Smoking cessation in Sri Lanka: A silver lining in COVID-19 crisis?

As the deadly COVID-19 pandemic threatens the entire world, claiming thousands of lives and disrupting economic activities, it would be wise to look at the role smoking cessation could play in the response. 

According to the World Health Organization (WHO) and the Government Medical Officers’ Association (GMOA), smokers are at a higher risk during this outbreak,and there is growing evidence that confirms COVID-19 and smoking is a noxious combination. 

Therefore, giving up smoking can offer protection from coronavirus in the short term, as the benefits of quitting smokingbegin just one hour later. Given that over a quarter(28.4 percent) of Sri Lankan men (15 years and older) smoke,one important intervention that can be taken right now, is utilizing this moment of panic as motivation to stop smoking. Unprecedented attention being paid to respiratory health at the moment will certainly help in this regard. 

Thisblog discusses the role ofsmoking cessation in reducing the chances of falling victim to the pandemic,which will not only assist in protecting public health, but will also make the population less susceptible to COVID-19 and its future recurrences, both now and in the longer term. 

Smoking epidemic and COVID-19 pandemic: Now is the perfect time to quit
According to the WHO, the link between smoking and COVID-19 is well-established; the habit harms the body, especially the cardiovascular and respiratory system. 

Research confirms that smokers are 1.4 times more likely to suffer the severe symptoms of COVID-19 and approximately 2.4 times more likely to be admitted to an ICU, need mechanical ventilation, 
or die, compared to non-smokers.

Given that lung function improves in as little as one month after quitting smoking, and after nine months’ time, lung function doubles and the risk of serious infection reduces substantially, giving up smoking now can help fight COVID-19 or the upcoming waves of it.

According to the WHO Sri Lanka, over half (51.8 percent) of the current smokers have attempted to quit smoking, while 34.4 percent  of former daily smokers have already quit smoking. AsIPS research shows, cessation support has an important role to play in reducing smoking prevalence, especially when it is combined with other policy interventions. As Sri Lanka continues itsstrict social distancing measures, closing all supermarkets, private pharmacies, and groceries, and imposing curfews to control the spread of COVID-19, the daily routines of smokers are disrupted already.A majority are off work and confined to their homes, reducing the opportunities to smoke and to buy tobacco. 

In addition, with many requests made by professional bodies to ban the sale of cigarettes in view of the pandemic, smokers will be motivated to give up, as the threat to their lives is closer to home now than ever before.

Therefore, the current situation in Sri Lanka can drive smokers to quit if they are approached through proper cessation channels. That said, it is possible that the intensity of smoking may increase, owing to social isolation (provided they have enough cigarettes for consumption); IPS research suggests that loneliness could lead to continuation in smoking. The good news is that these can be controlled through proper cessation channels. 

Furthermore, as this pandemic is already disrupting the economy, smoking will become relatively more expensive to people, especially for those who rely on daily wages, as they do not have much of an income right now to purchase cigarettes. This will be an additional incentive for them to quit. Thus, it is important to use this opportunity wisely, to help people to finally kick the habit, through properly targeted cessation channels. 

Cessation programmes in SL and the country’s readiness
IPS research shows that Sri Lanka’s current efforts in tobacco cessation focus on changing the behaviour of people, by conducting diversified programmes that target different groups. These programmes include educative sessions, trainings, one to one counselling, a national quit line, and awareness campaigns via electronic and print media. 

According to the Strategy for Tobacco Cessation in Sri Lanka 2020-2025, the two complementary approaches used are community tobacco cessation and clinical cessation. While community cessation programmes such as ‘tobacco-free villages’ are identified as more cost-effective, as they help a large number of people at once,to quit smoking within a short period of time, persons with the addiction are required to get support under 
clinical settings. 

However, given that the current situation in the country encourages self-isolation and social distancing, there are many challenges in delivering cessation support, and as such, prevailing cessation programmes in the country are likely to struggle to help smokers to quit in the immediate future. 

Quick, cost-effective cessation support during pandemic
International evidence suggests that, during an outbreak, the most successful way of controlling smoking is through online cessation channels, such as mass-media anti-smoking campaigns and free smoke-free mobile apps that assist smokers with personal quit plans. 

Therefore, it is suggested that more online support is introduced in Sri Lanka, in addition to raising awareness and increasing the capacity of the national quit line already in use.

For instance, mobile apps can be used to encourage people to quit smoking through a quit plan or a schedule that can be used during their stay at homes, whiletelephone calls and text messages can be used to deliver programmes remotely to help the smokers stick to the plan.This support can be introduced quickly and at a relatively low cost.

Support should be coupled with an awareness campaign, including using social media to inform people on how smoking could trigger the symptoms of the outbreak, and traditional media channels can be used to inform the people about the deadly combination of smoking and COVID-19 as a social message.

While the government has included smoking cessation advice in thehealth messages on tackling the spread of COVID-19, it is important that those messages are extended tothe general public through all radio channels, television programmes, social media, and text messages.

Way forward: A start to a stop!
As highlighted earlier, smoking is strongly associated with greater risk of hospitalization and deaths from COVID-19. Thus, smokers should seriously consider quitting now. This will improve their immunity, lung function, respiratory systems, and reduce their risk of serious symptoms that could later lead to death. 

As Sri Lanka strives to overcome the deadly COVID-19 through its health and safety measures,using timely cessation channels such as social media, online support, mobile apps, radios, text messages, and telephone calls are very important and come in handy at a time like this, when people are advised to be inself-isolation andpractice social-distancing. 

Reducing smoking rates through proper cessation support can help to make the population more resilient to the pandemic, and as such, should be key in the public health response.

Finally, if Sri Lanka can make this crisis an opportunity to incentivize smokers to successfully quit, it will be a great win, not only in terms of curbing the risk of the pandemic but also, in avoiding the burdens that future waves could bring into the public health system and more generally, in terms of reducing all the other negative health impacts of smoking in the longer term. Therefore, this is a window of opportunity to reduce tobacco prevalence for good. 
 (Chathurga Karunanayake is a Research Assistant at the Institute of Policy Studies of Sri Lanka (IPS). To talk to the authors, email [email protected])