Old cigarette ads often made outrageous claims about cigarettes, including, infamously, that they could cure asthma. (They can't.) So the rumors that smokers might be at lower risk for contracting COVID-19 seem similarly specious.
Oddly, such rumors seemed to be rooted in a grain of truth. (We'll get to that later.) Still, Salon spoke with three experts, all of whom said the same thing: it is almost certain that smoking puts you at greater risk of dying from a coronavirus infection.
"They're not saying that smoking prevents [coronavirus]. They're saying that nicotine prevents it," Dr. William Haseltine, the founder and former CEO of Human Genome Sciences, and currently the chair and president of the global health think tank Access Health International, told Salon regarding an April study in "Comptes rendus biologies" led by French neuroscientist Jean-Pierre Changeux.
"Smoking clearly exacerbates it. The nicotine, maybe an acetone," Haseltine continued. "I can tell they have to show the data, and I don't think they show the data here. All they do is speculate. But the danger is that many people may conflate nicotine with smoking. That's definitely bad for you."
He added, "There are many studies around the world, many different populations have shown that if you are a current smoker, your chance of dying from an infection is much higher than if you were not. This paper opens the possibility that nicotine may be a useful treatment; it doesn't show it, but speculates based on some detective logic. That logic may be correct. I can't say because I have to do the experiments to know if it is correct."
The study that Haseltine referenced was popularized by a Vice article last month with the headline "Why Are Smokers Being Hospitalized Less Often From Coronavirus?" It noted how the Changeux study found that "of 343 hospitalized patients, only 4.4 percent were recorded as smokers; of 139 outpatients, only 5.3 percent were recorded as smokers." Changeux notes that "more than a quarter" of the French population smokes cigarettes.
The article also featured a study led by Greek cardiologist and tobacco harm-reduction specialist Dr. Konstantinos Farsalinos, which concluded that their "preliminary analysis does not support the argument that current smoking is a risk factor for hospitalization for COVID-19 . . . . Instead, these consistent observations, which are further emphasized by the low prevalence of current smoking among COVID-19 patients in the US (1.3%), raises the hypothesis that nicotine may have beneficial effects on COVID-19." It acknowledged that "other confounding factors need to be considered and the accuracy of the recorded smoking status needs to be determined. However, the results were remarkably consistent across all studies and were recently verified in the first case series of COVID-19 cases in the US."
"The generalized advice to quit smoking as a measure to improve health risk remains valid, but no recommendation can currently be made concerning the effects of smoking on the risk of hospitalization for COVID-19," the study concluded.
Dr. Russell Medford, chairman of the Center for Global Health Innovation in Atlanta, shared his own thoughts with Salon about the studies in question.
"The nicotinic acid hypothesis that is the basis for all of these studies is not unreasonable from a molecular standpoint," Medford explained. "The data that relates to cigarette smoking to the progression of COVID-19, in the most recent study that I'm referring to, shows a significant risk of progression of disease in patients who have a current or recent or have a history of smoking. The two are not linked."
He added, "The nicotinic acid hypothesis and cigarette smoking are not to be linked together. I think that there is an incorrect assessment of the available data, that for some reason cigarette smoking is somehow protective, and it is simply not borne out by any of the data that I've seen. And indeed, a great deal of the data on meta-analysis suggests just the opposite — that outcomes and disease severity are enhanced by cigarette smoke."
Medford shared two scholarly articles with Salon that support his claims regarding how smoking increases one's vulnerability during the pandemic. One was written by Roengrudee Patanavanich, MD and Stanton A Glantz, PhD and published in the May 13 issue of "Nicotine & Tobacco Research." It concluded that "smoking and e-cigarette use increases risk and severity of pulmonary infections because of damage to upper airways and a decrease in pulmonary immune function. In particular, smokers have a higher risk of infection and mortality from Cov-MERS."
The other study was published in the journal "PLOS One" earlier this month and concluded that "compared to former and never smokers, current smokers were at greater risk of severe complications and higher mortality rate. . . . Effective preventive measures are required to reduce COVID-19 risk in COPD [chronic obstructive pulmonary disease] patients and current smokers."
Dr. Georges Benjamin, executive director of the American Public Health Association, echoed Haseltine's and Medford's observations.
"People should not think that smoking is going to help them with their disease," Benjamin explained. "We know that that is not the way the pathology of the disease works. When you smoke, you injure the lining of your airway and your lungs, and you may actually make yourself more susceptible to the virus. Now it may very well be that nicotine has some impact on the virus, but it's not going to be outweighed by the injury that you have by smoking."
John Maa, M.D., the past-president at San Francisco Marin Medical Society, and Dr. Bonnie Halpern-Felsher, a professor of pediatrics at Stanford University, wrote an editorial in The Hill warning against studies that suggest smoking can reduce one's susceptibility to the coronavirus. They pointed out that "a careful review of the data [from the French study] instead reveals the findings are more likely due to statistical flaws and sampling error, along with poor rates of screening and documentation of smoking history by physicians." They also expressed concern that the lead author of the French study, Jean-Pierre Changeux, had "ties to the tobacco industry, having previously accepted $220,000 from the tobacco industry-funded Council for Tobacco Research in the 1990s, and collaborated with RJ Reynolds and Philip Morris."
"Until we have unbiased data, supported by solid research design, and free of any tobacco industry influence, we would caution against the likely myth that smoking protects from acquiring COVID-19," Maa and Halpern-Felsher wrote.