Smoking, More Dangerous Than Ever During COVID-19 Pandemic

The other pandemic

Tobacco use is one of the worst common threats in our society. The World Health Organization (WHO) describes it as an epidemic due to the amount of associated deaths.¹ Yet, tobacco’s impact is globally noticeable. Tobacco kills more than 8 million people a year on a worldwide scale, and more than 7 million of those deaths are related to direct tobacco use.

Some might say that not all forms of tobacco consumption are harmful, yet studies show that alternative tobacco products are not a safe option either. Waterpipe smoking, cigars and even smokeless tobacco products are scientifically claimed to be harmful,² while many sources reveal the downsides of e-cigarettes use.¹ According to Public Health Ontario (PHO), tobacco use is the leading cause of preventable premature death globally and in Canada.³

The WHO states that while most tobacco users live in low- and middle-income countries, tobacco smoking is a worldwide public threat affecting not-only smokers but also non-smokers due to second-hand smoke. Moreover, around 1.2 million deaths in the world are the result of non-smokers being exposed to second-hand smoke. ¹ Let’s face it, smoking is harmful and there is no way around that. According to the Centers for Disease Control and Prevention in USA⁴, for every person who dies because of smoking, at least 30 people live with a serious smoking-related illness. Smoking tobacco causes exposure to over 7000 toxic chemicals, that can damage nearly every organ system in the human body.² Illnesses vary from cancers, heart diseases, strokes, diabetes, and respiratory diseases such as chronic obstructive pulmonary disease (COPD).

Smoking: A risk factor for COVID-19?

A few studies suggested that smokers may be at reduced risk of COVID-19 infection or progression. ^5,6,7 Some authors have then hypothesized that there may be a protective effect of nicotine on initial infection, via interaction of nicotine with the ACE-2 receptor, ^5,6 or on more severe disease progression after the infection, via the impact of nicotine on the anti-inflammatory cytokine pathway. ^5,6,7

These early findings have surprised many scientists! It is well documented that both COVID-19 and smoking can significantly affect the respiratory and immune systems, and they can both cause mild to severe illness and/or death.³ Moreover, cardiovascular diseases, chronic respiratory disease (e.g., COPD), diabetes, and cancer are associated with worse clinical COVID-19 outcomes.³ Now these are pathologies caused by smoking. One might therefore expect that smoking would be associated with more severe forms of COVID-19.

So far, PHO states that tobacco smoking may pose a theoretical increased risk of SARS-CoV-2 infection due to frequent hand-mouth contact during smoking. Furthermore, in a recent meta-analysis, smoking is identified as a risk factor for progression of COVID-19 to more severe or critical conditions or death, with smokers having 1.91 times the odds of experiencing such deterioration than never smokers.⁸ Following a systematic review of the literature, WHO and PHO also confirm that smoking tobacco is associated with increased chance of adverse health outcomes in hospitalized COVID-19 patients (e.g., admission to intensive care unit, death).

This apparent contradiction in research findings is likely the result of methodological limitations. For example, smoking was not correctly screened in patients infected and/or hospitalized for COVID-19, and those with a history of smoking were not necessarily counted as smokers. Thus, several analyses have been conducted on preliminary or incomplete data.⁸

So, is smoking a magnet to the SARS-CoV-2 virus? The question has to be answered with precautions as the interactions between COVID-19 and nicotine, or COVID-19 and tobacco remain not well understood.

COVID-19: A risk factor for smoking?

On another hand, one might wonder about the influence of the pandemic on smoking habits. It turns out that the dangers evoked by the COVID-19 virus infection may have encouraged many to ditch smoking. UK cessation rates indicated by the University of London increased by almost a third higher than the average in 2020, with a 7.1% rate. ⁹

In addition, another study in UK reported that 10 % of vapers have decreased their vaping consumption.¹⁰ Nevertheless, the same research indicates that half did not change their vaping consumption since COVID-19, and about 40 % reported an increase in vaping. Thus, most smokers seem to have stuck with their habit, if not with a slight change.

In an Italian survey, 36% of smokers reported smoking more than they did prior to lockdown, with an average increase of six cigarettes per day.¹¹ This trend was found mainly in people who reported a deterioration in their quality of life during lockdown, a decrease in the amount of sleep and an increase in anxiety and depression. The increase in cigarette consumption was also mainly in women. They had a more stressful perception of lockdown, as it led to a significant burden in childcare and housework for them. Finally, people who lost their job showed a higher odd of increasing cigarette in comparison with regular workers.

