Washing your hands, social distancing…and quitting smoking
Smokers are at a higher risk of aggravation or death if they develop COVID-19.
The individual and population impacts of smoking cessation measures are yet to be quantified, but if smoking cessation is achieved, the short and long-term benefits will be substantial.
Based on: High certainty evidence on the association between tobacco and disease severity, preliminary evidence on the mechanisms behind this finding, and indirect evidence on the most effective measures to achieve tobacco cessation.
What risks do smokers face if they develop COVID-19?
After conducting an exhaustive evidence search (a systematic review of 207 studies evaluating multiple prognostic factors, including tobacco and others), we can conclude with high certainty that, when compared with non-smokers, active smokers have a 65% higher risk of progressing to severe disease and a 57% higher risk of dying if they develop the disease (see the review here).
The most obvious cause as to why COVID-19 manifests more severely in smokers is the lung damage they suffer, which makes them more susceptible to respiratory complications. In fact, the risk of aggravation in patients with established lung disease from smoking (Chronic Obstructive Pulmonary Disease or COPD) is even greater (more details in our systematic review). In addition, recent laboratory studies have shown that smoking generates a series of short-term alterations that increase the risk of presenting a more severe disease, including: an increase in the expression of the ACE2 receptor, which is the virus’s entry route into the cells, changes in the respiratory epithelium, and alterations in the inflammatory mediators level. These three situations could be quickly reversed by quitting smoking.
Quitting smoking in pandemic times
Smoking cessation is difficult to achieve, even in normal times. Today, it is clearly even more difficult.
The evidence beginning to emerge shows that, while the number of smokers has remained constant during the pandemic, the number of those who want or have tried to quit is higher than the one usually reported.
The health benefits of capitalizing on this interest through measures that support tobacco cessation could be enormous.
Will we get more information on this topic in the near future?
Yes, we will. There are ongoing randomised trials that assess the effects of the interventions to quit smoking during the pandemic. Follow this link to the L·OVE platform in order to access them.
And what about smokers’ risk of contagion?
There is no trustworthy evidence yet that allows us to affirm or deny that the risk of contracting COVID-19 is effectively higher in smokers than in non-smokers, even though some preliminary studies showed that among hospitalised patients with COVID-19 there were less active smokers than expected. Sadly, this finding was taken and disseminated by part of the press and by lobbyists from the tobacco industry, thus contributing to the misinformation epidemic that spreads alongside the COVID-19 pandemic.
Although some groups have decided to investigate what substances within tobacco might have a therapeutic role, smoking will, in no case, be an advisable preventive measure to any known disease, COVID-19 or other.
Smokers have an increased risk of severe disease or death if they develop COVID-19.
Even though the individual and demographic impact on smoking cessation of any measure to be taken during this pandemic are not yet clear, if tobacco cessation is achieved, the benefits both in the short and long term would be substantial.
We estimate that the great majority of medical associations will support tobacco cessation. However, the emphasis and the resources dedicated to it in the different contexts might make substantial differences in the success rate achieved.