One assumption about COVID-19 that’s been accepted as so obvious it needn’t be supported with data is that smoking heightens the risk of infection, hospitalization, and death.
Cigarettes are one of the most lethal products on the market. Their hazards are so various and well-known that it seems intuitive that smokers would be at severe risk for the coronavirus. In March, New York City Mayor Bill de Blasio asserted that smokers and vapers are more vulnerable to COVID-19. In a television appearance, the surgeon general speculated that vaping could be the reason why more young people were hospitalized in New York than anticipated.
But these beliefs are under severe strain as data emerge across the world on risk factors for COVID-19. The elderly, the severely obese, and diabetics all appear to be at an elevated risk. So what about smokers and vapers?
In March, Dr. Konstantinos Farsalinos and two colleagues analyzed the data coming out of China. It was widely speculated that the higher hospitalization and death rates among Chinese men could be boiled down to the vast gender differential in smoking rates.
Paradoxically, Farsalinos found that smokers were significantly underrepresented among hospitalized COVID-19 patients. Another review of the Chinese data published in the European Journal of Internal Medicine concluded that “active smoking does not apparently seem to be significantly associated with enhanced risk of progressing towards severe disease in COVID-19.”
A similar pattern was soon discovered in the United States, France, and Germany. Data from the Centers for Disease Control and Prevention show smokers represented just 1.3% of COVID-19 cases analyzed. America’s adult smoking rate is 13.7%. Smokers were also significantly underrepresented in a study of New York City patients. In France, a study of 343 coronavirus patients found 4.4% were daily smokers. France’s daily smoking rate is 25%. In Germany, a peer-reviewed study of 50 patients found 6% were smokers. Germany’s smoking rate is 21%. It remains unclear whether smokers who are hospitalized with COVID-19 fare any worse than nonsmokers.
Reacting to the evidence, the Norwegian Institute of Public Health removed smoking as a risk factor for severe coronavirus symptoms in mid-April. Jean-Pierre Changeux, a world-renowned neurobiologist, was so moved by the data he saw in France that he is now investigating whether nicotine patches could play a protective role against COVID-19. Changeux theorizes that the nicotinic acetylcholine receptor plays a major role in the progression of the virus and could be a target for prevention.
There are, of course, numerous questions about the quality of the data we have thus far. While it’s too early to conclude why so few COVID-19 patients are smokers or how nicotine interacts with the coronavirus, the data do pose serious questions for researchers. If nicotine does play a protective role against COVID-19, it would be an extraordinary development that could prevent needless death and suffering.
Unfortunately, there’s a danger that ideology may stymie scientific investigation. Anti-tobacco groups have lashed out at the idea that nicotine could be in any way beneficial. On Friday, the Campaign for Tobacco-Free Kids attacked the French study as unreliable and claimed that in all likelihood, smokers and vapers are at higher risk from COVID-19. On April 17, a Bloomberg article smeared tobacco harm reduction advocates who questioned the as yet nonexistent link between e-cigarettes and coronavirus symptoms as spinning for Philip Morris.
Nicotine has long been stigmatized for its association with cigarettes and is far more reviled than the active drug in marijuana, THC. But it’s important to remember that it’s not the nicotine that kills smokers but rather the burning of tobacco and inhaling the resulting smoke. Divorced from cigarette smoke, nicotine is a relatively benign stimulant.
As with all aspects of the pandemic, we desperately need more and better data. But we shouldn’t start from the premise that nicotine’s relationship with COVID-19 is a question of just how much we hate Philip Morris. It’s a scientific question that should be studied until we find a satisfactory answer. Researchers shouldn’t be cowed into backing away from this question for fear the public will rush out of their homes and stock up on Marlboros.
Thankfully, we’ve moved on from the days of Mad Men. There are a plethora of nicotine products that pose little risk to their users, such as gums, patches, vapes, smokeless tobacco, and heat-not-burn tobacco. An endorsement of nicotine is no longer synonymous with an endorsement of smoking.
A crucial part of public health is disseminating accurate information. If scientists don’t thoroughly investigate the relationship between nicotine and COVID-19, we could miss out on a huge opportunity — or at the very least, a chance to better understand why the statistics have been found wanting.
Guy Bentley (@gbentley1) is a contributor to the Washington Examiner’s Beltway Confidential blog. He is the director of consumer freedom at the Reason Foundation.
