Many civil society organisations have welcomed the South African government’s decision to uphold the ban on tobacco sales, agreeing that tobacco use can worsen the progression of COVID-19. Banning tobacco sales will reduce tobacco consumption, thereby reducing the burden of severe cases of COVID-19 on the health system.
Tobacco smoke weakens the immune system and compromises the ability of the lungs to fight viral and bacterial infections. Having optimal lung function is critical when dealing with a virus such as COVID-19 that primarily attacks respiratory health. E-cigarettes have also been linked to lung damage and cardiovascular diseases during the pandemic.
Emerging research shows that people who use tobacco products are more likely to experience severe COVID-19 outcomes, which will have an impact on the health system and healthcare workers. They are more likely to require mechanical ventilators, ICU and are more likely to die. A systematic review of COVID-19 studies calculated that smokers were approximately 2.4 times more likely to be admitted to an ICU, or need mechanical ventilation, or die, compared to non-smokers. Another study in China found that smokers with COVID-19 were 14 times more likely to progress to pneumonia than non-smokers.
This decision by the government will help to reduce the impact of the pandemic by reducing the severity of disease in smokers who contract COVID-19. This decision will also reduce the demand on the health system by reducing the number of severe cases of COVID-19 that it has to treat.
Furthermore, the decision will protect non-smokers who are in close contact with smokers during lockdown from the dangers of second-hand smoke, especially women, children and household members with underlying conditions such as diabetes, hypertension, tuberculosis and asthma, which already put them at risk for severe COVID-19.
Health Minister Zweli Mkhize has stated that the common health profile of those who died from COVID-19 in South Africa included hypertension, cardio-vascular diseases (CVD) and diabetes. Tobacco smoking is one of the key risk factors for the onset of hypertension and CVD. Consequently, tobacco smokers may have severe complications from COVID-19 if they have multi-morbidity.
The government is required to take a precautionary approach when facing a disease such as this one, which spreads rapidly and which can have severe consequences such as pneumonia and death. Information about the virus is limited and there is no vaccine to provide protection against the virus. The government, therefore, has a duty to act to take steps to protect the right to health of the population.
As tobacco use is a preventable determinant of severe COVID-19 cases, reducing tobacco access and use will reduce the burden on the health-care system. There is a known limitation on the availability of resources to manage this pandemic, such as personal protective equipment, hospital beds, health-care workers, testing kits and screening resources, which includes community-health workers and sanitising equipment.
The government needed to act to reduce the demand for these critical resources to ensure that the right to health care can continue to be realised as the pandemic progresses.
The ban on tobacco sales is a measure that protects the health of the population as it reduces health harm for those who contract the virus, and reduces demand on the health system for severe cases of COVID-19. The government was correct to take this action to protect public health and ensure that the right to health is protected, even during the pandemic.
Organisations that have expressed their support of the tobacco sales ban include the Human Sciences Research Council (HSRC), the National Council Against Smoking (NCAS), the South African Medical Research Council, the Cancer Association of South Africa (CANSA), Africa Centre for Tobacco Industry Monitoring and Policy Research, the Heart and Stroke Foundation South Africa and the World Health Organization (WHO).
For images and additional releases, please visit the press office at http://www.pressa.africa/protectournext
RESOURCES TO HELP SMOKERS QUIT:
Call the National Council Against Smoking quit line at 011 720 3145 for tips to help you stop smoking or visit www.againstsmoking.co.za
CANSA runs an online programme, which also provides support and information for smokers who would like to stop smoking on http://www.ekickbutt.org.za/.
The Heart and Stroke Foundation South Africa has professional staff who provide educational support during the challenging time you may face while trying to quit tobacco smoking. During the period of the lockdown, you may call 084 2507374 for assistance.
AVAILABLE FOR INTERVIEW:
Savera Kalideen, Executive Director, NCAS
Dr Priscilla Reddy, Strategic Lead, Health and Wellbeing, HSRC
Dr Musa Mabaso, Chief Research Specialist, Human and Social Capabilities, HSRC
Dr Owen Kaluwa, Representative in South Africa, WHO
Eugene Mahlehla, Technical Officer Health Promotion and Health Risk Factors, WHO
Dr Brian Clever Chirombo, Country Director, WHO
Dr. Yussuf Salojee, Tobacco Control Expert
Dr Catherine Egbe, Specialist Scientist: Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council
Lorraine Govender, National Advocacy Co-Ordinator, CANSA
Professor Pamela Naidoo, CEO, The Heart and Stroke Foundation of South Africa
Prof Mosa Moshabela, Dean of the School of Nursing and Public Health, UKZN
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1 Liu, Wei; et al Analysis of factors associated with disease outcomes in hospitalized patients with 2019 novel coronavirus disease, Chinese Medical Journal: February 28, 2020 - Volume Publish Ahead of Print - Issue – doi: 10.1097/CM9.0000000000000775.
2 Sopori, M. Effects of cigarette smoke on the immune system. Nat Rev Immunol 2, 372-377, doi:10.1038/nri803 (2002); Qiu, F. et al. Impacts of cigarette smoking on immune responsiveness: Up and down or upside down? Oncotarget 8, 268-284, doi:10.18632/oncotarget.13613 (2017)
3 World Health Organization. Information Note: COVID-19 and NCDs. Published 23 March 2020. Available at: https://www.who.int/internal-publications-detail/covid-19-and-ncds; see also U.S. Department of Health and Human Services. The Health Consequences of Smoking: 50 Years of Progress. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.
4 WHO 2020, https://www.who.int/news-room/q-a-detail/q-a-on-smoking-and-covid-19
5 J Gotts et al What are the respiratory effects of e-cigarettes?, https://www.bmj.com/content/366/bmj.l5275
6 Liu, Wei; et al Analysis of factors associated with disease outcomes in hospitalized patients with 2019 novel coronavirus disease, Chinese Medical Journal: February 28, 2020 - Volume Publish Ahead of Print - Issue – doi: 10.1097/CM9.0000000000000775.
7 Vardavas, C. I., & Nikitara, K. (2020). COVID-19 and smoking: A systematic review of the evidence. Tobacco induced diseases, 18, 20. https://doi.org/10.18332/tid/119324
8 Liu et al Analysis of factors associated with disease outcomes in hospitalized patients with 2019 novel coronavirus disease, Chinese Medical Journal: February 28, 2020 - Volume Publish Ahead of Print - Issue – doi: 10.1097/CM9.0000000000000775.