The World Health Organization is warning that smokers are more likely to develop severe COVID-19 and die from the respiratory illness compared to nonsmokers, citing a review of studies by public health experts.
“Tobacco smoking is a known risk factor for many respiratory infections and increases the severity of respiratory diseases,” the WHO said Monday. “COVID-19 is an infectious disease that primarily attacks the lungs. Smoking impairs lung function making it harder for the body to fight off coronaviruses and other diseases. … There is currently insufficient information to confirm any link between tobacco or nicotine in the prevention or treatment of COVID-19.”
Tobacco use also increases chances of developing cardiovascular disease, cancer, respiratory disease and diabetes, which place people at higher risk of developing severe illness when infected with COVID-19, according to the WHO.
An analysis of 12 papers with data on smoking and COVID-19 found that smoking was linked with more than a doubling of the odds of the disease worsening in people who already had developed the respiratory illness, according to Dr. Stanton Glantz, director of the Center for Tobacco Research Control and Education at University of California, San Francisco.
One recent study found that 9.4% of hospitalized COVID-19 patients who died were smokers, compared to 5.6% who were nonsmokers or former smokers. The study, published in The New England Journal of Medicine, involved 8,910 hospitalized COVID-19 patients from 169 hospitals in Asia, Europe and North America.
“This peer-reviewed study strongly contradicts recent claims, based on nonpeer-reviewed data from France, that smokers are at lower risk of COVID-19 and by implication that nicotine may offer protection from COVID-19. The French statistics do not permit any credible conclusions regarding smoking, nicotine and COVID-19,” said Dave Lemmon, director of media relations for Campaign for Tobacco-Free Kids.
In late April, the Massachusetts Office of the Attorney General issued an advisory warning that smoking and vaping could make COVID-19 infections worse, damage lungs, weaken the immune system and increase the spread of the disease due to hand-to-mouth contact when using smoking and vaping products.
“As people across the U.S. and the rest of the world contend with coronavirus disease 2019, the research community should be alert to the possibility that it could hit some populations with substance use disorders particularly hard,” Dr. Nora Volkow, director of the National Institute on Drug Abuse, said in a blog post. “Because it attacks the lungs, the coronavirus that causes COVID-19 could be an especially serious threat to those who smoke tobacco or marijuana or who vape.”
Emerging evidence suggests that exposure to e-cigarette aerosols can harm lung cells and diminish the body’s ability to fight infections, Dr. Volkow said. One NIH-supported study found that mice infected with the influenza virus who were exposed to these aerosols experienced more tissue damage and inflammation.
Smoking and chronic obstructive pulmonary disease (COPD) have been linked to a higher susceptibility to Middle East respiratory syndrome (MERS), another coronavirus. Co-occurring conditions such as cardiovascular disease and other respiratory conditions can worsen diseases caused by other coronaviruses that affect the respiratory system such as severe acute respiratory syndrome (SARS) and MERS.
An estimated 5 million middle school and high school students reported vaping nicotine and marijuana products, while about 34 million U.S. adults smoke cigarettes, the most recent federal data show.
Last year, an outbreak of vaping-related lung illnesses emerged in the U.S., but the majority of them were linked to vitamin E acetate oil, a product found in THC products. Health officials reported that about 15% of the patients reported only vaping nicotine products.
Although other physicians have urged people to quit smoking and vaping during the pandemic, it is up to the individual to decide if now is a good time to try and quit, said Dr. Albert Rizzo, chief medical officer of the American Lung Association.
“I understand that people have to be in the right frame of mind, to have to decide on their own that this is a time they want to commit to the smoking cessation effort,” Dr. Rizzo said. “Maybe some individuals with being away from work and being away from coworkers who are smoking now is a good time to try and quit because they don’t have the peer pressure of those around them to keep smoking. Other individuals may find this is not the time to quit because they are housebound, worried about finances, their job, and they are using smoking as a crutch to get through that.
“As a lung doctor, it’s always a good time to stop smoking but I understand there are reasons people can’t at certain times,” he said.
He recommends people trying to quit smoking use FDA approved cessation products and available support programs.