Capitalizing on Smoking Cessation Could Curb Coronavirus Deaths

By Brian Barnett MD, Jack Turban MD 05/13/20

The data we have so far show that smokers are over-represented in COVID19 cases requiring ICU treatment and in fatalities from the disease. 

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Man in mask breaks a cigarette in front of him
If there were ever a time to quit, it’s now.  ID 180945177 © Ilkercelik | Dreamstime.com

Politicians have been hyper-focused on the drug hydroxychloroquine lately, hoping it will be a silver bullet for curbing deaths from coronavirus. Physicians, on the other hand, are less convinced it will be helpful. But we’ve already got a medical intervention that could dramatically alter the course of the pandemic: smoking cessation. Fighting the smoking pandemic could curb coronavirus deaths now and save lives in the years to come. 

Many people smoke and vape to stay calm. So with rising rates of coronavirus anxiety, it’s no surprise that cigarette and vaping sales are booming. But emerging evidence shows smokers are at a higher risk of serious coronavirus infection. If there were ever a time to quit, it’s now. 

The data we have so far show that smokers are over-represented in COVID19 cases requiring ICU treatment and in fatalities from the disease. One study from China estimated that smoking is associated with a 14-fold increased odds of COVID-19 infection progressing to serious illness. This might be because smoking increases the density of the lung’s ACE2 receptors, which the coronavirus exploits to infiltrate the body. On top of this, smoking weakens the immune system’s ability to fight the virus, as well as heart and lung tissue. All of this damage increases one’s risk of severe coronavirus infection and death. 

While less is known about vaping’s relationship to coronavirus, research suggests that it impairs the ability of immune cells in the lung to fight off infection. This appears to be related to solvents used in vaping products and occurs independent of their nicotine content. Vaping also shares another risk factor for coronavirus with smoking—it involves putting something you touch with your hands into your mouth over and over. Unless you’re washing your hands and cleaning your vape religiously, you’re putting yourself at risk. On top of this, we know that many people—especially those who are younger—like to share their vapes, which really increases the chances of catching the virus. 

Most smokers want to quit and find that their stress levels drop dramatically when they do. Many vapers want to stop too. Quitting alone can be nearly impossible though. Luckily, support is available. Primary care physicians are still working via telehealth, and they have a wide range of effective treatments for what doctors call “tobacco use disorder.” If you can’t reach your doctor, The U.S. Centers for Disease Control has created a national hotline for support and free counselling: 1-800-QUIT-NOW.

Psychotherapy is one approach to quitting. However, medications such as bupropion and varenicline are also effective and can be obtained with a phone call to your doctor. Nicotine replacement products like gum, lozenges, patches, and inhalers also greatly increase the odds of success and are available over the counter. Few people are aware that you can purchase these with your health savings and flexible spending accounts. 

34 million people in the US smoke, and there have already been nearly 700,000 documented domestic cases of coronavirus. Given the number of deaths we could face from people smoking during this pandemic, lawmakers should be doing everything they can to make it easier for people to quit. When patients have better insurance coverage for smoking cessation treatments, they’re much more likely to use them and quit smoking. 

Federal law requires insurers to cover cessation treatments, but they get around this by restricting access through the use of co-pays and limits on the amounts covered, while also forcing physicians to spend hours on the phone getting them to authorize coverage of medication. With people dying by the tens of thousands, Washington needs to close these loopholes now.

Amid the widespread panic around coronavirus, it’s important that we stay clear-headed and not overlook easy fixes that could save lives. We know that smoking cessation interventions could prevent deaths, so let’s make sure we’re taking advantage of them.

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Brian Barnett is an addiction and forensic psychiatrist practicing in Cleveland, Ohio. In addition to caring for patients and conducting research, he writes about addiction and mental illness for the public. His writing primarily addresses barriers to care for individuals seeking treatment, as well as the intersection of mental illness, addiction and the criminal justice system. His articles have appeared in publications such as HuffPost, Stat, Vice and the Washington Post. Follow him on Twitter @BrianBarnettMD.

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Jack Turban MD MHS is a clinical fellow in psychiatry at Harvard Medical School. His writing has appeared in STAT, The New York Times, The Washington Post, and The New England Journal of Medicine, among others. Follow him on Twitter @jack_turban.