Sarah-Leah Eisenberg, Mark J Eisenberg
Published: 04 May 2020
The COVID-19 epidemic presents a unique public health opportunity for smoking cessation. Smokers are at a higher risk of developing COVID-19 and are also at a higher risk of developing severe COVID-19 complications.1 Although there are no data available regarding the benefits of smoking cessation during the COVID-19 epidemic, there is evidence to suggest that smoking cessation for 4 weeks or more will lessen the risk of developing COVID-19 as well as the risk of developing severe COVID-19 complications.
Smokers also have an increased risk of developing severe complications once they become infected with SARS-CoV-2. A recent systematic review examined five studies that analyzed the smoking status of patients during the COVID-19 epidemic in China. The size of the patient population in all of these studies ranged from 41 to 1099 and the studies only included patients who were COVID-19 positive. The authors concluded that smokers (compared to non-smokers) were 1.4 (RR 1.4; 95% CI 0.98-2.00) times more likely to suffer from severe symptoms of COVID. They were also 2.4 (RR 2.4; 95% CI 1.43-4.04) times more likely to be placed in the intensive care unit (ICU), require mechanical ventilation, or die.
The authors of this study identified that at least 4 weeks of smoking cessation lowers the risk of respiratory complications compared to current smokers (RR 0.77; 95% CI 0.61-0.96 and RR 0.53; 95% CI 0.37-0.76). In another surgical study examining over 600,000 non-cardiac surgical patients, current smokers had a higher likelihood of 30-day mortality (RR 1.38; 95% CI 1.11-1.72) and a higher incidence of postoperative complications such as surgical site infection (OR 1.30; 95% CI 1.80-2.43), pneumonia (OR 2.09; 95% CI 1.80-2.43), unplanned intubation (OR 1.87; 95% CI 1.58-2.21), and septic shock (OR 1.55; 95% CI 1.29-1.87). Thus, based on data from the surgical literature, there is reason to conclude that 4 weeks of smoking cessation will be associated with a lower incidence of adverse events and intubation among COVID-19 patients.
Oxford University Press – DOI: https://doi.org/10.1093/ntr/ntaa075