1136/thoraxjnl-2020-216422
Maggi, F., Rosellini, A., Spezia, P. G., Focosi, D., Macera, L., Lai, M., Pistello, M., Iure, A. de, Tomino, C., Bonassi, S., & Russo, P. (2021). Nicotine upregulates ACE2 expression and increases competence for SARS-CoV-2 in human pneumocytes. ERJ Open Research, 7(2). https://doi.org/10.1183/23120541.00713-2020
Matos, C. P., Boléo-Tomé, J. P., Rosa, P., & Morais, A. (2021). Tobacco and COVID-19: A position from Sociedade Portuguesa de Pneumologia. Authors’ reply. Pulmonology, 27(3), 278–279. https://doi.org/10.1016/j.pulmoe.2021.01.012
World No Tobacco Day 2020 – COVID is no joke, it gets worse with smoke – Ministry of Health & Wellness, Jamaica. (n.d.). Www.moh.gov.jm. Retrieved May 18, 2021, from https://www.moh.gov.jm/world-no-tobacco-day-2020-covid-is-no-joke-it-gets-worse-with-smoke/
Ward, H., Atchison, C., Whitaker, M. et al. SARS-CoV-2 antibody prevalence in England following the first peak of the pandemic. Nat Commun 12, 905 (2021). https://doi.org/10.1038/s41467-021-21237-w
Sriram, K., Insel, P., & Loomba, R. (2020, May 14). What is the ACE2 receptor, how is it connected to coronavirus and why might it be key to treating COVID-19? The experts explain. The Conversation. https://theconversation.com/what-is-the-ace2-receptor-how-is-it-connected-to-coronavirus-and-why-might-it-be-key-to-treating-covid-19-the-experts-explain-136928
Nathine Morgan - Pharmacy Student, UTECH Jamaica