COVID-19 and tobacco: “commit to quit"

Author(s): Jesslyn Thay , Date: 27 May 2021

At the initial outbreak of the coronavirus pandemic smoking rates plummeted worldwide as scientists produced substantial evidence that tobacco smoking was linked to a higher risk of developing complications from COVID-19. However, as country-wide lockdowns dragged on for months, many smokers actually increased their tobacco intake.

The World Health Organization is sending a strong message for this year’s World No-Tobacco Day - “commit to quit”, a campaign to help 100 million people quit tobacco.

The health day on Monday 31st May, raises global awareness around the dangers of tobacco use, encouraging smoking cessation, promoting the health benefits of quitting smoking and health education of younger generations around tobacco and addiction.

Tobacco and infectious disease

Being a smoker does increase an individual’s risk of developing complications of any disease, but particularly respiratory diseases (Patanavanich and Glantz 2020). The World Health Organization (WHO) says: “Smoking impairs lung function making it harder for the body to fight off coronaviruses and other diseases.”

Smoking tobacco is a negative health behaviour, impacting on the overall health of an individual. While people are generally aware of the link between smoking and non-communicable diseases such as lung cancer and emphysema, many are unaware that tobacco use also negatively impacts the immune system, (Qui et al. 2017).

Many studies have shown that smoking increases the risk of developing life-threatening complications from COVID-19 The WHO conducted an extensive review into Smoking and COVID-19, they concluded: “At the time of this review, the available evidence suggests that smoking is associated with increased severity of disease and death in hospitalized COVID-19 patients”

Recent studies in the United Kingdom, showed smokers were twice as likely to visit hospital with covid-related symptoms – such as increased breathlessness - than non-smokers (Hopkinson et al., 2021).

To combat smoking during the pandemic, and the perceived risk of viral transmission during smoking, several countries imposed bans on selling tobacco. India and South Africa banned the sale of tobacco products, while 17 countries in the WHO-Mediterranean region banned tobacco waterpipe use in public places to reduce viral droplet transmission,  reported The Lancet .

There has also been debate among some scientists as to whether nicotine consumption has a mild protective effect from coronavirus. A clinical trial undertaken in Paris, France, fitted transdermal nicotine patches to healthcare workers, the results are still being analysed.

Meanwhile, contradictory preprint research actually suggests smokers had a lower incidence of contracting coronavirus as well as being less likely to have symptomatic COVID-19 (Miyara et al. 2020).

Lockdowns and health behaviours

Across the world enforced lockdowns to curb the virus spread forced millions of individuals to stay at home; many faced isolation, boredom and loneliness. These were key triggers for smokers to increase their cigarette consumption during the pandemic, even when they had considered quitting because of coronavirus.

In New Zealand, nearly half of daily smokers reported smoking more during than before the lockdown, on average, an increase of six cigarettes a day (Gendall et al. 2021).

This trend for increase smoking rates was reflected in Europe too. Almost 10% of participants in an Italian study started, relapsed smoking or increased their smoking intensity during the coronavirus pandemic. In total, the lockdown increased the participants cigarette consumption by 9.1% (Carreras et al., 2021).

Research by Penn State University College of Medicine, found Americans’ smoking patterns also changed due to the pandemic (Yingst et al 2021). Smokers who were isolated at home during lockdown increased cigarette consumption, One study participant stated: "Working at home allows me to smoke at will rather than being in a smoke-free environment for 8 hours per day."

In contrast, the Penn State researchers noted that around 10% of participants decreased their tobacco use. They attributed this decrease to schedule changes, being around non-smokers such as children, and for health reasons.

Looking forward:

Health professionals from across the world are hoping No World Tobacco Day 2021 will provide the inspiration for millions of smokers to quit, improve their health and decrease their risk of developing severe COVID-19.

The global coronavirus vaccination program is underway and over 1.78 billion doses have been given, with 408 million individuals now fully vaccinated against COVID-19, according to Our World in Data.

CABI Global Health has over 500 results when searching: ("smoking" or "tobacco") AND ("covid-19" or "coronavirus")



Ahluwalia, Indu B et al. (2020) COVID-19 pandemic: an opportunity for tobacco use cessation.The Lancet Public Health, Volume 5, Issue 11, e577

Carreras G, Lugo A, Stival C, et al (2021) Impact of COVID-19 lockdown on smoking consumption in a large representative sample of Italian adults Tobacco Control Published Online First: 29 March 2021. doi: 10.1136/tobaccocontrol-2020-056440

Hopkinson NS, Rossi N, El-Sayed_Moustafa J, et al (2021) Current smoking and COVID-19 risk: results from a population symptom app in over 2.4 million people Thorax Published Online First: 05 January 2021. doi: 10.1136/thoraxjnl-2020-216422

Makoto Miyara, Florence Tubach, Valérie Pourcher, Capucine Morelot-Panzini, et al. (2020). Low incidence of daily active tobacco smoking in patients with symptomatic COVID-19.  Qeios. doi:10.32388/WPP19W.2.

Patanavanich R, Glantz SA (2020). Smoking Is Associated With COVID-19 Progression: A Meta-analysis. Nicotine Tob Res. 2020 Aug 24;22(9):1653-1656. doi: 10.1093/ntr/ntaa082. PMID: 32399563; PMCID: PMC7239135.

Qiu, F., Liang, C. L., Liu, H., Zeng, Y. Q., Hou, S., Huang, S., Lai, X., & Dai, Z. (2017). Impacts of cigarette smoking on immune responsiveness: Up and down or upside down?. Oncotarget, 8(1), 268–284.

Yingst JM, Krebs NM, Bordner CR, Hobkirk AL, Allen SI, Foulds J. Tobacco Use Changes and Perceived Health Risks among Current Tobacco Users during the COVID-19 Pandemic. International Journal of Environmental Research and Public Health. 2021; 18(4):1795.