Researchers are looking at the potential of nicotine as a protective agent against respiratory inflammation caused by severe acute respiratory syndrome coronavirus 2—the strain responsible for Covid-19.
“There are studies showing that smokers are under-represented among Covid-19 patients, especially hospital patients,” Dr. Konstantinos Farsalinos, a Greek cardiologist, said during the virtual Global Forum on Nicotine. “We think that nicotine is the most plausible candidate for these smoking-related effects.”
Farsalinos, a research fellow at the Onassis Cardiac Surgery Center in Athens-Greece, said it is possible that nicotine, and not smoke, is the one responsible for the lower susceptibility of smokers to Covid-19 infection and hospitalization.
“In this is true, we expect that the beneficial effects of nicotine are going to be masked by the adverse effects of smoking,” Farsalinos said.
“The low smoking prevalence among hospitalized Covid-19 patients led us to generate a new hypothesis—that perhaps there is an interaction between SARS-COV 2 and nicotine acetylcholine receptors,” he said. Farsalinos said more studies and experiments were needed to prove this hypothesis.
Dr. Riccardo Polosa, a professor of Internal Medicine at University of Catania and director of the Center for Smoking Prevention and Treatment at the University Hospital, said several cohort studies in France, the UK and Israel showed that smokers were less likely to be infected by SARS-Cov2 than non-smokers.
“The mounting evidence does not point to smoking as a risk factor at least. It is not a risk factor for those susceptibilities. As a consequential educated guess, given that combustion-free nicotine delivery systems are much less toxic than combustible cigarettes, let me tell you that vaping and using heat-not-burn products is highly unlikely to be a risk factor for Covid-19 infection and disease,” Polosa said during the same forum.
Experts, however, clarified that the smoking epidemic could kill more than 7 million people this year, greater than the expected number of deaths from Covid-19. “Tobacco is the real pandemic. It is on track to kill five times as many people as Covid-19,” said Dr. John Oyston, a medical doctor from Canada.
GFN, traditionally held in Warsaw, Poland, is an annual conference organized by London-based Knowledge Action Change Limited to discuss the merits of tobacco harm reduction products such as e-cigarettes, heat-not-burn tobacco products and snus as safer alternatives to combustible cigarettes. Nearly 600 individuals participated in the 2020 forum which delivered presentations from 30 expert speakers on the theme “Nicotine: science, ethics and human rights”.
The participants in the forum talked about the latest evidence on the interplay between nicotine, smoking and COVID-19; the impact of the deliberate and continued misattribution of the so-called ‘EVALI’ lung-injury crisis to nicotine vaping instead of illicit THC; moral panics over low youth vaping rates taking precedence over the health of millions of adult smokers and vapers and Big Philanthropy’s effect on global public health.
Scientists and experts in public health and tobacco control highlighted the need for 1.1 billion smokers, and millions of adults who have switched away from smoking, to access appropriately regulated safer nicotine products such as vapes (e-cigarettes), Swedish snus, nicotine pouches and heat-not-burn tobacco products.
For decades it has been known that it is the burning of tobacco, and the release and inhalation of smoke, that causes disease. Nicotine itself is not a carcinogen. The UK Royal College of Physicians said in a 2016 report that “any long-term hazards of nicotine are likely to be of minimal consequence in relation to those associated with continued tobacco use.”
“Tobacco harm reduction is good public health. It starts with the people who matter-—people who smoke, and people who have switched to a chosen alternative —and it fosters and encourages change. Tobacco harm reduction is not antithetical to tobacco control; it should be part of it,” said GFN conference director Professor Gerry Stimson, emeritus professor at Imperial College London and former honorary professor at the London School of Hygiene and Tropical Medicine.
“Currently, obstacles to widespread adoption of tobacco harm reduction include big US philanthropic foundations with a myopic view of tobacco control, creating divisions where none should exist, and international organizations wedded to a narrow view of what defines success. The global public health community must develop more ambition about what can be done – as well as a healthy dose of compassion for the individuals living with the consequences of inaction, of whom around seven million will die this year,” Stimson said.
Prof. David Sweanor of the Centre for Health Law, Policy and Ethics at the University of Ottawa, said consumers in many countries including Sweden, Norway, Iceland and Japan have shown they move to alternatives to cigarettes when they get an option to.
“Imagine what would happen if people get access to a broad range of low-risk alternatives to cigarettes, if they get information on relative risk, and if they’re nudged toward those options through intelligent, risk-proportionate regulation? The opportunity we have is to fundamentally change the course of public health history, relegating cigarettes to history’s ashtray,” Sweanor said.
Clarisse Virgino, Philippine representative to the Coalition of Asia Pacific Tobacco Harm Reduction Advocates, said governments and health authorities were blocking access to safer smoke-free nicotine products to the detriment of consumers.
“Consumers become the collateral damage, the one who suffer if prohibitive policies are put in place,” Virgino said. “Such prohibition will affect those who made the switch and force them to return to combustible tobacco.”
About 15.6 million Filipinos are smokers, translating into a smoking prevalence of 23.3 percent of the adult population. As a result, smoking leads to around 117,700 deaths in the country each year, or 10 Filipinos dying of tobacco-related diseases every hour.
Nearly 80 percent of the world’s smokers live in low and middle-income countries such as the Philippines. Experts said the smoking epidemic, the single biggest cause of non-communicable disease, could kill 7 million people in 2020.
Nearly half of smokers are expected to die of smoking-related illnesses. THR advocates said the 1.1 billion smokers across the world would benefit from a switch to safer smoke-free nicotine products because it has been known for decades that it is the combustion or burning of tobacco, and the release and inhalation of smoke, that causes disease.
The Global Burden of Disease study estimates that smoking directly accounted for 7.1 million premature deaths in 2017, with an additional 1.2 million deaths attributed to second-hand smoke.
The annual forum, the seventh so far, was held online on June 11 and 12 this year amid the threat of the COVID-19 pandemic this year.
