The Politics & Sciences of Cigarettes in the era of COVID-19

While hospital admissions of smokers among COVID-19 patients are lower than expected, observers are warning against acceptance of the “weird” notion that smokers may be less at risk of contracting the nasty virus.

The Politics & Sciences of Cigarettes in the era of COVID-19

The ban on the sale of cigarettes and tobacco-related products as one of the ways to fight the Coronavirus has become a hot potato for governments across the globe. In the neighbouring South Africa, after President Ramaphosa recently announced that the sale of cigarettes would be permitted in the eased Level 4 of the lockdown regulations, it turned out that he might have jumped the gun. 

In a subsequent briefing by the National Command Council (NCC) on Wednesday 29 April, the Minister of Cooperative Government and Traditional Affairs, Nkosazana Dlamini-Zuma, said while some products had been added to the list of essential goods available during the lockdown, cigarettes and alcohol were still not permitted for sale. Dlamini-Zuma cited the sharing of cigarettes among smokers as the reason for the revised decision. “Besides the effect itself on a person’s lungs, the way tobacco is shared does not allow for social distancing. The virus will be shared among them,” the minister said in a televised press conference on Wednesday. 

While the decision by the Government of South Africa appears to be politically motivated by pressure from anti-smoking advocacy groups backed by a majority of the ANC top brass, scientific research continues to debunk much of the conduit role that smoking might play in contracting the Covid-19 virus. Whereas scientists do not deny the already existing health hazards that may come with smoking, more “weird” proof continues to come out showing that smokers may be at less risk. 

The UK’s Daily Mail reported in the edition of April 28 that a review of 28 studies shows that the number of smokers among hospitalised patients is lower than expected.  According to the report, the University College London (UCL) academics looked at 28 papers and found the proportions of smokers among hospital patients were lower. UCL reviewed 28 studies from China, the US, France, South Korea and the UK. One of the studies showed that in the UK, the proportion of smokers among COVID-19 patients was just five per cent, a third of the national rate of 14.4 per cent. In France the rate was four times lower. In China, a study noted 3.8 percent of patients were smokers despite more than half of the population regularly smoking cigarettes.   

When smokers do get diagnosed with the virus, however, they appear to be more likely to get so sick that they need ventilation, two studies in the review showed. Researchers admit that hospitals are probably not recording patients' smoking status properly, potentially because they are too busy, patients are too sick to answer or because people lie in their answers. But they are struggling to knock down mounting evidence suggesting an apparent protective effect given by cigarettes, which one expert reportedly described as “weird.” 

A review of five early studies on the topic last month made the exact same conclusions that smokers may avoid serious infection but their outlook is worse if they do. Two of the authors on the recent UCL review received research grants from smoking cessation lobbies. Their paper was titled “The Association of Smoking Status with SARS-CoV-2 Infection, Hospitalisation and Mortality from COVID-19: A living rapid Evidence Review” and was published on the study-sharing website Qeios.  Most of the countries involved in the studies did almost all of their testing in hospitals. 

But the researchers noted that smokers were more likely to be tested, possibly because their symptoms, like a cough, are more obvious due to their habit. “We would therefore caution against drawing any conclusion as to whether smokers are at increased risk of SARS-CoV-2 infection at this early stage,” the UCL team made the disclaimer.

As the Botswana government is expected to announce some eased lockdown regulations on May 7, smokers in Botswana will be waiting with bated breath to find out whether the government will lift the ban on the sale of cigarettes. As in other countries, South Africa in particular, it will all depend on whether the government bases its decision on politics, science or the economics of the tobacco business.