Highlights
- The claim about smoking’s protective action against COVID-19 has been proven to be a myth propagated by pro-tobacco lobby.
- A Nature article pointed out a serious misinterpretation of data in the oft-cited study published in July 2020 which made the unverified claim that smoking protects COVID patients.
- In April 2021, 9 months after publication, the study was retracted after it emerged that authors had financial links to the tobacco industry.
- Smoking and vaping contribute to chronic diseases, including heart disease, type 2 diabetes, emphysema and chronic obstructive pulmonary disease, which lead to worse COVID-19 outcomes and represent significant public health challenges even in the absence of the COVID-19 pandemic.
- The pandemic presents an opportunity to discourage smoking and vaping, say experts.
Abu Dhabi: In the early stages of the pandemic, speculation emerged that tobacco smoking might prevent COVID-19 infection. It was an unproven claim efficiently weaponised to promote the tobacco industry based on pseudo science.
Following the study’s publication in July 2020, a massive Twitter discourse emerged on nicotine as potential prophylactic or therapeutic for the coronavirus. There was no rigorous clinical trial to back such a big claim. Instead, it was based on a cross-sectional study, the weakest form of "observational studies". Still, the claim went viral.
Then, nine months later, came the bombshell: the journal retracted the paper after the researchers were discredited as their financial link to the tobacco industry was revealed.
This episode unmask how the social media landscape is a double-edge sword, as it greatly expands information reach but subjects consumers to confirmation bias, especially when exposed to inadvertent (or deliberate) framing of scientific discourse that pivots toward misinformation.
Solid science on ill effects of smoking
The science on the ill health effects of smoking stands on solid ground. For example, the European Association of Urology stated that “tobacco smoking is the most important risk factor for bladder cancer and upper urinary tract cancer.”
The Abu Dhabi Public Health Centre (ADPHC) had also issued warnings against the hazards of smoking.
“Smokers are more vulnerable to COVID-19 as their fingers, and possibly contaminated cigarettes, are often in contact with their lips, thereby increasing the possibility of transmission of virus from hand to mouth,” the centre stated.
Smokers are more vulnerable to COVID-19 as their fingers, and possibly contaminated cigarettes, are often in contact with their lips, thereby increasing the possibility of transmission of virus from hand to mouth.
The Ministry of Health and Prevention (MoHAP) issued a similar warning in July 2020, adding that sharing smoking tools with others also contributes to the spread of COVID-19.
Smoking impairs lung function
“Smoking increases the risk of severe COVID-19. This is possibly because smoke and the other substances mixed with tobacco impair the respiratory tract's defence systems, leading to reduced immune function and susceptibility to infection,” said Dr Saheer Sainalabdeen, specialist in respiratory medicine at Medeor Hospital, Dubai.
“Moreover, each individual has a specific lung function based on age, sex, height, and ethnicity, and any infection reduces lung function. For a smoker with already compromised lung function, the further fall secondary to COVID-19 infection will create the need for oxygen support, and even and other ICU ventilatory support,” he added.
Smoking increases the risk of severe COVID-19. This is possibly because smoke and the other substances mixed with tobacco impair the respiratory tract's defence systems, leading to reduced immune function and susceptibility to infection.
Risks from mask removal
In addition, smokers remove the face mask when smoking, which further contributes to the spread of COVID-19. Dr Sainalabdeen said COVID-19 worsens underlying lung diseases like chronic obstructive pulmonary disease, making any COVID-19 infection more severe. “Smokers also live with heart diseases, which only worsen along with severe COVID-19 infection,” the doctor warned.
Increasing benefits of quitting
The benefits of quitting the injurious habit are known to be almost immediate, and build up over time for the smoker.
“If a habitual smoker quits, it has an immediate positive effect on the lungs. The person also has a better chance at recovering from any bout with COVID-19 than if he or she has been smoking at the time of contracting the infection,” said Dr Sandeep Pargi, pulmonology and respiratory medicine specialist at Aster Hospital, Mankhool.
If a habitual smoker quits, it has an immediate positive effect on the lungs. The person also has a better chance at recovering from any bout with COVID-19 than if he or she has been smoking at the time of contracting the infection.
All smoking harmful
The doctors also warned against all forms of smoking, including the smoking of traditional pipes like midwakh and of waterpipes or shisha. This aligned with warnings issued by the MoHAP, which said that “sharing smoking tools with others increases the possibility of transmitting the virus between people”.
Shisha smoking in a group also poses additional risks because people often smoke shisha in closed spaces in close proximity.
“The available literature says loose forms of tobacco, vaping and electronic cigarettes are equally or more harmful than cigarettes, as is shisha. They should all be avoided,” Dr Sainalabdeen urged.
Is the claim that smokers are protected against SARS-CoV-2 infection backed by science?
There’s no science. It’s a myth, an erroneous claim.
How did the myth that smokers are protected from COVID-19 and data misinterpretation emerge?
