Covid-19 is changing our lives, maybe for ever, and remarkable efforts are being made to save people’s lives. Action on smoking and vaping cessation must become part of these efforts because, already, data clearly show the influence of smoking on the disease caused by Covid-19.
Smoking wreaks destruction on the lining of the lung and impairs respiratory function. Respiratory function disruption is a primary element of Covid-19’s attack mechanism in causing severe disease progression and death. If you are a smoker, you are at far greater risk of severe illness and death from coronavirus than are non-smokers or ex-smokers.
Published studies from Wuhan in China show that smokers with Covid-19 respiratory disease have a poorer prognosis than non-smokers; have a higher prevalence of more severe disease; a higher prevalence of disease progression; a higher need for intensive care unit (ICU) usage; a higher need for ventilation; and are more likely to die.
And the differences are not trivial.
We know smoking and vaping are associated with an inflammatory process in the lining of the lungs, the very place that Covid-19 causes its most serious damage
In one study of 1,099 Covid-19 patients admitted to hospital in Wuhan, 31.7 per cent of patients who were smokers had severe disease compared with 14.5 per cent who were never smokers, having nearly twice the risk ratio. Smokers had nearly four times the progression to a worse state (16.2 per cent versus 4.7 per cent): these worse states were admission to ICU; use of mechanical ventilation; or death. There are also other similar published scientific studies, with fewer numbers, but similar findings.
In the US, the question of vaping as a cause of the high prevalence of illness in young adults has been raised but full data to confirm this is not available yet. It would not be surprising, as we know smoking and vaping are associated with an inflammatory process in the lining of the lungs, the very place that Covid-19 causes its most serious disruption and damage.
The 16th anniversary of Smokefree Ireland was on March 29th. A time of life-changing significance for smokers and those exposed to second-hand smoke, a landmark for international tobacco control. Ireland was the first country in the world to introduce a national ban on smoking in the workplace, in pubs, clubs, restaurants and bingo halls.
It was comprehensive, making no allowances for weather, size of establishment, or expensive artificial ventilation, and it worked.
We know it worked because our pubs became clear of smoke, the health of bar workers improved, and fewer people died of cardiovascular diseases, respiratory diseases, and stroke.
Smoking became denormalised and the prevalence of smoking fell. The fall has been most marked in our young people. Smoking fell from 33 per cent in 2003 to 14 per cent in 2019 in 16-year-old students. Smoking is at an all-time low among adults also, at some 17 per cent.
The success of the Irish smokefree legislation as a policy initiative did not happen by accident. It was a success because of timing, dedication, planning, implementation, and the existence of strong leadership and a powerful, convinced, credible political champion.
When we analysed what had happened, we found that a well co-ordinated and broad-based advocacy coalition with a unified voice and a clear focus on health is of paramount importance in promoting public awareness of the issues, countering opposition arguments and ensuring political support for the cause.
In Covid-19 we are lucky to have a clear, authoritative, consistent, united voice from the Department of Health, the HSE, and impressive, able politicians working in harmony.
Unlike Smokefree Ireland, there is no significant opposition to what is being done. We have an enforceable and implementable approach to protecting all our people equally from the effects of the virus.
Nevertheless, there is one big difference – timing, the need to respond so quickly. While planning for this type of emergency is part of health planning, this pandemic developed very rapidly and the structure of the challenge did not become clear immediately.
China bought us some time and rapidly identified and shared the genetic structure of the virus but there was still so very much to be done. As in 2004, in 2020 we need to engage with the “street level bureaucrats”, namely industry representatives and workers, to ensure ground-level support for the interventions we know can work if implemented but, as we found with smokefree, implementation plans must be followed meticulously, compliance must be monitored on a consistent and continuous basis, and the law supported by substantial penalties if necessary, aimed at the few who are reckless.
Smokers should know and be reminded that they will also help others by reducing demand for scarce resources
What can stopping smoking contribute? The message is clear. Smoking is an avoidable risk factor for a poorer prognosis in Covid-19 infection, including death. Stopping smoking is an intervention that can help. Access to personal protective equipment (PPE), ICU capacity, and mechanical ventilation are the ultimate scarce resources, and interventions which can make a difference when the small percentage of very severe cases arrive in hospital. There is very little we know that can be changed which can reduce demand for ICU beds except stopping smoking.
Now is an ideal time to make a national effort at smoking cessation and treatment of nicotine dependence. Many smokers, like everyone else, are off work, are willing and, if informed, anxious to stop smoking. They are also more likely to do it knowing it will help save their lives, not just in the long term but now. They should know and be reminded that they will also help others by reducing demand for scarce resources.
We must strongly encourage smoking cessation and vaping cessation and provide a national treatment plan, free of charge, for all smokers and vapers and do it now. It is the best time ever to take Irish Government policy on the tobacco endgame seriously and go for it.
Consultant respiratory physician Prof Luke Clancy is director general of TobaccoFree Research Institute Ireland