Tobacco usage is one of the major concerns of preventable mortality and morbidity worldwide. Tobacco epidemic has always been one of the biggest public health threats leading to mortality of 80 lakh people a year around the world. Among them 12.5% are the result of non smokers being being exposed to second hand smoke. The smokeless tobacco is on the rise in recent years accounting 300 million people which in turn is highly addictive.
Impact of pandemic on tobacco consumption
The Pandemic and the countermeasures ordered in response to it, have had social and economic consequences with additional negative effects in the form of temporary or definitive unemployment. This has led to the worrisome rise in the tobacco consumption and smoking relapses. The crisis to access to usual care owing to fear of nosocomial or nosohusial infections, and sudden divergence of healthcare resources to COVID19 had a dramatic negative impact on the smoking rehabilitation.
Is Tobacco protective against COVID19 Pneumonia?
Smokers are generally at increased risk of infectious diseases, whereas in contrary some studies have suggested tobacco may be protective against COVID19 and the world’s media outlets gave a extensive coverage to these. These were based on several hypothesis. Lets breakdown the myth,
1) These emerged from hospitalised studies. Indeed the prevalence of smoking among among hospitalised patients was typically lower than the general population.
2) Smoking status is generally poorly documented in hospital medical records leading to classification bias, moreover data on current smokers, period of abstinence, level of tobacco use may not have been recorded (reverse causality bias).
3) Various confounders have been not excluded.
4) Active smoking may affect the nasopharyngeal viral load decreasing the RT-PCR sensitivity.
5) In addition, owing to the vague symptom of chronic cough, smokers are more likely to be tested than non smokers.
6) Smokers may have fewer social relationships than non smokers.
Tobacco – prognostic factor for COVID19 pneumonia
The largest meta analysis included 47 studies with a total of 32849 hospitalised COVID19 patients (Reddy et al.2020), confirmed that current smokers had increased risk of severe COVID19. History of smoking was assessed and found to have been associated with severe or critical covid, progression and need for ventilation, and in-hospital mortality. Each association had significant P value
Smoking also up-regulates the angiotension converting enzyme 2 receptors, which are potential targets for COVID19 (Brake et al. 2020)
Underdog went on loose!!!
During COVID19 pandemic, tobacco control is a greater challenge than ever for health policy makers, healthcare providers. World tobacco day 2021 is to remind us the need for vigilant public health measure and not to compromise the combatting smoking WHO 2000-2024. Healthcare providers should provide evidence based pharmacological treatment and behavioural smoking cessation therapies with remote support. Smokers helpline should offer their services to all smokers including asymptomatic and symptomatic COVID19 patients. Over 80% of the tobacco consumers live in low to middle income group according to WHO, warranting the interventions to be targeted in these groups in particular since they are at high risk for COVID19. Public health campaigns held in response to pandemic should reference the importance of tobacco prevention and cessation. The current crisis within crisis must be tackled with the combined efforts health policy makers and healthcare providers.
Dr Saravana Bharathy, Consultant, Internal Medicine, Dr Mehta’s Hospitals