This indicates the position of the pandemic in behavioural patterns of smoking, contributing to a small shock in the industry and not a major disruption.

Many shared stories of their smoking relapse or rise. As it also is for the YouTuber ‘Cynical Mikey’, smoking may have been more of a coping mechanism for most, especially during the pandemic. “I feel like I’m sick every day, and I know the reason for that is not just because I’m smoking but because I’m smoking more than I did ever before,” said Mikey.¹² Others revealed that the pandemic made it a lot harder for distractions to have the same effect, as there are a lot less options available, less places to go to and less things to buy or to do.¹³

Dr. Bradford Bemiss, from Loyola University Medical Center, said “In these uncertain times, it may be tempting and comforting to reach for a cigarette or vaping device or other tobacco products or marijuana products. And yet, there’s never been a more important or better time for you to quit smoking or vaping. Not only to improve your overall health, but to protect yourself from the most dangerous symptoms of COVID-19.”¹⁴

With COVID-19, cigarettes and e-cigarettes cessation advocacy is at its highest, and research is still being done here at Ditch Labs in order to help people quit.

References

¹ World Health Organization. (2020, May 27). Tobacco. https://www.who.int/news-room/fact-sheets/detail/tobacco.

² Drope, J., & Schluger, N. W. (2018). The tobacco atlas. American cancer society. https://tobaccoatlas.org/topic/health-effects/

³ Public Health Ontario (2020, July 31). Tobacco and COVID-19 – What We Know So Far. https://www.publichealthontario.ca/-/media/documents/ncov/covid-wwksf/2020/08/what-we-know-tobacco-covid.pdf?la=en

⁴ US Department of Health and Human Services. (2014). The health consequences of smoking—50 years of progress: a report of the Surgeon General. https://aahb.org/Resources/Pictures/Meetings/2014-Charleston/PPT%20Presentations/Sunday%20Welcome/Abrams.AAHB.3.13.v1.o.pdf

⁵ Farsalinos, K., Barbouni, A., & Niaura, R. (2020). Smoking, vaping and hospitalization for COVID-19. Qeios. doi:10.32388/Z69O8A.12.

⁶ Farsalinos, K., Niaura, R., Le Houezec, J., Barbouni, A., Tsatsakis, A., Kouretas, D., ... & Poulas, K. (2020). Nicotine and SARS-CoV-2: COVID-19 may be a disease of the nicotinic cholinergic system. Toxicology reports, 7, 658. doi:10.1016/j.toxrep.2020.04.012

⁷ Kloc, M., Ghobrial, R. M., & Kubiak, J. Z. (2020). How nicotine can inhibit cytokine storm in the lungs and prevent or lessen the severity of COVID-19 infection?. Immunology letters, 224, 28-29. https://doi.org/10.1016/j.imlet.2020.06.002

⁸ Patanavanich, R., & Glantz, S. A. (2020). Smoking is associated with COVID-19 progression: a meta-analysis. Nicotine and Tobacco Research, 22(9), 1653-1656. https://doi.org/10.1093/ntr/ntaa082

⁹ Schraer, R. (2020, July 14). Coronavirus: Smokers quit in highest numbers in a decade. BBC News. https://www.bbc.com/news/health-53403610

¹⁰ Kale, D., Herbec, A., Perski, O., Jackson, S. E., Brown, J., & Shahab, L. (2021). Associations between vaping and Covid-19: Cross-sectional findings from the HEBECO study. Drug and alcohol dependence, 221, 108590. https://doi.org/10.1016/j.drugalcdep.2021.108590

¹¹ Carreras, G., Lugo, A., Stival, C., Amerio, A., Odone, A., Pacifici, R., ... & Gorini, G. (2021). Impact of COVID-19 lockdown on smoking consumption in a large representative sample of Italian adults. Tobacco Control. Doi: 10.1136/tobaccocontrol-2020-056440

¹² Cynical Mikey. (2021, February 12). I'm smoking again! And I feel terrible! Quitting cigarettes is hard. Being a smoker is harder... YouTube. https://www.youtube.com/watch?v=UeDcs0JdmNA&t=321s

¹³ Fakuade, M. (2020, November 12). How the pandemic got people smoking again. Vox. https://www.vox.com/the-goods/21561419/smoking-cigarettes-covid-19-pandemic-juul-health-boredom

¹⁴ Loyola Medicine. (2020, June 2). Covid-19: Smoking and Vaping during Covid-19. YouTube. https://www.youtube.com/watch?v=r9EuBFR7924