Media release from SmokeFree Tasmania on 4 October 2021 https://www.smokefreetasmania.com/media/press-release/

Articles explaining the links

A number of researchers have highlighted the fact that smoking is a danger to people who contract COVID-19.

A webinar from the European Respiratory Society on Smoking and COVID-19 – what have we learned? June 2021 Dr. Sukhwinder Sohal from Tasmania is one of the speakers on this webinar

The New York Times has recognised the link between smoking, vaping and COVID-19, and has referenced our Tasmanian paper.

Smokers are 14 times more likely to progress to pneumonia, intensive care and death if they contract COVID-19

COVID-19 regularly updated data for Australia is available. Please consider donating to this site, as it is run by expert individuals – and is independent of government. You can also give advice about what other data might be helpful.

Smoking is the elephant in the COVID-19 room

BMJ Tobacco Control is highlighting COVID-19 and smoking

A package of resources on smoking and COVID-19, regularly updated, has been provided by Marita Hefler at BMJ Tobacco Control.

Engineers Linsey C Marr and Charles P Lunsford at Virginia Tech have reported on the transmission of viruses in droplets and Aerosols.

The CDC has highlighted the link to smoking in COVID-19 progression. this reinforces the Chinese research, which reports the same issue.

CDC and WHO also says children can be affected, ” A large study by Dong et al confirms that children can become very ill from COVID-19.

“A recent study showed that a number of children in China have developed severe or critical disease and one child has died, said Dr. Maria Van Kerkhove, head of WHO’s emerging diseases and zoonosis unit, at a news conference on Wednesday. “What we need to prepare for is the possibility that children can also experience severe disease.”

The new study, which was published online in the journal Pediatrics, looked at 2,143 cases of children with confirmed or suspected COVID-19 that were reported to the Chinese Centers for Disease Control and Prevention between Jan. 16 and Feb. 8. More than 90% of the cases were asymptomatic, mild or moderate cases. However, nearly 6% of the children’s cases were severe or critical, compared with 18.5% for adults.”

A blog in the Journal of the European Respiratory Society reports that countries are doing little to warn smokers, to help them quit, nor to implement the FCTC. Furthermore, this is not the end.

” COVID-19 is a dress rehearsal for the next pandemic, and the next, and the one after that – the new normal. Wang et al comment on emerging zoonotic viruses (EZV): “Now is not a time for blame. Rather, there are lessons the global health community can and should learn and act on so that we can better respond to the next EZV event, which is almost certain to happen again. These lessons are definitely not unique to China (28).”

A blog in Tobacco Control by Drs Kathryn Barnsley and Sukhwinder Sohal says :

ACE2 could be a novel adhesion molecule for Covid-19 and potential therapeutic target for prevention of fatal microbial infections.  

Smokers contract more respiratory ailments, including colds, which also belong to the coronavirus family. Smokers are 34% more likely than non-smokers to contract  influenza,  and smoking is consistently associated with higher risk of hospital admissions after influenza infection.

Overall mortality is higher in older smokers, and smokers also have increased rates of bacterial pneumonia and tuberculosis. Further, many deaths from Covid-19 have been associated with underlying health conditions.

The damage caused to lungs by smoking makes patients more susceptible to pulmonary infections, both bacterial and viral.

Are COPD and other smoking related illnesses such as cardiovascular disease and diabetes masking reporting on smoking related Covid-19?

China has a high male smoking rate at around 50% in rural areas and is estimated to be about 44.8% overall. Most of the deaths identified from Covid-19 were in men in older age groups,

COPD is a smoking caused illness and is the fourth leading cause of death in the world.  Vaccination against influenza is strongly recommended for patients with COPD, because the frequency and progression of COPD exacerbations is strongly linked to respiratory viruses in 30% of cases.

We must bolster research, especially now, but also commit to the future as viruses will continue to emerge, especially zoonotic threats. “This is normal” says Professor Richt, a veterinary medicine researcher.

 Lum and Tambyah point out the medical system is built largely on commercial considerations; for example, when SARS (another coronavirus) emerged in November 2002, much effort was expended on vaccines and treatment, yet those funds disappeared as the epidemic subsided. “Scientists are now thawing old isolates from their freezers and rewriting grants, which…will be lost…when this epidemic inevitably comes to an end.”

