Smoking and COVID-19. What is the evidence?
Smoking is one of the major causes of respiratory disease and is a well-known risk factor for respiratory infections such as tuberculosis, influenza, and pneumonia. Tobacco smoking, waterpipe smoking, and electronic vaping can increase the risk of lung failure, respiratory distress, and decrease in lung functions.
Discussions on the relationship between COVID-19 and smoking have emerged with the pandemic, including claims that nicotine might protect against COVID-19. These claims have been refuted by the World Health Organization (WHO), however. It confirmed that the link between tobacco use and the disease needs further documentation and research, and those who smoke are likely to be more vulnerable to COVID-19 infection.
A WHO media release stated, "Smokers may also already have lung disease or reduced lung capacity, which would greatly increase the risk of serious illness. Conditions that increase oxygen needs or reduce the ability of the body to use it properly will put patients at higher risk of serious lung conditions such as pneumonia."
Furthermore, WHO has warned smokers about issues such as the action of bringing hands to mouth facilitating the transfer of the virus into the body, the sharing of tobacco products transmitting the virus between people, and tobacco weakening the respiratory system making a smoker more vulnerable to the virus.
Current research suggests a possible association between smoking and the increase in severity of COVID-19 symptoms. Additionally, studies and data have shown that heavy smokers who suffer from chronic diseases such as diabetes might be at risk of sudden stroke if they contract COVID-19 (Qureshi et al. 2020). Smoking cigarettes can lead to respiratory illnesses, such as COVID-19, among vulnerable populations. It can cause inflammation and cell damage throughout the body and can weaken a person's immune system, making it less able to fight off disease.
Further warnings from WHO related to smoking include the types of tobacco used and the dangerous effects of the way it is smoked. For example, as waterpipe smoking is typically an activity that takes place within groups in public settings, this increases the risk of transmission of diseases and could encourage the transmission of COVID-19 in social gatherings.
Unfortunately, there are many misconceptions among users of waterpipes and Medwakh/dokha that these modes of tobacco consumption are less harmful than cigarettes (Aden et al., 2011). Recent studies have shown that dokha poses potential harm due to its chemical composition and its release of toxic metals and compounds (Elsayed et al., 2018).
E-cigarettes and vaping expose the lungs to toxic chemicals but, so far, there is no proven link that these increase the risk of COVID-19 or the severity of COVID-19. However, e-cigarette use has been proven to increase the risk of respiratory infections, including pneumonia (FDA).
There has never been a better time to quit smoking. If you need resources to help you stop, contact Abu Dhabi Public Health Centre, Ministry of Health and Prevention, or Dubai Health Authority. There are also many online information sources and services that can help you to stop smoking as detailed below.
- Adnan I Qureshi, Foad Abd-Allah, Fahmi Alsenani, Emrah Aytac, Afshin Borhani-Haghighi, Alfonso Ciccone, Camilo R Gomez, Erdem Gurkas, Chung Y Hsu, Vishal Jani, Liqun Jiao, Adam Kobayashi, Jun Lee, Jahanzeb Liaqat, Mikael Mazighi, Rajsrinivas Parthasarathy, Thorsten Steiner, M Fareed K Suri, Kazunori Toyoda, Marc Ribo, Fernando Gongora-Rivera, Jamary Oliveira-Filho, Guven Uzun, Yongjun Wang. Management of acute ischemic stroke in patients with COVID-19 infection: Report of an international panel. International Journal of Stroke, 2020; 174749302092323 DOI: 10.1177/1747493020923234
- Aden B, Karrar S, Shafey O, Al Hosni F. Cigarette, Water-pipe, and Medwakh Smoking Prevalence Among Applicants to Abu Dhabi's Pre-marital Screening Program 2011, Int J Prev Med. 2013;4(11):1290‐1295.
- Elsayed Y, Dalibalta S, El Kouche M. Chemical characterization and safety assessment of dokha: An emerging alternative tobacco product, Science of The Total environment, 2018; 615, 9-14. https://doi.org/10.1016/j.scitotenv.2017.09.25
Assistant Professor in Public Health
College of Health Sciences