Smokers not more susceptible to COVID-19 infection: Researchers

Giving smokers alternative nicotine delivery means they might prefer these products over cigarettes, and produce better outcomes, says Polosa

It's not news that smoking is bad for human health and the leading risk factor for many heart problems and cancers. It also reduces immunity, and makes people more likely to respiratory infections.
But researchers have found recently that smokers might not be more susceptible to infection or illness caused by the novel coronavirus (COVID-19). However, according to Riccardo Polosa, Professor of Internal Medicine at Italy's University of Catania and a world-renowned researcher into tobacco harm reduction, there is still an area of active research and the jury remains out on the claims.
Polosa sat down with Daily News Egypt to talk further on this critical issue.
Do you think that smokers are most vulnerable to COVID-19?
As with any viral infection, the symptoms and severity of symptoms generally depend on two key factors: the viral load and the immuno-competence of the host. For SARS-CoV-2, about 80% of the infected population seems to deal adequately with the viral infection developing only asymptomatic forms or slight symptomatic disease.
However, there are 20% of individuals that will go on to develop a severely symptomatic form of the disease, either because they have been exposed to a highly elevated viral load, as in hospital staff, or due to depressed immunologic defences, as in elderly people with comorbidities.
Smokers do not seem to be more susceptible to infection or disease caused by the coronavirus, and, quite surprisingly, the scientific evidence suggests the opposite, that smoking may be protective against COVID-19. This is still an area of active research and the Jury is still out.
Are smokers likely to have more severe symptoms? Are those using vaping products or e–cigarette less likely to be affected?
Smokers are less likely to get infected with SARS-CoV-2, or to end up in hospital with the coronavirus. No data is available for e-cigarette users, but, given that e-cigarettes are much less toxic than tobacco cigarettes, a consequential educated guess is that vaping is highly unlikely to be a risk factor for infection and/or disease.
Do smokers pass infection faster than non-smokers?
Besides the notion that smokers are less susceptible to SARS-CoV-2 infection, currently there is no data to argue about the propagation speed of the virus.
In your opinion, what are the alternatives to smoking cigarettes?
The first alternative to smoking is to not smoke! But stopping smoking is not easy, and many smokers like cigarettes. For smokers who cannot or do not want to quit, there is an alternative, which is switching to much less harmful, combustion-free products such as e-cigarettes or heated tobacco products. Toxicological data of combustion-free nicotine delivery products are on average 90% to 95% less harmful than combustion cigarettes. Moreover, rapid innovation in vaping product design is likely to further reduce their residual toxicological risk. Promoting wider access to much less harmful combustion-free nicotine delivery products, such as tobacco cigarettes substitutes, may contribute to accelerating the decline of the prevalence of smoking.
Is it correct that vaping is less harmful than cigarettes?
There is nothing to be suspicious about! Vaping products are less harmful than tobacco cigarettes. Public Health England recognises the reduced harm caused by e-cigarettes as an alternative to combustible cigarettes, with e-cigarettes being up to 95% less harmful. E-cigarette in England can be sold inside hospitals, and family doctors can advise their patients to quit smoking by switching to e-cigarettes.
Do you think that smoking rates will decline due to harder circumstances worldwide?
A recent survey of 1,825 participants by the Center of Excellence for the Acceleration of Harm Reduction (CoEHAR) in Catania, showed a slight decrease in cigarette consumption during the COVID-19 lockdown. But, on the other hand, the same respondents stated that they stockpiled cigarettes and e-liquids, a behaviour similar to that of citizens who stocked up foodstuffs during the lockdown. In spite of the media campaign promoting smoking abstinence, there has been no sign of a decline in smoking rates during COVID-19.
Do you think that that e-cigarette helps smokers to quit?
Yes. Population surveys, randomised controlled trials and observational studies have shown that e-cigarettes can be used to help smokers quit. Efficacy is variable depending on the specific product-user interaction.
What bad habits smokers should quit?
Smokers must stop smoking. If they cannot, they should at least try switching to combustion-free nicotine delivery products. By quitting or switching, they will massively reduce the chances of exposing themselves and bystanders to toxic substances in tobacco smoke.
Rampant rumours suggest a link between COVID-19 and smoking. Do you think smoking companies have to create less harmful products?
Tobacco cigarettes can kill, so there is no doubt that most efforts should be spent in developing innovative cigarette substitutes that provide the best smoking-like experience but without the harm of the toxic substances of tobacco smoke. These products may not be risk free, but their impact on human health is likely to be substantially less damaging than conventional cigarettes, regardless of any potential effect of smoking on COVID-19.
Based on your studies and expertise, are vaping and e-cigarette less harmful than cigarettes, do they have the same long-term effects?
This is an important question. No data is available for the long term health effects of e-cigarettes, but, given that e-cigarettes are much less toxic than tobacco cigarettes, a consequential educated guess is that vaping is highly unlikely to be a risk factor for significant health effects compared to continuing smoking. New studies are being performed on exclusive vapers who have never smoked in their life. Data will not be available for many years. Therefore, the jury is still out on long-term health effects of e-cigarettes.
There have been demonstrations against e-cigarettes which have caused deaths. Can you estimate the percentage of deaths by e-cigarette compared to cigarette smoking?
Let's be clear, e-cigarettes do not kill people. Sadly, the media misrepresented the outbreak of acute severe cases of lung injury and deaths in the US in the fall of 2019. For several months, commercial vaping products were blamed for the illnesses and deaths in numerous newspapers, TV, and radio stories.
Although the data was available on the US CDC website, the media failed to report that 82% of cases (of which 66% male) were among users of illegal THC cartridges, not including underage patients who may not have admitted to their illegal activities. The US Food and Drug Administration (FDA) shut down 44 illegal THR online vape sites with Operation Vapor Lock and subsequently the number of new cases plummeted.
With new cases down to near zero and having identified Vitamin E acetate, a thickening agent in illegal/black market THC liquids consumed with vapourisers, as the culprit of the outbreak, the CDC stopped reporting on this respiratory condition on 25 February 2020.
The media gave little attention to these important developments and to the fact that the outbreak was confined to the US black market supply chain, with no cases of lung illness being reported among users in the European Union or elsewhere in the world. Moreover, no appreciable effort was spent by the media in rectifying the misinformation.
What do you recommend for smokers?
My advice to tobacco smokers is to try to quit, it is never too late to quit smoking! If you cannot or do not wish to give up your cigarettes, please consider trying substitute combustion-free products. Giving smokers an alternative with efficient nicotine delivery means that they might prefer one of these products over cigarettes and in the end this will produce better outcomes.