Professor Dr. Arup Ratan Choudhury :
Smoking is one of the leading causes of death in the world, killing more than eight million people a year, according to the World Health Organization (WHO). Tobacco has emerged as one of the major risk factors responsible for most deaths and diseases in Bangladesh. All forms of tobacco consumption kills about 161,253 people on average every year, accounting for 19 per cent of all deaths in Bangladesh, according to the World Health Organization (WHO). According to Global Adult Tobacco Survey (GATS) data, an initiative of WHO, over 20 per cent of the country’s population currently use smokeless tobacco, while 18 per cent are simply addicted to smoking.
In Bangladesh, tobacco use significantly decreased among adults from 43.3 per cent in 2009 to 35.3 per cent in 2017. Among them, the decline was 58 per cent to 46 per cent among males and 28.7 per cent to 25.2 per cent among females, according to the GATS. According to WHO: Tobacco responsible for 1 in 5 deaths in Bangladesh and ‘Tobacco major cause of deaths in Bangladesh’.
Now, it is thought that smoking may also make people more vulnerable to developing serious complications if they catch coronavirus. There is evidence to suggest that smoking increases the severity of the virus if you catch it. The largest study looking at 1,099 patients in China, found that smokers were 1.4 times as likely to have severe symptoms and 2.4 times more likely to be admitted to an Intensive Care Unit (ICU), need ventilation or die compared with non-smokers who caught coronavirus. Smokers are considered at higher risk of developing complications such as respiratory difficulties and pneumonia if they catch coronavirus because their baseline respiratory health is likely to be poor.
We do know that smokers contract more respiratory illnesses, including the common cold which is also a coronavirus, than non-smokers. They also tend to have a higher rate of bacterial pneumonia and tuberculosis. Furthermore, smokers are twice as likely as non-smokers to contract influenza and have more severe symptoms. They are also at an increased risk of having an underlying respiratory condition such as chronic obstructive pulmonary disease (COPD), a type of lung disease which could be exacerbated by the virus.
Additionally, smoking is a risk factor for developing other non-respiratory-related issues like heart disease and cancer which are also associated with complications for those who catch coronavirus. Research shows that smoking compromises the immune system and increases susceptibility to infections.
All these conditions increase your need for oxygen or reduce your body’s ability to utilise the oxygen properly, putting patients at risk of developing serious lung complications like pneumonia when infected with Covid-19. There have been some concerns that smokers are more likely to contract the virus because of the action of putting your hand to your mouth or using unwashed, contaminated hands to roll cigarettes which can increase the transmission of the virus from hand to mouth. The health minister of United Kingdom mentioned : “It is abundantly clear from the research into previous coronaviruses that smoking makes the impact of a coronavirus worse.”During the Middle Eastern Respiratory Syndrome (MERS) outbreak in 2012, smokers were found to be more likely to die than non-smokers if they caught the virus.
Turkish anti-addiction group mentioned Smokers are 14 times more likely to contract coronavirus compared with those who do not. Professor Mucahit Ozturk, president of anti-addiction group Turkish Green Crescent, urged those who smoke to quit to protect themselves from the contagion. “Using tobacco and tobacco products increases the risk of catching the coronavirus; therefore, avoiding all addictive substances plays an important role in protecting ourselves against the virus.
However, the evidence has been less clear when it comes to the relationship between smoking and Covid-19, the disease caused by the novel coronavirus, specifically.
A further small study of 78 people with Covid-19 also found a statistically significant higher proportion of smokers in the group whose condition adversely progressed compared with the group that showed improvement or stabilization. Smoking is associated with increased development of acute respiratory distress syndrome (ARDS) in people with a risk factor like severe infection, non-pulmonary sepsis (blood infection), or blunt trauma. Public health experts already have warned smoking remains a risk factor for the virus taking a more serious turn. When someone’s lungs are exposed to flu or other infections the adverse effects of smoking or vaping are much more serious than among people who do not smoke or vape. The director of the UK Centre for Tobacco & Alcohol Studies, already mentioned smokers who contract coronavirus are more likely to end up in intensive care than non-smokers with the virus. The recent evidence on the pulmonary effects of e-cigarettes reported multiple ways that e-cigarettes impair lungs’ ability to fight off infections:
Some smoking products such as water pipes can involve sharing mouth pieces and hoses, which could also facilitate the transmission of Covid-19.
A study of 30 healthy non-smokers exposed to e-cigarette aerosol found decreased cough sensitivity. If human ciliary dysfunction is also negatively affected, as suggested by animal and cellular studies, the combination of reduced coughing and impaired mucociliary clearance may predispose users to increased rates of pneumonia. Exposure to e-cigarettes may also broadly suppress important capacities of the innate immune system. Healthy non-smokers were exposed to e-cigarette aerosol, and bronchoalveolar lavage was obtained to study alveolar macrophages.
We are aware that smoking can increase the number of ACE2 receptors, so smoking may give the virus more receptors to use to invade cells and duplicate itself. It is therefore thought that this may be a cause of smokers’ poor outcomes with covid-19. Cigarette smoke suppresses the function of immune cells but also causes activation and recruitment of inflammatory cells into the lungs, which leads to the release of other chemicals, further changing the function of immune cells adversely. This may explain why smokers may be more susceptible to developing the serious consequences of Covid-19.
People who smoke are generally at higher risk of respiratory tract infections, like lung and chest infections, and there is growing evidence that people who smoke may be at higher risk of Covid-19 and its complications. People with poor lung health and other conditions like cardiovascular disease and cancer (which can be caused by smoking) may also be at higher risk of complications if they do become infected with the virus.
It seems most likely that the increase in severity of Covid-19 symptoms in smokers is a result of a combination of factors, including smoking-induced health conditions, poor baseline respiratory health, the ACE2 receptor hypothesis, comorbidities (concurrent conditions) and a suppressed immune system.
GOOD NEWS FOR SMOKERS-
The damage done to your respiratory system’s ability to fight infections starts recovering immediately after you stop smoking. You are no longer bathing your lungs in toxic chemicals, so you are better off. The cilia (liitle hairs that move foriegn particles out of your lungs so you can cough them out) are recovering. Smokers have a higher risk of getting coronavirus because they are constantly putting their hands to their lips. And then, if they get coronavirus, they run a greater risk of getting a severe case because their lung function is impaired.
Quick tips to curb your cravings:
1. Delay: Delay as long as you can before giving in to your urge.
2. Deep breathing: Take 10 deep breaths to relax yourself from within until the urge passes.
3. Drink water: Drinking water is a healthy alternative to sticking a cigarette in your mouth.
4. Do something else to distract yourself: Take a shower, read, go for a walk, listen to music!
5. For people who smoke, stop smoking medications like nicotine replacement therapy (NRT) can help to reduce cravings and manage withdrawal symptoms.
Studies shows that smokers lose at least one decade of life expectancy compared with people who have never smoked. But if you’re a smoker and think it’s too late to save your health, reconsider. The study also found that people who quit smoking by age 40 reduce their risk of smoking-related death by an astounding 90 per cent.
Smoking damages lungs and other parts of your body, and it makes more vulnerable to Covid-19 infection. It is the right time to quit smoking for a safer and better health.
(Professor Dr. Arup Ratan Choudhury BDS, PhD, FDSRCS (England), Recipient of EKUSHE PODOK, Honorary Senior Consultant Department of Dentistry, BIRDEM; Founder President, MANAS, Member-National Drug Control Advisory Board & National Tobacco Control Task Force; email: [email protected])
