We are still in the early days of the COVID-19 pandemic, and many questions remain. What is the relationship between smoking and risk of infection, hospitalization, or severe complications? Do smokers who switch to vaping nicotine face similar risks? And, finally, is the media reporting on these issues accurately?

The only certain answer to the first two questions is that it’s too early to say. We need more data.  Ideally, a careful nicotine use history would be recorded for all patients with COVID-19 admitted to hospitals. Where feasible, these patients would be tested for nicotine use and for the products of combustion from cigarettes and bidis to verify self-reported histories.

As scientists love to say, “More research is needed.” There are knowns, known unknowns, and probably a lot of unknown unknowns. Current evidence on the relationship between COVID-19, smoking and nicotine vaping ranges from strong to none.

Strong evidence 

Long-term smokers are more likely to suffer from colds, influenza, and pneumonia than non-smokers.  They are also more likely to develop ‘comorbidities’ like chronic obstructive pulmonary disease (COPD). However, at least in the United States, ‘only’ 13–15% of current smokers suffer from COPD. These individuals are more likely to suffer severe COVID-19 complications.

Moderate evidence 

Based on the above table, there is currently no evidence that smokers who are diagnosed with COVID-19 are more likely to be hospitalized than non-smokers. But disease severity may differ. For example, one study of 1,099 COVID-19 patients in China found that 21% of smokers, and only 14% of non-smokers, developed complications. Unfortunately, there is no evidence yet on any potential links between COVID-19 and vaping. There is, however, intriguing evidence that most smokers who switch to nicotine vaping have fewer respiratory tract infections (colds and flus), coughs, and phlegm. 

No evidence

So far, there is no credible evidence that smokers or nicotine vapers are more likely to be infected with coronavirus. Nor is there evidence linking vaping to COVID-19 hospitalization or complications. Logically, there are three possibilities for nicotine vapers — vaping may increase, decrease, or have no effect on COVID-19 risk. All three possibilities should be studied during this pandemic.

Is the media reporting this accurately?

Here is a small, representative snapshot of relevant global news between April 8 and April 13, 2020:

·  Jamaican group warns smoking is a risk factor for COVID-19 complications

·  Health groups warn that smokers are at greater risk during pandemic

·  Kenyan anti-tobacco chairman: smoking increases COVID-19 risks

·  Japanese should quit tobacco over COVID-19

·  National effort in Ireland needed to reduce smoking amid COVID-19 threat

·  Public vaping should be banned to prevent COVID-19 transmission

·  Twenty Bangladeshi anti-tobacco groups call for temporary cigarette sales ban due to COVID-19

·  Huge amounts of data confirm that smokers are at greater risk from COVID-19

·  Massachusetts attorney general sends smoking and vaping health advisory

·  Experts say smokers are at greater risk of COVID-19

·  Risk for smokers and vapers during COVID-19

·  Juul use may result in ‘more serious complications’ from COVID-19

·  Smokers and others with COPD may be at greater risk of COVID-19

·  Philippine Department of Health warns against smoking and vaping amid pandemic

·  Smoking and “possibly” e-cigarette use are risk factors for severe COVID-19

·  “Unfounded statements” on vaping and COVID-19 are “completely unacceptable”

My take

The relationship between smoking and COVID-19 is complex, possibly counterintuitive, and rarely reported accurately in the press. With or without COVID-19, we must never forget that there is overwhelming evidence linking smoking to 7 million deaths every year from cancer, heart, and lung disease. There is an urgent need to develop and ensure access to safer and more effective smoking-cessation products and services.

* Average smoking rates for adults (male and female) in each country. In France, Germany, and the United States, gender differences in adult smoking are modest. Note, however, that in China at least 44.8% of men smoke, but only 2% of women.