It emerged with the publication in the European Respiratory Journal in July 2020 of a paper that claimed current smokers are 23% less likely to be diagnosed with COVID-19 compared to non-smokers. It also claimed smokers were at a “significantly lower risk of acquiring the virus”. The research was vigorously shared on social as well as by several mainstream media outlets.
The paper came from “observational studies”, which reportedly found an “inverse relationship” between smoking and SARS-CoV-2 infection. It was not a properly-designed clinical trial following a randomised controlled trial (RCT). On April 22, 2021, the paper was retracted by a medical journal after it was discovered some of the paper’s authors had financial links to the tobacco industry.
The bottomline: it was a false, unscientific claim, with no rigours of clinical trial and statistical analyses. Smoking affects a person’s overall health and damages nearly every organ of the body, and causes more severe COVID-19 symptoms, increasing the risk of death.
In a Nature article published on February 26, 2021, Naomi A. van Westen-Lagerweij of the Netherlands Expertise Centre for Tobacco Control, and her fellow researchers, stated that the myth arose from "misinterpretation of data".
Specifically, they pointed out the “methodological flaws of various studies on which hasty conclusions were based”.
“The finding that smoking is not associated with SARS-CoV-2 infection contradicts earlier studies which found that smokers are more vulnerable to infections in general — and to respiratory infections in particular,” van Westen-Lagerweij wrote.
Does cigarette smoke transmit coronavirus?
While cigarette smoke hasn’t conclusively been proven to transmit the virus, experts warn that the need to lower the face mask when smoking could allow smokers who may be unknowingly infected to spread the virus.
Moreover, vapers who are smoking could be up to 20% more likely to transmit the virus by spreading it in clouds of smoke, according to researchers in Italy, Mexico and New Zealand.
Shisha or water pipe smokers, on the other hand, also face heightened risk of contracting COVID-19, especially when smoking in shisha parlours.
Who benefitted from this claim?
There are indications the tobacco industry benefitted from the social media — as well as traditional media — hype behind this claim.
Several countries, including China and France, saw an increase in tobacco consumption during the pandemic, said van Westen-Lagerweij, who is based in Utrecht’s Trimbos Institute. A spike in tobacco consumption among smokers has also been reported in other countries, possibly correlated to the smoking-protects-you-from-COVID hype.
The Nature article stated: “Interestingly, the lead author of this particular research has been funded by the tobacco industry in the past. Other researchers who have made similar claims can be linked with the tobacco industry.” This indicates a possible “conflict of interest”.
Who downplayed the role smoking plays in increased severity of COVID-19?
It’s a fact that supporters of the tobacco industry had been actively involved in downplaying the role of smoking in COVID-19 pandemic by spreading false claims, an industry watchdog stated.
In a report entitled “COVID-19 and Tobacco Industry Interference (2020)”, the Global Center for Good Governance in Tobacco Control stated the tobacco industry has “exploited the global health crisis to present themselves as benevolent partners in the fight against COVID-19, thus obscuring the economic and social costs of tobacco.”
The centre has called on the WHO Framework Convention on Tobacco Control (FCTC) to be implemented, “counter the tobacco industry’s tactics and save millions of lives.”
July 2020
A research paper was published by the European Respiratory Journal, which found “current smoking was not associated with adverse outcome” in patients admitted to hospital with COVID.
It also claimed smokers were at a significantly lower risk of acquiring the virus. The paper was reported on by several mainstream media outlets.
April 22, 2021
The European Respiratory Journal issues a retraction notice for the paper (published in July 2020).
The paper was retracted by a medical journal, after it was discovered some of the paper’s authors had financial links to the tobacco industry.
An analysis of the paper identified several biases “which may give the false impression that smoking is protective in Covid-19”, the journal editors wrote.
How does coronavirus affect smokers?
Smoking affects a person’s overall health and damages nearly every organ of the body. Since smoking tobacco affects and damages the lungs, it increases the risk of respiratory infections and makes it easier for the coronavirus disease (COVID-19) to invade the lung tissue, causing more severe symptoms and increasing the risk of death.
◉ The WHO has warned that because smoking impairs lung function, there is an increased risk of severe symptoms if respiratory infections, including coronaviruses, are acquired by smokers. Covid-19 is an infectious disease that primarily attacks the lungs.
◉ Several epidemiological studies have found a higher smoking prevalence among COVID-19 infected patients.
◉ Smoker patients with different comorbidities are at higher risk of contracting the COVID-19 virus and have a worse prognosis for the virus as well as for their comorbidities.
◉ There's a clear link between smoking and higher infection risk, and death. A 2004 study (published in the Archives of Internal Medicine) titled “Cigarette smoking and infection”, researchers Lidia Arcavi and Neal L. Benowitz established that smoking raises the risk of infection of both bacterial and viral diseases, such as the common cold, influenza and tuberculosis.
◉ As for coronavirus infection, a study published in Emerging Infectious Diseases in 2016 shows smoking as a “putative risk factor” for MERS coronavirus infection. Experts point to a growing body evidence that smokers have worse outcomes after contracting the virus than non-smokers.
