The American Cancer Society states that there is no direct evidence, but showing that a history of smoking makes a person more likely to get COVID - 19. However, there is evidence that smoking increases the risk of other types of viral lung infections. The increase in risk stems from changes in a person's immune system, as well as the damage to the cells lining the airways in the lungs.

According to the American Cancer Society, much of the speculation about the possible link between tobacco use and COVID - 19 in media is based on early studies from China in which case men were getting COVID - 19 at higher rates than women. A study of nearly 1100 hospitalized COVID - 19 patients found that about 58 per cent were men. Men have much higher smoking rates than women in China. Thus this is one possible explanation for the difference. But in Italy, where women's smoking rates are much closer to men's, researchers have also reported significantly more COVID 19 related hospitalizations in men than in women, possibly an even larger difference than in China. Researchers are continuously trying to understand these differences and what they might be showing.

Meanwhile, the WHO observes that people often touch their mouths with their fingers while smoking, which is known to be a risk factor for getting COVID - 19. Though there is no direct research showing this factor actually increases the risk, it reinforces the importance of washing hands frequently and not touching faces.

The logic between smoking and worse COVID - 19 is that smoking is an established risk factor for respiratory infections, including the flu, because it weakens the immune response that a person can mount against a viral infection. Smoking is a well-established risk factor for chronic obstructive pulmonary disease and heart disease which are clearly risk factors for having more severe illness from COVID - 19.

A recent analysis of six studies in China finds that smoking is most likely linked with poorer outcomes in COVID - 19 patients. One of these studies received a lot of media attention. It revealed that among a sample of COVID - 19 patients in China, smokers were more likely to be in the group of patients whose condition worsened while hospitalized.

The Centers for Disease Control and Prevention (CDC) states that "older adults and people of any age who have serious underlying medical conditions might be at higher risk for severe illness from COVID - 19". They are cancer treatment, smoking, bone marrow or organ transplantation, immune deficiencies, poorly controlled HIV or AIDS, and prolonged use of corticosteroids and other immune weakening medications. Meanwhile, the WHO reports that conditions that increase oxygen needs or reduce the ability of the body to use it properly will put patients at higher risk of serious lung conditions such as pneumonia, adding that "smokers may also already have lung disease or reduced lung capacity which would greatly increase risk of serious illness."

It is vital to protect people from exposure to secondhand smoke and e-cigarette aerosol during this time when we are in close quarters with family members and others. People exposed to secondhand smoke are at a higher risk for developing cancer, heart disease and stroke, among other diseases. Exposed infants are at higher risk of sudden infant death syndrome. Research also shows that secondhand aerosol from e-cigarettes can contain toxic substances and should be treated similarly to secondhand smoke. Smokers and e-cigarette users need to go outside, but within the other recommended parameters of safe social distancing.

There are large and immediate benefits of quitting smoking, no matter when it is done. Perhaps these benefits apply more now than ever. There isn't yet direct evidence that quitting can help people avoid more serious outcomes if they get COVID - 19. But we do know that there are some health benefits that occur fairly quickly after quitting. There are rapid improvements in blood carbon monoxide levels and in the function of respiratory tract cilia (tiny hairs in the airways that help keep them clean) and slightly slower improvements over time in immune function. These improvements could potentially help people who get COVID - 19.

Secondly, for some smokers, this pandemic might motivate, or a teachable moment for those who had not thought much before about quitting. Approaching them for quitting during this time of COVID - 19, they might listen to try out quitting.

However, we should take into consideration that for some smokers, trying to quit during a time of stress might make it harder to succeed. People who choose not to quit should not be ridiculed. But we should do everything to support those who choose to quit to succeed.

By Manjari Peiris

Stay Safe, Stay at Home, Stay Informed, But Don't Forget to Wash Your Hands.

- Asian Tribune -