The Difficulty and Wisdom of Quitting Smoking During the Pandemic

A recent review in the Journal of the Medical Association reminded readers that “...cigarettes remain the leading preventable cause of death” and that smoking “kills half a million Americans each year.” But as the reviewer points out, the cigarette epidemic has become invisible because of the more urgent needs of the Covid-19 pandemic.

Somehow the few television ads showing the physical devastation, and ultimately premature deaths caused by nicotine addiction don’t seem to have the same impact as nightly television broadcasts of hospital wards jammed with Covid-19 patients requiring heroic measures to stay alive. Some of those patients may be in need of intensive care because they are smokers, according to several reports and warnings from the American Cancer Institute, Centers for Disease Control and Prevention, and the World Health Organization ("WHO"). The WHO published a review of the current studies on smoking cigarettes as a risk factor for coronavirus in June.

Because smoking may impair lung function, increase susceptibility to infections, and decrease immunity, smokers are assumed to be at greater risk for getting Covid-19. Or are they? Evidence that they might be so susceptible comes from studies in China showing that men were contracting Covid-19 considerably faster than women, and the reason given was that their smoking rate is 20 times higher. Did the effect of smoking on their lungs increase their susceptibility? The WHO suggested that the physical act of bringing one’s fingers to the lips might also have increased virus transmission. But while the report concluded that there isn’t substantial epidemiological evidence that smoking increases susceptibility to the virus, the proverbial jury is still out.

Whether smokers are more likely to experience severe complications of Covid-19 is more certain. It is important to realize that all the studies quoted in the WHO report (and others not cited there) date back only a few months, and the information is gathered from hospital records. No one has set up a study in which smokers and non-smokers are followed for a year to see who is more likely to become ill from the virus and, once ill, to have milder or more severe symptoms (all other factors like age, gender, and exposure being equal between the two groups).

Once a smoker falls ill with Covid-19, there is some evidence that he or she may be sicker because of lung complications due to smoking. One study quoted by the WHO report found a statistically significant association between smoking status and admission to an Intensive Care Unit, ventilator use, or death. Although more information is needed to learn exactly how smoking frequency, duration, and type of cigarettes might relate to the severity of Covid-19 symptoms, the data are compelling. Indeed, organizations both governmental and private have been warning smokers to quit in order to decrease their morbidity and mortality from the virus.

But how? Given the anxiety, boredom, depression, difficulty sleeping, concentrating, increased appetite, irritability, and even mild flu-like symptoms (scary) that accompany nicotine withdrawal, who is going to help smokers succeed?

It turns out that there are numerous websites that may be able to help. One website, smokefree.gov, lists agencies, apps, social media sites, and online “quit coaches” that are available. The smoker can click on “live help,” a service provided by the National Cancer Institute, Monday through Friday 9 am to 9 pm EST and chat in English or Spanish with a live smoking counselor. I clicked on this site and had to apologize to the “live” counselor that I was just curious. Smokers can also visit the Psychology Today Therapy Directory to find a therapist.

The constant social isolation and boredom facing the smoker (and the rest of us) may work against success, regardless of how many interventions are available. People who used to leave their workplace to smoke outside now, if they work for home, can smoke whenever they wish. Sitting in front of a computer screen to participate in a Zoom conference causes many of us to feel restless, due to the enforced immobility. If we can’t move away from the screen, at least we can give our hands something to do by smoking. Those fearful of gaining weight while home because it is so easy to eat when bored may reach for a cigarette rather than a pint of ice cream. Nicotine is known to induce calmness, albeit only temporarily; so smoking during this period of chronic anxiety offers quick relief.

Of course, if the smoker is not allowed to smoke inside his home and must, by state law, wear a mask outside, smoking will be difficult or perhaps impossible. Perhaps this will be the catalyst to begin withdrawal from nicotine. (And it’s better than setting one’s mask on fire!)