There is sufficient evidence that smoking worsens the outcome of Covid-19. From experts point of view, smokers and those who vape could have higher chances of contracting Covid-19, contributing to the spread of the virus and developing severe lung illness. The experts highlighted frequent hand-to-mouth movements from smoking  and vaping, as well as the impact of smoking on lung function and the immune system.

Several studies from China suggest smokers are at risk of severe covid-19 illness that may require admission to the intensive care unit and need mechanical ventilation or even higher odds of dying.

Why are smokers thought to be at greater risk? 
There are three considerations. 

First.
The act of smoking involves repetitive and frequent hand-to-mouth movements. Our hands are constantly in contact with easily contaminated high-touch surfaces like door handles and lift buttons. Our dirty hands may easily transfer the virus to our eyes, face or mouth with a higher risk of viral entry and infection. Frequent smoking may also make the wearing of a mask less practical and less effective.

A recent study from Hong Kong showed that people are most infectious one to two days prior to the developing symptoms when viral shedding is highest. Hence the rationale for the face masks even if one is asymptomatic. 

Secondly. 
Smoking is known to impair our lung function and immune system. The coronavirus seems to have a predilection for our respiratory system (airways and lungs) and chronic smokers may be more susceptible to a severe infection  due to ‘weaker’ lung from long term smoking damage and a depressed immune response. Many smokers develop emphysema or chronic obstructive pulmonary disease, which reduces their lung reserve and capacity to fight the virus.

Thirdly.
The coronavirus requires a living host (human) to replicate and cause harm. Smoking can cause a significant increased expression and upregulation of ACE-2 receptors in the smaller airways and lungs. The virus has more opportunity to invade the body and smokers have a higher odds of a severe covid-19 infection due to a higher viral load.

Smoking is a well-known risk factor for many respiratory infections. Smoking increases inflammation in the airways and lungs and also reduces the ability of the lungs to clear itself of these microorganisms. In an ideal world ,it is an opportunity to quit smoking.
 

Being away from social settings and work might actually provide the perfect opportunity to not be swayed by societal pressure to smoke. If one does decide to quit ,it should be planned ahead and done with the support of all at home. 

Willpower is important, but efforts to quit tend to be more successful when it is combined with medications and psychological support. 

As people are still anxious with the pandemic, we should urge the government to capitalise on this opportunity to educate the public on the dangers of smoking and the need to protect themselves and their loved ones. Screening and smoking cessation are complementary and should go hand-in-hand. 

This can be done in combinations with the various public service announcements on hand washing and social distancing. Work can also be done with the Ministry of Health (KKM) and the National Security Council (MKN) on utilising telcos in sending appropriate SMSs that can serve as both a reminder and warning for those who smoke. As always, all forms of warning must be coupled with information on the availability of quit-smoking services.

Article prepared by : Dr Siti Noor Azlidah Ali
Reference: Article by CodeBlue , https://codeblue.galencentre.org (22nd April 2020)

Date of Input: 20/01/2021 | Updated: 06/07/2023 | izzatussofia