While the sale of tobacco has not been banned during the second wave of COVID-19 in South Africa, it remains clear that there has never been a more urgent time to stop using tobacco products.
When it comes to COVID-19, smoking and vaping add greatly to the risks, says Dr. Sharon Nyatsanza of the National Council Against Smoking (NCAS).
Together with wearing masks, washing hands, and social distancing, key measures for ending the COVID-19 pandemic should include stopping tobacco use, says NCAS and other health organisations forming the #protectournext initiative.
Nyatsanza explains that tobacco products weaken the immune system, making it harder for the body to fight off infection. “Since COVID-19 attacks the respiratory system, patients who already suffer from smoking-related lung damage or inflammation are more at risk of severe forms of the disease. There is clear evidence that smoking is associated with more than double the risk of intensive care unit admission and death in people with COVID-19 admitted to hospital.”
Nyatsanza further cites a new study published in Thorax, which shows smokers have a higher COVID-19 symptom burden. “Smokers are 29% more likely to report 5 or more symptoms and 50% more likely to report 10 or more symptoms. We must ensure that COVID-19 does not find our respiratory and cardiovascular systems compromised by tobacco or vaping.”
Dr Catherine Egbe of the South African Medical Research Council agrees, saying, “The links between smoking, respiratory and cardiovascular diseases are well established and conclusive, so it’s no surprise that smoking increases the risk of disease progression of COVID-19. E-cigarettes are also dangerous, as emerging evidence shows that exposure to the aerosols produced by these products harms lung cells, damages lung tissue and increases inflammation, diminishing the ability of the lungs to respond to infections like COVID-19. There is also concern that vapour may contain virus particles, putting people close to those using e-cigarettes at risk.”
Professor Pamela Naidoo of the Heart and Stroke Foundation South Africa highlights that smoking is a high-risk factor for diseases such as COPD, diabetes, cardiovascular diseases and cancers; all of which have been cited as underlying conditions associated with higher vulnerability to COVID-19. “Why add smoking or vaping to all the existing risk factors for COVID-19, such as obesity, diabetes and cardio-metabolic diseases? It simply increases your susceptibility to becoming infected with the virus.”
Behaviour risks The physical act of smoking itself increases the possibility of hand-to-mouth virus transmission and the social behaviour of using waterpipes or hookahs can increase the risk of spreading the virus.
Social distancing and lockdown regulations also mean many smokers are spending more time at home, with more risk of second-hand smoke exposure for their families. Dr Melissa Wallace, Head of Research at CANSA, says, “When we smoke, those around us breathe second-hand smoke containing the same harmful and disease-causing chemicals that weaken the immune system. While it can be daunting, there is great value for you and your family in quitting smoking right now, and the benefits in terms of your physical and mental health can be felt in a short space of time.”
Government obligations to reduce tobacco harm
While the government has not imposed further cigarette sale bans at this stage, Nyatsanza says government needs to do more to make smokers aware that they may be at increased risk for COVID-19. The new Control of Tobacco and Electronic Delivery Systems Bill, which brings South Africa in line with its WHO FCTC commitments, should be passed with urgency.
Nyatsanza says South Africa should also focus on implementing the six policy measures of the WHO’s MPOWER package to reduce tobacco use, including offering smokers help to quit tobacco, warning about the danger of tobacco and enforcing bans on tobacco advertising, promotion, and sponsorship.
“More government support should be given to providing resources for smokers who need to quit, including smoking cessation hotlines and supportive counselling services in line with the WHO #committoquit initiative. We must further protect public health from tobacco industry pressure and interference at the vulnerable time. In the time of COVID-19, health must win over profit.”
THE EVIDENCE: While research continues to emerge, several strong studies have provided clear evidence that smokers are more severely impacted by COVID-19.
March 2020 Analysis based on data from China provided initial evidence of the link between smoking and heightened vulnerability to COVID-19. A review from Tobacco Induced Diseases shows smokers are approximately 2.4 times more likely to be admitted to an ICU, need mechanical ventilation or die compared to non-smokers.
Stan Glantz and Roengrude Patanavanich conducted a meta-analysis of 12 published papers to determine the association between smoking and COVID-19 progression, showing smokers have 2.25 times the odds of severe COVID-19 outcomes than never smokers.
Research published in The European Respiratory Journal suggests that smokers have elevated ACE2 receptors – the cell receptors that the coronavirus uses to invade the body – in their airways. People with more ACE2 receptors seem to have a higher risk of severe COVID-19 infections.
A study in the Journal of Adolescent Health showed that smoking was by far the most prevalent risk factor for people in their late teens and 20s.
A study by UCLA researchers shows that direct cigarette smoke exposure increases the number of SARS-CoV-2 infected cells, by destroying the body’s first line of defence in the airways. The reduction in the interferon response by smoking is one mechanism whereby SARS-CoV-2 may more easily enter and replicate in epithelial cells.
A study of over 2.4 million people published in Thorax shows smokers have a higher COVID-19 symptom burden, with smokers 29% more likely to report 5 or more symptoms and 50% more likely to report 10 or more symptoms.
Call the National Council Against Smoking – Quitline at 011 720 3145 for tips to help you stop smoking. www.againstsmoking.co.za
CANSA runs an online programme which also provides support and information for smokers who would like to stop smoking on http://www.ekickbutt.org.za/.
The Heart and Stroke Foundation South Africa has professional staff that can provide educational support during the challenging time you may face during trying to quit tobacco smoking. During the period of the lockdown, you may call 084 2507374 for assistance.
Available for interview:
Dr. Yusuf Saloojee, acting Executive Director, National Council Against Smoking (NCAS)
Dr. Sharon Nyatsanza, Project &Communications Manager, NCAS
Dr Catherine Egbe, Specialist Scientist: Alcohol, Tobacco and other Drug Research Unit, South African Medical Research Council
Professor Pamela Naidoo, CEO, The Heart and Stroke Foundation of South Africa
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