“There is no better time to think about how smoking affects your health, your loved ones and your financial position during this COVID-19 pandemic.
Smoking can mean you are more susceptible to developing lung disease. I want to remind everyone that there is light at the end of this COVID-19 tunnel, not at the end of a cigarette.
Chronic diseases such as respiratory diseases (including asthma), heart and circulatory diseases, high blood pressure, diabetes, kidney diseases and some cancers are more common among Aboriginal and Torres Strait Islander people and tend to occur at younger ages, than among other Australians.
I would like to remind everyone especially during these times of COVID-19, stop sharing cigarettes with others or smoking used cigarette butts. Every step counts to ensuring the wellbeing of yourself and those close to you.”
Donnella Mills Chair of NACCHO
The National Aboriginal Community Controlled Health Organisation (NACCHO) is spreading the message to all Australians that ‘There is light at the end of the tunnel, not at the end of a cigarette’ on World No Tobacco Day.
For this year’s World No Tobacco Day, NACCHO’s message is particularly timely during the COVID-19 pandemic.
” People who smoke have a higher risk of catching respiratory infections like colds and flu than non-smokers.
They are also more likely to experience complications that lead to more severe illness such as pneumonia.
Because (coronavirus) COVID-19 is primarily a respiratory disease, we expect smokers to be more susceptible.
As COVID-19 is caused by a new virus, we are still learning about its effects on the body, what factors might increase the risk of infection, and who might experience more severe symptoms. Here we summarise what we know from the emerging evidence specifically in relation to smoking as a risk factor
See part 3 below
“Being more stressed or depressed could be seen as a reason to advise a smoker to quit rather than to put it off.
This is very important in these stressful times, and for Aboriginal and Torres Strait Islander people who experience more stressful events.
Quitting smoking is always a good first step in improving your health and can increase your confidence to take on bigger problems.”
Study leader, Menzies’ Professor David Thomas says health staff can emphasise the research evidence of the benefits to stress management, mental health and well-being that come with successfully quitting smoking.
The study was conducted in partnership with the National Aboriginal Community Controlled Health Organisation, its affiliates, 34 Aboriginal Community Controlled Health Services and Torres Shire Council. Download Press Release with access to study
Stress may not be a major long-term obstacle to Aboriginal and Torres Strait Islander people quitting smoking, as previously believed, according to new research released by Menzies School of Health Research (Menzies) today.
The study found that more smokers who reported being stressed at baseline made quit attempts and stayed quit for longer in the next year, contrary to past research that mainly reported smokers’ perceptions that stress caused them to go back to smoking.
Forming part of the national Talking About The Smokes study led by Menzies in partnership with Aboriginal Community Controlled Health Services, the 759 study participants completed baseline surveys and follow-up surveys a year later.
Many health professionals and smokers believe that smoking relieves stress. But this relief may be merely because smoking a cigarette relieves the recurring symptoms of nicotine withdrawal caused by the time elapsed since their previous cigarette.
Download full press release
Are people who smoke at higher risk of COVID-19 infection?
It is not certain that smokers are more likely to be infected with COVID-19. At the moment the evidence is mixed on whether or not smokers have an increased risk of infection. This may be for several reasons:
- The evidence we have at the moment is mostly based on hospital admissions, so only really tells us about those people who seek help for their symptoms. Smokers might not recognise mild symptoms, such as increased cough. A large population study in the UK supports this possibility.
- The study (which is ongoing) uses a smartphone app where people record their health, including any symptoms like coughing, sneezing or fever. Data from 1.5 million users showed smokers were more likely to experience symptoms associated with COVID-19 than non-smokers. At the moment we don’t know if those smokers with symptoms went on to be confirmed cases of COVID-19, but this information may become available as the project continues.
- Information about smoking in these studies is usually based on self-report. It might be that people are not reporting their smoking status because they want to be seen to be doing the right thing.
- There is evidence people are quitting because of COVID-19. These people might be classed as former smokers, however if they only quit recently, perhaps they remained at risk of infection.
- It is possible that because smokers are aware of their increased risk to lung and chest infections, they are being ultra-cautious to avoid catching COVID-19.
What we do know is that the behaviours that smokers engage in put them at greater risk of infection. This includes:
- frequent hand to mouth action when smoking;
- sharing cigarettes;
- collecting and smoking discarded butts;
- limited physical distancing in designated smoking areas.
- damages your lungs, so they simply don’t work as well;
- weakens your immune system. This means the body has more trouble fighting the COVID-19 infection;
- increases the risk of getting a secondary infection such as pneumonia. Lungs naturally produce mucus, but people who smoke have more and thicker mucus that is hard to clean out of the lungs. This mucus clogs the lungs and is prone to becoming infected with bacteria.
The most recent evidence shows that if smokers get COVID-19 and are admitted to hospital then they are more likely to have severe symptoms and die than former or non-smokers. A study published in May 2020 combined hospital data from Asia, Europe and North America. The researchers found that active smokers were almost twice as likely to die than former or never smokers.
What about former smokers, or people who recently quit – are they still at more risk of COVID-19?
We don’t known if people who have quit smoking have a higher risk of getting COVID-19 or are more likely to get severe disease compared to people who have never smoked. What we do know is that:
- People who have been quit for a while and have normal lung function are less prone to respiratory infection than active smokers, so this is probably true for CVID-19 as well.
- It is also likely you’ll have a lower risk of severe complications if you become infected than if you were still smoking.
