COVID-19: Smokers Are At A Higher Risk

26 May 2020

Article by: Nur Yee Jie Min, Corporate Communications
Facts approved by: Dr Anand Sachithanandan, Consultant Cardiothoracic Surgeon

The COVID-19 pandemic has impacted people in many forms, and it is clear that we need to look after one another to prevent the spread of the disease.

Fellow Malaysians have stepped up by staying at home during the Movement Control Order (MCO), protecting themselves by wearing a face mask in public areas, and maintaining good personal hygiene by constantly washing their hands and using hand sanitisers.

These are some of the healthy habits which we have adopted to help prevent the spread of the disease, however there are those habits which are not ‘health friendly' especially during these unprecedented times. One of them is the habit of smoking. But are smokers genuinely more susceptible of contracting and spreading the coronavirus or is this just a quit the bait conspiracy?

Recently, scientists have identified that tobacco smoking and possibly even e-cigarettes can increase the expression and production of the angiotensin-converting enzyme-2 (ACE-2) receptor, thereby enabling greater viral entry, reproduction and transmission.

The ACE-2 receptor located mainly in the lungs (type II pneumocytes) and the lining (epithelium) of the airways has been established that the critical entry point for the COVID-19 coronavirus to infiltrate and subsequently bind to human cells.

“This is a plausible scientific reason why smokers may be more susceptible to a more severe COVID-19 illness due to the greater viral load,” said Dr Anand Sachithanandan, Sunway Medical Centre Consultant Cardiothoracic Surgeon.

A recently published New England Journal of Medicine study of 1,099 COVID-19 patients in China found that 17 out of 137 current smokers (12.4%) required admission in the intensive care unit (ICU) or mechanical ventilation or have died. Meanwhile, 44 out of 927 non-smokers (4.7%) were not in those categories.

“This is an observational study, hence it is difficult to adjust for possible confounding risk factors but it suggests that smokers are more likely to develop the severe disease that requires admission to ICU, mechanical ventilation or results in death compared to non-smokers,” Dr Anand said.

The coronavirus which causes the COVID-19 disease predominantly affects the respiratory system and like all viruses, it requires a living host to survive and replicate, causing severe illness. It spreads from person to person through small droplets from the nose or mouth when a person with COVID-19 coughs or sneezes. But there is emerging evidence that the virus can be contracted through airborne transmission, thus the importance of wearing a mask.

“Smokers may have an increased risk of contracting the coronavirus due to the repeated hand to mouth movement, where they are more likely to touch their face – increasing the risk of infection. And if a smoker is COVID-19 positive, he or she increases the risk of spreading the coronavirus when they exhale the smoke which theoretically contributes to the airborne transmission of the coronavirus,” Dr Anand said.

This critical time presents an opportunity for us to do things differently and for smokers, it is a good chance to kick the habit. Quitting can significantly reduce the risk of contracting the virus and if they do develop an infection, they may have a less severe infection if they quit smoking.

“To quit smoking during these anxious times may be difficult and those who are not able to should at least smoke more considerately; away from people and loved ones to reduce the risk of airborne transmission when they exhale the smoke,” Dr Anand stressed.

Facts approved by Dr Anand Sachithanandan, Consultant Cardiothoracic Surgeon

Tags: covid-19