The curious case of smoking and COVID-19

While the science is still inconclusive, there are credible studies which suggest that smoking may not increase your likelihood of hospitalisation if you get COVID-19.

In fact, some studies found that smokers may be at lower risk than non-smokers.

However, there is also research which suggests that a history of smoking can have a negative effect on COVID-19 patients.

One preprint article looked at the hospitalisation statistics from several studies in China. It argued that far fewer smokers diagnosed with COVID-19 were being hospitalised than expected, given China’s demographics.

The study stated that on average, 26.6% of people in China are smokers. Smoking is also prevalent in men – 50.1% – compared to women – 2.1%.

Despite the fact that men accounted for more hospitalisations than women, the proportion of smokers among those who were hospitalised for COVID-19 was much lower than expected, according to the article’s authors.

While the article has been controversial, Vice reports that it has undergone peer review and will be published in the journal Internal and Emergency Medicine.

It is not the only study involving smoking to have obtained such controversial results.

Another article released in preprint which looked at patients in New York City found that smoking was not a significant factor in determining whether someone with COVID-19 would need hospitalisation.

Leora Horwitz, a co-author of the paper and director at the Center for Healthcare Innovation and Delivery Science at NYU Langone Health, said they do not understand the smoking results yet and are investigating them further.

Scientific debate

It should be noted that COVID-19 is a rapidly-developing area of scientific enquiry and there is still a lot of uncertainty and crucial debate as new research is published.

One preprint article found that smoking can double your risk of contracting a severe case of COVID-19 if you are infected by the coronavirus.

There have also been reports that French researchers are testing nicotine patches on COVID-19 patients and frontline workers, resulting in France banning the online sale of nicotine substitutes.

A draft order from the European Commission said that as a result of the media coverage around the potential beneficial effects of nicotine on COVID-19, regulations are needed to limit the dispensing of nicotine replacement treatments.

Health authorities around the world, including the Department of Health in South Africa and the World Health Organisation, continue to advise that smoking can make people more vulnerable to COVID-19.

“Smokers are likely to be more vulnerable to COVID-19 as the act of smoking means that fingers (and possibly contaminated cigarettes) are in contact with lips which increases the possibility of transmission of the virus from hand to mouth,” the World Health Organisation states.

“Smokers may also already have lung disease or reduced lung capacity which would greatly increase the risk of serious illness.”

Ban on sale of cigarettes in South Africa

Research which shows that smokers are not necessarily at greater risk of requiring hospitalisation for COVID-19 will be particularly contentious in South Africa, where the government has chosen to stand by its ban on the sale of cigarettes.

Anger flared among South Africans when the government appeared to reverse its decision to allow the sale of tobacco products under its level 4 lockdown regulations.

President Cyril Ramaphosa announced on 23 April 2020 that the sale of cigarettes would be permitted after South Africa moved from its “total lockdown” under alert level 5, to more relaxed regulations under alert level 4.

However, the National Command Council on COVID-19 reversed its decision by the time it announced the official regulations for level 4 on 29 April.

Minister in the Presidency Jackson Mthembu added the government would not back down on its ban on tobacco products.

Critics have said the government’s ban of tobacco sales will allow illicit trade to flourish – with reports suggesting that cigarettes can now sell for R80 a pack, or R780 per carton.

Legal action

In a bid to get the government to change its mind, South Africans started an online petition to lift the ban on cigarette sales.

It received over 500,000 signatures from people who feel their rights are being infringed without a valid reason.

British American Tobacco also stated that it would launch legal action against the government to have the ban overturned.

It backtracked on this, however.

“We have taken the decision not to pursue legal action at this stage but, instead, to pursue further discussions with the government on the formulation and application of the regulations under the COVID-19 lockdown,” the company said.

British American Tobacco also announced that it is entering consultations with employees regarding a voluntary retrenchment programme, as it needs to cut about 300 jobs in South Africa.

The company added that the huge trade in illegal cigarettes in South Africa over several years was forcing it to take corrective action.

Nearly half of all cigarettes sold in South Africa are illegal, costing the South African government more than R20 million in tax revenue every day, said the company.

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The curious case of smoking and COVID-19