We don’t know how long you need to be smoke free to reduce any potential risk, but we do know that stopping smoking improves lung health within a few weeks. Risk of lung infections such as bronchitis and pneumonia also decrease in about 4-6 weeks after quitting. This is particularly important as Australia heads into flu season. Being smoke free improves your health and reduces your risk of getting respiratory viruses. And it improves your ability to fight off any illness.
Is it still safe to start, or continue to use, Nicotine Replacement Therapy (NRT) and other stop smoking medications?
For people who smoke, stop smoking medications or NRT (can help to reduce cravings and manage withdrawal symptoms. Combined with tailored support (for example from Quitline or your local Aboriginal Medical Service), these medications give people the best chance of successfully quitting. There is no evidence or reason to believe that COVID-19 has an impact on the safety and effectiveness of these medications.
- Anyone already using these medications can be reassured that it is safe to continue.
- Anyone thinking about starting these medications, should be see a qualified practitioner as usual.
There is also no evidence that stop smoking medications change the risk of contracting the virus. They are also unlikely to increase or reduce symptom severity. You may have read media stories suggesting nicotine could protect against COVID-19. This is not true. This is not a reason for anyone to smoke, smoking carries many risks to our health and wellbeing. It is also not sensible for non-smokers to start using NRT as it will not protect them from COVID-19. Hand hygiene and physical distancing are much more effective ways to stay safe.
How can you tell the difference between nicotine withdrawal symptoms and COVID-19 symptoms?
People who have recently stopped smoking may experience nicotine withdrawal symptoms, including cravings, irritability, and difficulty concentrating. These symptoms are usually temporary and disappear after about 2 to 4 weeks.
Quitters might also experience a cough and sore throat. These withdrawal symptoms may be confused with some of the symptoms of COVID-19. However they are usually temporary and not accompanied by other COVID-19 symptoms, such as fever. Fever is not a symptom of nicotine withdrawal.
Anyone concerned about COVID-19 should visit www.healthdirect.gov.au/symptom-checker/tool/basic-details, call the National COVID-19 Helpline on 1800 020 080, or speak to their doctor or AMS.
What are the risks of e-cigarettes and COVID-19?
As with traditional tobacco products, the evidence around COVID-19 and e-cigarette use (or “vaping”) is still emerging. However the evidence does show a higher number of severe respiratory infections in people who use e-cigarettes, so the risks may well be similar for vapers as they are for smokers. This is because using e-cigarettes has some similar effects to tobacco smoking on your body, including:
- increased inflammation in the lung;
- increased coughing and wheezing, probably indicating lung damage;
- lowered immunity and ability to fight off infection.
Vapers also engage in some of the behaviours that increase risk for smokers (such as frequent hand to mouth action). Vapers should follow good hygiene rules, washing their hands before and after vaping. It is also important not share devices with another person. Vapers should be reminded not to use e-cigarettes near others or in an enclosed space because the aerosol (vapor) produced might carry the virus if the vaper is infected. If someone touches a surface on which aerosol might have settled, they should wash their hands immediately with soap and water.
Is this a good time to quit?
It is always a good time to stop smoking. For some people, concerns about COVID-19 can act as a motivator to quit. Evidence from the UK and the USA supports this:
- In a UK survey of over 1,000 people, 2% said they had quit because of fears around COVID-19.
- In addition, a quarter of former smokers in the survey said they were less likely to resume smoking.
- In the USA survey of smokers, 20% of respondents had made a quit attempt because of COVID19.
Anyone who wants to quit should be encouraged to quit. As described, NRT and other stop smoking medicines are still safe to use.
However it is also important to recognise that for some people this will not be a good time to quit. Additional stress from being in lockdown, or being out of work can be a trigger to smoking. In a UK survey, 4% of former smokers reported that the pandemic had made them more likely to relapse. In a USA survey, 30% of smokers said they were smoking more. For people continuing to smoke, advice around harm reduction for themselves and others is important. Smokers should be reminded to:
- pay extra attention to the existing hygiene advice: wash your hands thoroughly and frequently, particularly before and after smoking, cough into your elbow, try to avoid touching your face, and maintain a physical distance from others;
- do not share cigarettes or roll a cigarette for someone else;
- smoke outside, not in the house, to reduce the impact of second hand smoke.
Smokers should also be reminded to get a flu shot, because they are at increased risk of becoming infected with the influenza virus. As we head into flu season with COVID-19 also around, the risk of catching a respiratory illness is higher than usual.
Smoking might put you at greater risk for contracting COVID19, but we don’t know for sure. Emerging evidence suggests smokers are more likely to have severe illness if they are infected. We should encourage smokers to:
- stay safe by following hygiene and physical distancing rules, not sharing cigarettes or vaping devices;
- protect others from second and third hand smoke by maintaining a smoke free home;
- quit if they can.
The dangers of smoking and exposure to second hand smoke have not changed. Stopping smoking has many health benefits beyond a link with COVID-19, and it saves a lot of money. It is always a good time to quit. As we head into flu season, quitting has never been more important – quit for life, not just for COVID-19.
You can find more information about COVID-19 on HealthInfoNet: https://healthinfonet.ecu.edu.au/learn/health-topics/infectious-conditions/covid-19-updates-and-information/
National COVID-19 Helpline: 1800 020 080
Quitline 13 78 48 -this includes access to Aboriginal Quitline counsellors – Aboriginal and Torres Strait Islander community members who are trained to support our community in quitting.
With thanks to Cancer Council’s Tobacco Issues Committee and Quit Victoria for their contribution to this article.