Smoking in time of corona: Why limiting smoking important in battle against COVID-19

The COVID-19 pandemic has already claimed thousands of lives worldwide. As expected with any respiratory illness, there is clear evidence that smokers are much more vulnerable to COVID-19 than non-smokers. 

As such, Sri Lanka’s National Authority on Tobacco and Alcohol (NATA) has made a request from the government to temporarily ban the sale of cigarettes to help curtail the spread of COVID-19. In addition, the Government Medical Officers Association (GMOA) has also called for a temporary ban on smoking in Sri Lanka. Meanwhile, the country’s director general of Health Services has likened the sale of cigarettes to selling “death” and has requested shop owners to refrain from selling cigarettes. 

In this context, this article discusses how smokers can make the crisis worse and provides short-term policy recommendations that can help control the spread of the disease in Sri Lanka. In particular, the article makes a compelling case for imposing a temporary ban on cigarette sales in Sri Lanka. 

Smokers make COVID-19 pandemic worse
The World Health Organisation (WHO) has recommended stopping smoking as smokers are more vulnerable to the disease. Even though smokers have been identified as one of the high-risk groups, they have not received as much attention as the other high-risk groups (older people and those with 
pre-medical conditions).

Any kind of tobacco smoking is harmful to the body, especially the cardiovascular and respiratory systems. Data from China, where COVID-19 originated, shows that people who have cardiovascular and respiratory conditions caused by tobacco use (or otherwise) are at a higher risk of developing the severe COVID-19 symptoms. 

The WHO estimates that there are 1.1 billion current smokers across the world. This group, with weaker lungs and immunity, is more likely to fall victim to COIVD-19.

Furthermore, smokers are more likely to suffer the severe symptoms of COVID-19, as they are more likely to have other medical conditions that put them at a higher risk. In this regard, the link between COVID-19 and cardiovascular health is important to consider because tobacco use and exposure to second-hand smoke are major causes of cardiovascular diseases (CVDs) globally.  

Thus, COVID-19 can make pre-existing cardiovascular conditions worse. Prolonged use of tobacco is one of the factors that leads to the progression of COVID-19 pneumonia, according to a study from China. Moreover, COVID-19 patients who have a history of tobacco use are not only susceptible to severe symptoms but they also have a higher risk of death. 

Smoking is also detrimental to the immune system and its responsiveness to infections, making smokers more vulnerable to infectious diseases such as COVID-19. Additionally, the hand-to-mouth action of smoking also makes smokers more vulnerable to COVID-19, as they touch their face and mouth more often. 

Apart from the risk to themselves, smokers also impose a higher burden on the health systems during the pandemic. The current crisis has already placed a huge strain on health systems and services in every country. There is an urgent need for an intensive supply of health resources, both human and physical. 

Health systems are compelled to divert all their resources and capacities in one direction – to fight against the COVID-19 pandemic. Regular health services are limited in most countries and only essential health services are provided. In such a dreadful situation, smokers put additional pressure on hospitals and medical staff. On top of that, smokers put others’ lives in danger, as smokers who contract COVID-19 can spread it to others through second-hand smoke.

Policy options to curtail risk 
There are two main policy options to reduce and control the impact of smokers on the current crisis. The first is to reduce the supply by banning smoking products until the situation is contained. A smoking ban can be implemented fairly easily in the country now, due to the widespread restrictions on people’s movements and the ability to purchase goods. 

The public health case for banning smoking products is stronger than ever, given the smokers’ higher vulnerability to COVID-19 and their influence in making the pandemic more severe. 

Further, a temporary ban would allow the government to test reactions and impacts and to consider more permanent restrictions. It might also persuade people to give up smoking for good, provided that effective cessation support is given. 

The other option is helping smokers to quit. Quitting tobacco use has an almost immediate positive impact on lung and cardiovascular function and these improvements increase the ability of COVID-19 patients to respond to the infection and reduce the risk of death. 

Further, quitting makes smokers less likely to become infected because the absence of smoking reduces contact between fingers and mouth. In this context, the demand for smoking cessation support would increase and it is very important to make use of this excellent opportunity. 

Providing adequate cessation support as well as using effective cessation support channels suitable for an outbreak situation is important. Web-based smoking cessation programmes, which include  websites, computer programmes and other electronic aids (e.g. Smokefree.gov, QuitNet) and mobile phone applications (e.g. MyQuit Coach,  Cessation Nation, QuitNow!) are attractive platforms to help people quit during the current pandemic. 

(Sunimalee Madurawala is a Research Economist at the Institute of Policy Studies of Sri Lanka (IPS). To talk to the authors, email [email protected])