The coronavirus disease 2019 (COVID-19) is a new illness caused by a virus that can affect people’s lungs and airways. Symptoms of COVID-19 are a cough, a high temperature and shortness of breath. There are some groups of people who may be more at risk of serious illness if they catch coronavirus, including older people, people with long term health conditions and people who are immunosuppressed. Increasingly experts are concerned about the impact of COVID-19 infection on people who smoke.

Smoking
Smoking harms the immune system, reducing the bodies’ natural protection against a range of health conditions, including respiratory infections like COVID-19. It is well-established that people who smoke are at greater risk of: 
•    getting acute respiratory infections;
•    these infections lasting longer; and
•    these infections being more serious than it would be for someone who does not smoke.

These risks are also greater for people exposed to secondhand smoke, including children.

COVID-19 and smoking
Currently there is not enough evidence to be certain that people who smoke are more susceptible to COVID-19 infection than those who don’t smoke, however given COVID-19’s impact on the respiratory system, it is very likely. In addition, new research from COVID-19 patients in China has found that people who smoke were more likely to see their disease progress to the severe stage compared to non-smokers (1), which is in line with evidence on disease severity among other respiratory infections.

COVID-19 and e-cigarettes
There is no definitive link between vaping and respiratory illness. Despite some speculation that e-cigarette use could increase risks from COVID-19 and that people infected with coronavirus could transmit the virus through e-cigarette aerosols, to date there is no good evidence for this. Therefore, our position on e-cigarettes remains unchanged: Cancer Research UK would continue to encourage people who smoke to think about switching to e-cigarettes to reduce their risk of respiratory infections. E-cigarettes are a relatively new product – they aren’t risk free and we don’t yet know their long-term impact. However, the evidence so far shows they are less harmful than smoking and can be a helpful cessation tool.

Stopping smoking
The best way for people to reduce their risk of cancer and improve their overall health is to stop smoking completely.  For people who want to stop smoking, there are a number of tools available to support people to quit. Stop smoking services are still open and the majority are supporting patients using telephone and video calls. Patients can also use prescription medications like nicotine replacement therapy and varenicline, and e-cigarettes. It’s important that people who want to quit smoking continue to have access to the best tools to help them quit.  Find out more about the tools available to support people to quit here.

In response to the COVID-19 pandemic, England’s Chief Medical Officer has advised that “If you are going to give up smoking, this is a very good moment to do it”. Similar advice was offered Scotland, with interim Chief Medical Officer Gregor Smith urging Scots: “please, if you can, try to cut down or even stop your smoking”.

Further information and advice for health professionals
If health professionals are interested in the link between smoking and COVID-19, more information can be found on the #QuitforCovid campaign page at todayistheday.co.uk. 

Health professionals should continue to have supportive discussions with patients about how to stop smoking, referring to stop smoking services where available and providing prescription medication.

Reference:
1.    Zhao, Q., Meng, M., Kumar, R., Wu, Y., Huang, J., Lian, N., Deng, Y. and Lin, S. (2020), The impact of COPD and smoking history on the severity of Covid‐19: A systemic review and meta‐analysis. J Med Virol. Accepted Author Manuscript. doi:10.1002/jmv.25889

Further Resources 

-    In response to the COVID-19 pandemic, the #QuitforCOVID campaign was launched in early 2020. For information about the campaign, click here. 
o    Note that public support for Quit for Covid is not uniform across the UK. For example, while support is strong in England and Wales, in Scotland, ASH Scotland and the Scottish Government’s public messaging is limited on this to ensure that general Covid messaging is as simple as possible.
-    For information on the tools available to support people to quit, click here. 

CRUK online resources: smoking cessation and e-cigarettes
CRUK E-cigarettes hub and CRUK Smoking cessation hub:
•    One-stop hub for all health professionals
RCGP position statement on e-cigarettes and supporting podcast and video:
    Suitable for the busy GP – 10 minutes long
    Addresses key concerns around safety, passive vaping and entry into smoking
Webinar – Smoking cessation: Why and how to support your patients to stop smoking (when time and funding are against us!)
    Suitable for the busy GP – 20 minutes long
    Addresses current smoking cessation strategies available to GPs
E-learning modules – Very Brief Advice and Smoking cessation
    Behaviour change and cancer prevention
    Essentials of smoking cessation
    30 minutes each, offering practical support
Primary care and cancer matters: practice case study video on helping patients quit
    5 minutes to find out what they achieved and what you can do