COVID-19 pandemic underscores the health risks for smokers with chronic bronchitis

A staggering 20% of the world’s population is currently living under lockdown, as governments and public health professionals are resorting to drastic measures to bring the coronavirus pandemic under control.

Three months after the novel coronavirus COVID-19 emerged in the Chinese city of Wuhan, there’s a lot which remains uncertain about the disease. Are coronavirus survivors immune to the virus, for example—and how long will this immunity last? The answer could be critical both for health policy going forward and in the race for a coronavirus vaccine.

We are, however, starting to develop a clear profile of the people most susceptible to the virus. Children appear unlikely to have more than mild symptoms if they are infected, while people aged 60 and older, as well as those with underlying health issues like asthma or high blood pressure, face dramatically higher risks.

One factor partially explains why the epidemic’s epicentre is now squarely situated in Europe: it’s extremely likely that smoking and vaping increase the chances of developing life-threatening pneumonia from the coronavirus. Data on Chinese patients diagnosed with COVID-19 has suggested that a history of smoking is the single biggest risk factor for severe complications—raising the risk of death by as much as 14 times.

This is bad news for Europe. Some 15-20% of Europe’s adult population over the age of 40 suffer from impaired lung function because of Chronic Obstructive Pulmonary Disease (COPD), for which tobacco use—both smoking traditional cigarettes and next-generation products like e-cigs— is a major contributing factor.

Underscoring the worrying prevalence of tobacco use in Europe, tobacconists are, along with essential services such as banks and grocery stores, among the very few shops which Italy, France, Spain and Switzerland have allowed to remain open during lockdown.

BPCO whistleblowers ring the alarm

Groups such as France’s BPCO (the French acronym for COPD) association have sounded the alarm in recent days about the particular risk which the coronavirus poses to COPD patients. The chronic condition, which can lead to progressive and irreversible obstruction of the airways, doesn’t receive the attention it deserves for as widespread as it is. In France, where more than a quarter of the population smokes, the disease affects 5 to 10% of adults. Some 700,000 French citizens are severely impacted by the illness, while 150,000 rely on supplemental oxygen to survive.

As the BPCO association underlined, COPD patients are already “permanently suffocating”, making them uniquely vulnerable to respiratory diseases like the flu or the novel coronavirus. Philippe Poncet, the organisation’s head, deplored the fact that governments have yet to take any specific measures to protect COPD sufferers from COVID-19. “Since coronavirus destroys the lungs, it’s us, those suffering from COPD, who will die first”, Poncet underlined, calling on the French health ministry to make hospital services more aware of the unique challenges COPD sufferers face and to provide them with FFP2 masks and disinfectant gel.

A new opportunity to highlight the risks of smoking and vaping

The dramatic risk which the novel coronavirus poses to people with respiratory issues linked to tobacco use has put renewed emphasis on the myriad health problems which smoking can contribute to.

In recent years, European governments have made increasing efforts to curb tobacco use—unfortunately, with middling success. In France, for example, the government recently fulfilled its promise to tighten the fiscal screw on tobacco manufacturers. As of March 1^st, the price of a pack of the most popular cigarette brand in France reached the symbolic price of €10 as new government taxes went into effect.

Other European countries have tried similar strategies—a pack of smokes now costs over €13 in Ireland, for example, which clearly has a dissuasive effect. Unfortunately, there is a wide disparity in cigarette prices across the European bloc—a pack is roughly €2.50 in Bulgaria—which runs the risk of encouraging smokers to resort to the black market.

To make matters worse, European governments aren’t prepared to tackle the widespread underground trade in tobacco products. Thanks to undue influence from the tobacco industry, the system which the EU is implementing to combat illicit cigarette trafficking has been widely denounced as ineffective.

Indeed, some experts have raised concerns that the tobacco industry—known for its long history of deception, including having been involved in smuggling its own products—has infiltrated the EU’s anti-illicit trade system, contrary to the World Health Organisation’s fundamental principles.

Focusing anti-tobacco efforts on hiking taxes on cigarettes may also have the undesirable consequence of directing consumers towards other products like electronic cigarettes. The industry has tried to hold these out as “safe” alternatives—but the evidence is mounting that electronic cigarettes and so-called “heat not burn” products irritate lung tissue, leaving users vulnerable to  diseases including the new coronavirus.

New risk patterns identified for heated tobacco products and electronic tobacco smokers

Indeed, outbreaks of severe lung disease among e-cig consumers has led the scientific community to warn against these products. As per the precautionary principle, public health experts, including the World Health Organisation, have urged countries to regulate and tax e-cigarettes and heated tobacco products no differently than conventional smokes.

With the coronavirus pandemic posing a serious threat to anyone with compromised lung function, it’s even more urgent that authorities take the measures recommended by public health bodies to curb the use of both conventional and next-generation tobacco products.