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Smoking and Covid-19: This is what the science says

There has been much debate about government's continued ban on the sale of vaping and tobacco products. Cooperative Governance and Traditional Affairs Minister Nkosana Dlamini Zuma, a qualified medical practitioner, has been vilified for her insistence that the decision was based on scientific evidence. IOL asked an expert to explain the science linking smoking to increased health risks during the Covid-19 pandemic. Here is Professor Elvis Irusen's response:

The science is unequivocally clear: A smoker has a greater than 10 x chance of getting Covid 19 pneumonia, being hospitalised, deteriorating to the point of needing intensive care and death. They now become a danger to others and put health resources at risk. A smoker on a ventilator is robbing someone else of the opportunity to have their lives saved.

Smoking has a general effect of interfering with lung immunity and the various defence mechanisms the lung has to protect us.

More science: Covid-19 enters cells by attaching to the ACE2 receptor ( angiotensin converting enzyme 2) [ A common drug used world-wide to treat hypertension, ACE inhibitors, blocks this receptor, so people may be aware of ACE]. Smoking increases the number of receptors in the lung, making it easier for the virus to attach and to make people sick.

Even more science: children especially those below 10 yrs have very few ACE2 receptors which is one of the reaons why children seldom get Covid-19.

Once Covid-19 has damaged the lung, in the acute illness, smoking makes people immediately more susceptible to other infections such as bacterial infections which could aggravate the condition leading to ICU and death. ( even if the Covid itself was not going to kill).

In general, smoking does not increase the RISK of getting Covid-19. However, Covid-19 is acquired by people frequently bringing their hands to their mouths/ faces. So if someone has the virus on their fingers and hands are not washed then the act of smoking will increase their risk. Secondly if people are sharing cigarettes then this is clearly highly risky as an infected person will pass to an uninfected person.

By causing more severe infections, smokers are increasing the pool of Covid19 people in the community, are a risk to vulnerable members in their family and then the medical community.

Finally, is this not an opportunity to see if one can give up smoking? Especially those who are not very addicted. It is estimated that 200 000 people will stop smoking in the UK from a study that has already been done to see how many have stopped smoking during the pandemic.

Smoking cessation now will lead to many important health benefits in the future: less likelihood of emphysema/chronic bronchitis/ lung cancer, heart attacks and strokes to name a few.

* Professor Elvis Irusen ( MBChB, FCP (SA), Pulmonology, PhD, FCCP) is Head of the Division of Pulmonology at Stellenbosch University's Faculty of Medicine and Health Sciences.

Originally appeared in IOL at

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