Smokers Are 1.4 Times More Likely To Report Severe Covid Symptoms As Compared To Non-Smokers

The harmful effects of tobacco are well-established. Tobacco consumption causes 8 million deaths every year, of which more than seven million are from direct use and 1.2 million are due to non-smokers being exposed to second-hand smoke. Additionally, studies suggest that products with tobacco contain approximately 4,000 toxic chemicals.

And now more than ever, amid the pandemic, we need to be aware of the repercussions smoking can cause. Infection induced by Covid-19 begins at a neurotransmitter protein called ACE2 receptor which is present on the surface of the cells and tissues in the lungs, heart, blood vessels, kidney, liver, intestines, and epithelial cells in the upper and lowers respiratory tracts.

The virus contains a coat of proteins that are spike-like which plug into our ACE2 receptors. It then injects into us its genetic material which replicates itself, ruptures the host cell, and then spreads through the body. If our lungs are exposed to tobacco smoke, they can accumulate a large number of ACE2 receptors in the respiratory tract. This makes them more vulnerable to damage. Therefore, prolonged exposure to tobacco provides our body with a mechanism for viral susceptibility and severity of the disease when infected. Smokers who have been infected with Covid-19 have reportedly had severe infections compared to non-smokers. This is due to the increased risk of the virus for people who consume tobacco.

Furthermore, when there are pre-existing comorbidities like diabetes, respiratory disease, among others, in people who consume tobacco, the impact of Covid-19 is aggravated. Being an important immune modulator, tobacco also suppresses the immune system by reducing antibody responses and thereby causing hindrance to fighting coronavirus.

Therefore, smokers are 1.4 times more likely to have severe symptoms of Covid-19 and 2.4 times more likely to get admitted to an ICU, requiring mechanical ventilation, or die compared to non-smokers.

Tobacco smoking also increases the likelihood of virus transmission by exhaling respiratory droplets while exhaling tobacco smoke, spitting, sharing mouthpieces for waterpipe use. Smokers and tobacco consumers often touch their lips or face with their hands; therefore, this increases their chances of contracting the virus. Moreover, disposed cigarettes after smoking can prove to be a means of transmission.

Additionally, chewing tobacco products increases the production of saliva and there is a strong urge to spit. Then, the virus is transmitted through the saliva that one spits out.

Despite this, the market value of the tobacco industry worldwide is said to be approximately USD 932 billion and is expected to touch USD 1 trillion by the year 2026. There are desperate attempts by the tobacco industry to prove the therapeutic effect of nicotine on Covid-19. Some studies have come up in the last year, pushing the positive narrative of smoking, majority of them were sponsored by the tobacco industry and using skewed data. Recently European Respiratory Journal retracted a study linking smoking to lower COVID severity, stating 2 out of 5 authors of the study have financial ties with the tobacco industry. WHO also has issued a clear warning against such studies?

By now we are aware that Covid-19 has an adverse impact on the respiratory system. Therefore, tobacco consumers should promptly make the decision to quit and take immediate action to reduce their risks of viral transmission.

Once a person quits smoking, the benefits can begin immediately. The body begins to recover within 24 hours and starts repairing tobacco-related damage. Within one or two weeks, circulation improvement is noticed and lung function increases. Post nine months, coughing and shortness of breath reduce as well.  

Government guidelines since the Covid-19 outbreak have emphasized the need to stop tobacco use. 

There are various nicotine replacement therapies like nicotine patches and nicotine gums that can help smokers to quit smoking. Tobacco users should take immediate steps to quit by using proven methods such as toll-free quit lines, mobile text-messaging programs, and nicotine replacement therapies.

We are fighting a battle on two fronts one against the virus and another against tobacco and we cannot afford to lose either.  

(The author is a consultant, pulmonology at Fortis Hospital Vasant Kunj, Delhi.)