Nicotine patches as protection against COVID-19? This daring hypothesis has been proposed in France. In South Africa, however, smoking is now completely banned.
South Africa has taken another sensational measure in the fight against the novel coronavirus: With the national lockdown, which began at the end of March, a nationwide tobacco ban was imposed from one day to the next, in addition to restrictions on the sale of alcohol.
This South African smoking cessation is a sort of unique social experiment. The responsible minister, Nkosazana Dlamini-Zuma, justified the ban by arguing about the higher risk of smokers suffering from COVID-19 complications, and the possible burden this may have on the health system. While the tobacco industry mobilizes to put up a fight, consumer protectors criticize the move as a serious encroachment on personal rights; followed by economists warning about the loss of tax revenues. The government apparently considers that a good 10% of smokers will give up their vice. With almost ten million tobacco consumers in South Africa, that would be one million people.
This assessment corresponds to the result of a survey, of which the author of an article in the standard.at (in German) has expressed slight doubts over its accuracy. The author explains that in the South African context "at least 90% of smokers" are resorting to bad quality cigarettes or to smoking rooibos tea leaves wrapped in newspaper, as the sale of cigarette paper has also been banned. The black market is flourishing, which is not exactly beneficial to health: "Anyone who smokes these things, in the long run, will soon need a respirator even without having the virus. Thanks to minister Nkosazana Dlamini-Zuma," says the standard correspondent.
The politician and trained physician Nkosazana Dlamini-Zuma (NDZ), already advocated a strict smoking ban in public places when she was health minister in Nelson Mandela's cabinet. This commitment was honored in 1999 with the World No Tobacco Day Award by the World Health Organization. It remains to be seen what this strategy will bring. While the curfew in South Africa has now been lifted (despite a high four-figure number of new SARS-CoV-2 infections every day), as have the alcohol ban and casino closures, the tobacco ban remains in place as of mid-July 2020.
For a few weeks now, one discussion in media platforms has been haunting us: whether smoking or nicotine itself can even protect us from coronavirus. Google spits out over 16 million results on the issue, and the smoker and steamer scene is bubbling over it. The sensational and confusing news comes from France’s largest hospital, the renowned La Pitié Salpetrière. Researchers at Sorbonne University’s teaching hospital found a significantly lower proportion of smokers among COVID-19 patients than in the general population. Their hypothesis: the controlled use of nicotine, for example as a patch, snuff, or chewing gum, could protect against viral infection via the competitive binding of nicotinic acetylcholine receptors (nAChR).
The pneumologist Dr. Marion Heiß-Neumann (Munich Asklepios Clinic, Germany), quoted on the German-language portal br.de, considers this a rather "courageous thesis" and says: "Personally, I would not rely on the virus not being able to overcome the receptor... In view of the lack of systematic recording and reliable figures, among other things, it is doubtful whether the French study design really allows valid conclusions to be drawn about the total number of smokers suffering from COVID-19.
On the other hand, it is undoubtedly always worth quitting smoking. Current registry data from the USA show, in line with previous evidence, that the cardiac risk caused by smoking hardly exists after some time of abstinence.1 In a cohort of more than 2,000 patients who had their first heart attack at an age of 50 years or less, just over half (53%) were active smokers. One year after the infarction, the clear majority of them continued nicotine abuse; only slightly more than a third (38%) had stopped. During a median 10-year observation period, the mortality rate in the smoking-cessation group was 4.7%, compared with 13.2% among those who continued to smoke. With the cessation of tobacco use, the adjusted mortality risk decreased by 70%.
In this study, patients who quit smoking after an infarction even had lower long-term mortality than kidney smokers. The scientists from Harvard Medical School explain this advantage by the fact that early heart attacks in people without any nicotine abuse are due to less easily controllable risk factors such as a genetic predisposition. "The results underline the critical importance of smoking cessation, especially for those who suffer a heart attack at a young age," the authors say.1
Especially in corona times, it is worthwhile to stop smoking. For example, researchers from the University of Mainz Clinic (Germany) not only found in a meta-analysis that both e-cigarettes and waterpipes can damage the vessels to a similar extent as tobacco smoke.2 Rather, the risk of a worse COVID-19 prognosis and the associated death risk is also increased, regardless of the type of tobacco product.
According to the Mainz analysis, tobacco consumption increases the risk of COPD by 704%, hookahs by 218%, and e-cigarettes by 194% compared to non-smokers. For lung cancer risk, the increase rates are 1,210% (tobacco cigarettes) and 122% (water pipes; no reliable statement can be made for e-cigarettes), for arterial stiffening the rates are 10% (cigarettes), 9% (hookahs ) and 7% (e-cigarettes).2
Various meta-analyses indicate an increased risk for smokers to contract Covid-19, even to the point of intensive care or death. All authors emphasize that more data must be collected and that the conclusions are only preliminary. However, the Robert Koch Institute in Berlin also includes smokers in the risk group for COVID-19 infection and the pneumologist Prof. Stefan Andreas (University Hospital Göttingen) makes it clear: "We know that every type of lung disease occurs more frequently, and usually more severe, in smokers".
Should we push for smoking cessation in these corona times even more than usual? And if not now, then when?
References:
1. Biery DW et al. Association of Smoking Cessation and Survival Among Young Adults With Myocardial Infarction in the Partners YOUNG-MI Registry. JAMA Network Open 2020;3(7):e209649
2. Münzel T et al. Effects of tobacco cigarettes, e-cigarettes, and waterpipe smoking on endothelial function and clinical outcomes. Eur Heart J 2020:ehaa460