The solid foundations of scientific research programs relating to emerging disease threats, which include laboratories, staff, equipment, and predictive modelling must be preserved so they can be built on at times of crisis. Not rebuilt every few years.

In coming months, WHO and countries should:

• Ensure that the smoking status of patients identified with Covid-19 is recorded and included in all data sets, so that it can be determined if smokers are indeed more vulnerable.

Fund research into:

• ACE2 as a novel adhesion molecule for Covid-19 and potential therapeutic target
• If smokers, including young asymptomatic smokers, are more likely to transmit Covid-19 than non-smokers
• Whether countries with high smoking rates are more vulnerable to Covid-19 than those with low smoking prevalence

Take decisive action to:

• Provide COVID-19 context-specific advice to smokers to quit
• Prioritise smokers as a vulnerable group, who should exercise caution and avoid areas where they may be liable to be exposed to Covid-19
• Prioritize smokers for vaccination when a vaccine is developed
• Fund and rapidly accelerate tobacco control actions, including taxation increases, minimum price policies, regulation of engineering and content of cigarettes, retail measures to reduce accessibility, enhanced cessation support and mass media anti-smoking campaigns.

Governments must take action to support strong scientific public health research systems, and to rapidly reduce smoking in all countries in accordance with the WHO Framework Convention on Tobacco Control (FCTC). This takes on new urgency in this time of global pandemic, as it appears highly probable that smoking exacerbates COVID-19 contraction, transmission and mortality.

Another article in the |Journal of Clinical Medicine says:

The epicenter of the original outbreak in China has high male smoking rates of around 50%, and early reported death rates have an emphasis on older males, therefore the likelihood of smokers being overrepresented in fatalities is high. In Iran, China, Italy, and South Korea, female smoking rates are much lower than males. Fewer females have contracted the virus.

If this analysis is correct, then Indonesia would be expected to begin experiencing high rates of Covid-19 because its male smoking rate is over 60% (Tobacco Atlas). Smokers are vulnerable to respiratory viruses.

Smoking can upregulate angiotensin-converting enzyme-2 (ACE2) receptor, the known receptor for both the severe acute respiratory syndrome (SARS)-coronavirus (SARS-CoV) and the human respiratory coronavirus NL638.

This could also be true for new electronic smoking devices such as electronic cigarettes and “heat-not-burn” IQOS devices.

ACE2 could be a novel adhesion molecule for SARS-CoV-2 causing Covid-19 and a potential therapeutic target for the prevention of fatal microbial infections, and therefore it should be fast tracked and prioritized for research and investigation.

Data on smoking status should be collected on all identified cases of Covid-19

Dr. Sukhwinder Sohal says smokers are more at risk from COVID-19

Smokers are more likely to get the coronavirus, a Tasmanian academic and researcher says.

University of Tasmania senior lecturer and head of the respiratory research group Dr Sukhwinder Singh Sohal said research showed that a lot of people with the virus were smokers.

“It is clear that smokers are more vulnerable,” Dr Sohal said.

“In Tasmania we have a high rate of smoking compared with the rest of Australia so people should try to quit now.

“There can’t be a better motivation now than the coronavirus.

“We need to make smokers aware that they are at higher risk and even passive smokers and people who use electronic cigarettes are at risk.”

Dr Sohal and fellow researchers, including Tasmanian researcher Dr Kathryn Barnsley, have just published research into smoking and COVID-19 in the Journal of Clinical Medicine.

They said that in the epicentre of the original outbreak in China male smoking rates were high at around 50 per cent and older males had died from the virus.

A recent Chinese study found that smokers are 14-times more at risk for severe coronavirus infection and 14 per cent more likely to get pneumonia.

“In Iran, China, Italy, and South Korea, female smoking rates are much lower than males. Fewer females have contracted the virus,” they wrote.

“If this analysis is correct, then Indonesia would be expected to begin experiencing high rates of Covid-19 because its male smoking rate is over 60 per cent.

“Smokers are vulnerable to respiratory viruses.”

Dr Sohal said smoking stimulates a specific receptor used by coronavirus to get entry into the lung cells making smokers and patients with COPD (chronic obstructive pulmonary disease) more vulnerable to viral infection.

“We provide first human lung tissue evidence for increased expression of this receptor in smokers and patients with COPD,” he said.

Dr Sohal said in light of the deadly COVID-19 pandemic, governments should be trying to reduce smoking rates.

