Are Smokers And Tobacco Users At Higher Risk Of Covid-19 Attack?

Dr Mridul Kumar Sharma: A new kind of coronavirus discovered late last year in central China has now spread with ruthless momentum to every continent on earth except Antarctica. A pneumonia of unknown cause detected in Wuhan was first reported to the WHO Country Office in China on 31 December 2019 and since then the world has witnessed a large volume of cases in almost all the countries. In some countries like Italy, the USA and India this novel coronavirus has been significantly lethal, killing thousands every day and is still going strong.

The novel corona virus, also known as COVID 19 or SARS coV 2, has killed thousands, disrupted daily life in ways that would have seemed unthinkable at the early part of the 2020. It now poses a dire threat to the health of the world economy as well. The outbreak was declared a Public Health Emergency of International Concern on 30 January 2020 and WHO declared novel coronavirus outbreak a “pandemic” on March 11th, 2020. After the first wave of the pandemic, a second wave engulfed the world. The second wave of the pandemic has been so far been much more dangerous than the first wave of the pandemic. Although the vaccination against the deadly COVID 19 virus has started, it will take months before each and every citizen of our country is vaccinated.

As of 7^th June 2021, 28909178 cases have been detected in India and total death toll has been 349293. Many families have been devastated by the wrath of this highly infectious and deadly virus. During the first wave of the outbreak, India was in a complete nationwide lockdown from 25th March to May 2020. The lockdown had to be extended in many states and it resulted in severe strain to the Indian economy. When the second wave hit our country, once again almost all the states declared either partial or complete lockdown for periods ranging from weeks to months.

Yet it has not been an easy task to contain the outbreak. Various factors that are responsible for a person to be attacked by the virus have been well known and well discussed. However, latest scientific studies have thrown light on some new aspects of the COVID-19 attack. IT has been found that smokers are at a significantly higher risk of COVID-19 attack compared to the non-smokers.

The new coronavirus mostly spreads through respiratory droplets leaving an infected person’s mouth or nose when he or she coughs or breathes out — and when these are either inhaled or ingested by a healthy individual, or transferred by hand from a contaminated surface to the eyes, nose, or mouth.

There is evidence that the coronavirus can hold out for a long time on surfaces. A recent US study shown it can survive for up to four hours on copper, a day on cardboard and two or three days on plastic and stainless steel. It also survives in aerosols – droplets suspended in the air – for as long as three hours.

For this reason it is extremely important that the infected person wears a mask. Social distancing and hand washing are the two other most important habits to be followed strictly in order to stay away from this extremely contagious viral infection.

COVID 19 has generated highest level of interest among the doctors, scientists, virologists and epidemiologist. And that is why scientists have been able to find out the nature of the virus and its pathogenicity very quickly. It is now known how the virus looks like, with its spike protein that docks into human cells in the lung airways through a protein called ACE-2. This process is helped by another protein called Furin. These two proteins are so abundant in our lung airways and lung cells that a few viruses are enough to lodge into the airways and multiply to increase their number. But it may take 1-2 weeks for the virus to get deep into the lung and cause symptoms. The incubation period of the virus is 2-14 days. The infected person develops the symptoms such as fever, cough, shortness of breath etc. usually after 5 days of infection. Some patients may develop gastrointestinal symptoms like diarrhoea and vomiting.

It has been seen that the virus is more fatal in some groups of patients for example in elderly population and people having other comorbidities like hypertension, diabetes, chronic kidney disease or other chronic lung disease.

It has been seen that the novel corona virus is more common among people who smoke. There can be many reason why this phenomenon is seen.

Smoking is associated with many lung diseases like COPD, bronchitis, lung cancer or various types of Interstitial lung disease for example Respiratory bronchiolitis ILD, Desquamative interstitial pneumonia, pulmonary Langerhans cell histiocytosis, idiopathic pulmonary fibrosis etc. Epidemiological studies of many countries, it has been seen that COVID-19 is more common among people having pre-existing lung diseases and also it’s very fatal among these groups of patients.

“There’s not very much data at this point on COVID-19 in smokers, but we do know from reports from China, smokers seem to be over-represented in groups of people who have severe or critical COVID-19,” said J. Taylor Hays, M.D. Director of the Nicotine Dependence center at Mayo Clinic in Rochester, Minnesota and Professor of Medicine, Mayo Clinic College of Medicine.

An article published in new England journal of medicine “Clinical Characteristics of Coronavirus Disease 2019 in China” in the month of February have looked at 1,099 patients in China with COVID-19, showing that of 173 patients who had severe symptoms, 16.9% of them were current smokers and 5.2% had previously smoked. Among the patients with less-severe symptoms, 11.8% were current smokers and 1.3% former smokers.

The study showed that in a group of patients that either needed mechanical ventilation, admission to an Intensive Care Unit, or ultimately died, 25.5% were current smokers, which was more than twice the rate of current smokers in a group of patients that did not have these severe adverse outcomes.

Other reason why smokers can be at higher risk of developing the novel corona virus is that the act of smoking means that fingers (and possibly contaminated cigarettes) are in contact with lips which increases the possibility of transmission of virus from hand to mouth.

Smoking products such as water pipes often involve the sharing of mouth pieces and hoses, which could facilitate the transmission of COVID-19 in communal and social settings.

So it can be safely said that smokers are at an increasing risk of developing the novel corona virus and most smokers develop severe disease when they have the infection. Cessation of smoking, therefore, is extremely important.