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Three recent European studies are making bold claims and generating sensational media headlines—like “Smokers seem less likely than non-smokers to fall ill with covid-19.”
But does the science support these studies?
No, according to many health experts.
“The results of a small study with significant flaws are being blown out of proportion and people’s lives are potentially being put at risk as a result,” said Dr. Anna B. Gilmore, professor of public health at the University of Bath.
WHO even issued a statement on May 11, 2020. They urge researchers, scientists and the media to be cautious about “amplifying unproven claims that tobacco or nicotine could reduce the risk of COVID-19.”
“There is currently insufficient information to confirm any link between tobacco or nicotine in the prevention or treatment of COVID-19,” according to the WHO statement.
What Do the European Studies Say about Smoking, Nicotene, and COVID-19?
The bold studies emerged in France.
Researchers at a Paris hospital examined 480 patients and found a lower number of smokers treated for coronavirus than the amount in the general population. They theorized “a link exists between nicotine and a protective effect from the virus,” Politico EU reports. Still, the study noted that nicotine is a drug of abuse and could have severe pathological consequences.
A third study in Italy made similar claims that more non-smokers than smokers were among coronavirus hospital patients. Still, they noted smokers were twice as likely to die due to coronavirus.
No external scientists peer-reviewed any of these studies.
Public health experts have been quick to criticize these studies.
Jason Sheltzer, a fellow at Cold Spring Harbor Lab, created a Twitter thread that called the Paris studies “severely flawed.”
“[They are] comparing statistics that shouldn’t be compared,” he tweeted. “There is no convincing evidence that smoking protects against coronavirus.”
Why Are Health Experts Challenging the New Studies on Smoking and COVID-19?
The studies have a limited scope, Eleanor Murray, an epidemiologist at Boston University, told ctvnews.
“I’m seeing them report just the prevalence of smoking in the COVID patients and the prevalence of smoking in the general population. But for most areas, COVID patients are much older than the general population,” Murray told ctvnews.
“The life expectancy among smokers is lower than among non-smokers. And so it’s entirely possible that if you’re looking at a sample that’s mostly older individuals, you might just expect any sample like that to have fewer smokers than the overall general population.”
Murray noted the older age of patients in these studies (median age of 71 in Italy). Many have comorbidities that influence smoking behavior. And the studies did not take into account other social determinants of health.
“Old people or people with other conditions are more likely to be hospitalized for COVID-19, but those people — because they’re so fragile — would be more likely to have quit smoking,” Filippos Filippidis, a senior lecturer in public health at Imperial College London, told Politico EU. “It would be likely that a very small proportion are current smokers.”
What Additional Criticism Is Facing the New Studies on Smoking and COVID-19?
Jean-Pierre Changeux, lead author on the second Paris study, has long-standing links with the tobacco industry.
Also, the Paris studies didn’t determine when the smoking coronavirus patients quit, either.
“It is known that ex-smokers and particularly those who recently quit are likely to use nicotine. Yet the study makes no attempt to determine whether the ex-smokers are using nicotine. Given the high proportion of ex-smokers in the study with COVID-19, it seems wholly inappropriate to suggest that nicotine, yet alone smoking, are protective without first obtaining this information,” wrote Gilmore of the University of Bath in a review of the Paris studies.
Gilmore added the findings of these studies are inconsistent with the broader emerging literature on the links between smoking and COVID-19. They are also inconsistent with more widely accepted research on how infection occurs.
“[This] hypothesis goes against more widely accepted hypotheses (for which there is arguably more evidence) that smoking (both active and former smoking) and nicotine increase the expression of the ACE-2 receptors through which the virus enters cells,” Gilmore wrote in her review. “Indeed one study finds that former smokers may be especially susceptible. It has also been hypothesised that nicotine might increase the risk of neuroinfection.”
In the end, the studies’ conclusions are “wishful thinking,” Murray said.
“Taking the conclusion from [preliminary studies] that there’s some protective effect of nicotine is probably wishful thinking, just because there’s really no clear evidence here either way of whether smoking is at all protective [against] COVID,” Murray said.
The WHO statement stresses “ethically approved, high-quality, systematic research that will contribute to advancing individual and public health.”
“Promotion of unproven interventions could have a negative effect on health,” the statement said.
Many More Studies Link Smoking to Severe Cases of COVID-19
For now, other new studies continue to heavily link smoking to severe coronavirus cases.
According to new research in the Journal of Adolescent Health, 1 in 3 young adults is at risk of severe COVID-19, and smoking plays a big part in that risk.
The most notable result of the study was that medical vulnerability stood at 16.1% for the 6,741 non-smokers, versus 31.5% for the full sample of 8,405 young adults, which included smokers.
Smokers are more likely to develop a severe case of COVID-19, compared to non-smokers, according to a recent meta study by UCSF public health experts.
The researchers analyzed 19 studies on smoking and COVID-19 severity in 11,600 patients in the United States, China, and Korea. When COVID-19 progressed, current or ex-smokers had more acute or critical conditions and a higher risk of death, according to HealthDay News.
“Smoking is associated with substantially higher risk of COVID-19 progression,” study co-author Stanton Glantz, of the Center for Tobacco Control Research and Education at UCSF, told HealthDay News.
Another of the UCSF study’s researchers responded to the lower tobacco use among COVID patients in the European studies.
“But this low prevalence may actually be due to an under-assessment of smoking, especially when you consider the difficult conditions involved when caring for people in often overwhelmed health systems,” Dr. Roengrudee Patanavanich of Ramathibodi Hospital at Mahidol University in Bangkok, told HealthDay News.
How Does Smoking Aid COVID19 Progression?
Serious consequences of COVID-19 feature pneumonia and affects the lung function. It is especially worrysome for those with weak lung or immune systems, reports Guardian Australia.
Your lungs cannot effectively clean out this excess mucus. So the mucus stays in your airways, clogs them, and makes you cough. This extra mucus is also prone to infection like COVID-19.
There is no safe level of tobacco smoke exposure and that smoking cessation is the most effective means of harm reduction.
Smoking kills far more people than coronavirus.
“Certainly we would not recommend someone to take up smoking based on [these European studies],” Murray told ctvnews. “And we would still be recommending that people quit smoking because smoking has a lot of negative [health effects].”
WHO continues to say that “available research suggests that smokers are at higher risk of developing severe disease and death.”
“COVID-19 is an infectious disease that primarily attacks the lungs. Smoking impairs lung function making it harder for the body to fight off coronaviruses and other diseases,” they wrote in their statement. “Tobacco is also a major risk factor for noncommunicable diseases like cardiovascular disease, cancer, respiratory disease and diabetes which put people with these conditions at higher risk for developing severe illness when affected by COVID-19.”
Vinayak Prasad, program manager leading the WHO’s Tobacco Free Initiative, reiterated this.
“It’s a no brainer that the severity of infection would be higher among long standing smokers, especially if they have comorbidities,” Prasad told Politico EU.
In the Wake of COVID-19 Pandemic, Get Help to Quit Smoking!
Lung health is essential. This is even more so with a COVID19 pandemic that affects the respiratory tract.
“Within 20 minutes of quitting, elevated heart rate and blood pressure drop. After 12 hours, the carbon monoxide level in the bloodstream drops to normal. Within 2-12 weeks, circulation improves and lung function increases. After 1-9 months, coughing and shortness of breath decrease,” according to WHO.
Lots of smokers are quitting amid coronavirus. You can quit smoking today!
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By The Numbers
of healthcare workers should focus on infection control