“Research suggests that vaping and smoking make people similarly vulnerable to respiratory infections and to worse complications of these illnesses,” he said.

“Smoking/vaping and respiratory infections act like a ‘double whammy’ on the lungs and immune system, and amplify one another’s effects.

” I also appeal to local and national health organisations to come forward and support this research further for a healthy planet before it’s too late!

“We should have a stimulus package for health professionals including researchers working on COVID-19, as they have done for business.”

Hon. Ivan Dean MLC has published an article in the Launceston Examiner.

We need to raise awareness about smoking, because smokers are vulnerable to respiratory viruses and infections including the flu and COVID-19.

We hear about “flattening the curve” so that the health system and hospitals are not overwhelmed and reduce the mortality from the spread of COVID-19.

The Tasmanian government and our public health experts have taken strong decisive action which I applaud. We are fortunate to have such high-quality staff within Public Health Service, who have experience with managing communicable diseases.

However, until recently nobody was talking about COVID-19 and smoking. There were lots of mentions of “underlying health conditions”, without noting that many of these are caused by smoking. If this doesn’t give smokers an extra incentive to quit for their health, then nothing will.

There is a strong link between the high smoking rates of males in China, between 40 to 60 per cent and high death rates in the older men from COVID-19. In China few women smoke. Evidence from China demonstrates that smokers are 14 times more likely to progress to pneumonia, intensive care, and death, than non-smokers.

Tasmania has the highest smoking rate in Australia after the Northern Territory. In some municipalities Tasmania has smoking rates which are similar to China, around 40 per cent, and an older age profile compared to all other states and territories.

At 30 June 2019, Tasmania had the highest median age of all the states and territories (42 years), followed by South Australia (40 years). Italy also has a much older population and Italian medics are making heart breaking decisions about who is treated, because of insufficient beds, staff and equipment. We can only hope that this issue will not need to be faced by our medics in Australia.

COPD and lung cancer are both caused by smoking, and COPD is the second leading cause of potentially preventable hospitalisations in Australia. In 2018 there were 14,000 people in Tasmania with COPD.

These individuals are more prone to lung infections, higher exacerbation rates, more inflammation, and loss of lung function compared to rest of the population.

Tasmania had a higher rate of adults who were overweight or obese compared with Australia (70.9 per cent compared with 67 per cent) driven by a higher rate of obesity (34.8 per cent compared with 31.3 per cent). Obesity is linked to diabetes, as is smoking. Diabetes is estimated to affect 27,000 to 33,000 Tasmanians.

So, in Tasmania we have a perfect storm for inviting infection, transmission and high mortality rates from COVID-19 of our citizens. High smoking rates, older age profile, high rates of obesity and diabetes all put the population at greater risk than other states.

Now is the time to ramp up efforts to help people to quit smoking and get them to refrain from using any vaping product which damages the lungs, such as waterpipes, e-cigarettes and heat-not- burn products such as IQOS.

It will be a “double whammy” on the Tasmanian health system with dual tobacco users. People must come before the bottom line profits of retailers of tobacco.

We must act now to: Legislate to raise the smoking age to 21 years (T21), to prevent a health disaster in our young people now and in the future; Increase action to help people to quit, which means increasing funding to Quit for more media advertising; Ensure access and provision of smoking cessation aids such as nicotine replacement therapy, and various prescription drug therapies; Implement policies and programs to lower smoking rates during pregnancy.

We do not know yet if smokers are more likely to transmit COVID-19, but they are certainly more likely to be associated with other diseases such as meningococcal infection. It may be months or years before we have the data on COVID-19 transmission “super-spreaders”.

I strongly urge the government to raise the smoking age to 21 years. It should not be left up to me, an Independent member of Parliament to act on this. This is a legislated recognised health emergency. The government must act now.

Furthermore, I strongly urge the government to act to beef up Quit campaigns, to help people stop smoking, before they become premature casualties of COVID-19.

Dr. Mike Ryan from WHO says we should act fast, and he said, “speed trumps perfection” and “be fast, have no regrets. You must be the first mover. The virus will always get you if you don’t move quickly,” Dr Ryan said.

Admirably, the Tasmanian government has acted fast on containment, border protection, self-isolation, contact tracing. The government needs to act now on reducing smoking, to reduce the risk of COVID-19 transmission and overwhelming our hospital intensive care units with smokers.

• Ivan Dean is the Independent member for Windermere.