It all used to be so easy. Smoking is bad for you, the best smoker is a quit smoker, but if you can’t quit then vaping appears to be a safer option than smoking.
Although these facts remain the same, Covid-19 has changed the medical landscape and some early research has suggested that a history of smoking may substantially increase the chance of adverse health outcomes for Covid-19 patients, including being admitted to intensive care and requiring ventilation.
In addition, Chinese data now 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.
Although Covid-19 is here to stay for the foreseeable future and the death toll from it will continue to rise globally as a result, we must never forget that other health problems do not take a break or become furloughed in the meantime. Smoking kills one person every 6 seconds around the world, and just under 100,000 patients every year in the UK.
Whilst we have all had to dramatically alter both our working practices and our lifestyles to deal with the virus, we should still be looking to use each consultation with a smoker to help them quit if that is what they would like to do. Many questions now need considering such as whether remote consultations will be effective at helping smokers quit, will funding still be available for local smoking cessation clinics and – a simple one – are e-cigarettes a risk factor for Covid-19?
The short answer is that – although less dangerous than smoking tobacco – they are likely to be a risk, for two main reasons. The first is one of touch. Smokers and users of e-cigarettes are often touching their lips with their fingers and this increases the likelihood of the virus being passed into the body. Sharing an e-cigarette is also risky, and with access to e-cigarettes being limited in some countries under lockdown, sharing vaping devices may be more common at the moment.
The second is one of damage to the lungs. Tobacco smoke destroys the lung cilia that in turn reduces the lungs ability to keep the airways clear of secretions and particles, and it can also adversely impact on the body’s immune system making it more difficult to defend a viral attack. In addition, Covid-19 appears to enter the lung cells by binding to ACE2 receptors, and smoking increases the levels of these.
Whether the long-term use of e-cigarettes can lead to COPD is still unknown, but there is some evidence that suggests exposure to the particles in e-cigarettes may harm lung cells and so reduce the ability to respond to infection, with one study finding that influenza virus-infected mice exposed to these aerosols were found to have enhanced tissue damage and inflammation. However, far more work is needed in this area before a definitive answer is found.
Whatever the risk to smokers (significant) and vapers (less but not insignificant) in connection with Covid-19, we should now be doing all we can to help our smoking patients quit all forms of tobacco completely to not only improve their long-term health but also reduce their risk if affected by the virus.
This means continuing to use each patient contact as an opportunity to advise as to treatments now available to them, and not to forget that even very brief advice alone (as little as 30 seconds) can help 1 in 40 smokers quit.
The greatest quit rates are achieved with a combination of pharmacotherapy and supportive counselling and now, more than ever, we need to redouble our efforts in the area of tobacco harm reduction in this new coronavirus era.