Coronavirus and Smoking

Certain groups of people are at higher risk of getting seriously sick from COVID-19. If you smoke or vape, you're one of them. That means it's even more important for you to take steps to protect yourself from the new coronavirus.

Are Smokers More Likely to Get COVID-19?

When you smoke or vape, your fingers touch your lips. This raises the chance that the virus will spread from your hand to your mouth.

If you use a smoking product like a water pipe, you may share its mouthpieces or hoses with others. If you use it with someone who’s infected, you could get sick, too.

Smoking and vaping can also lower your immunity to respiratory infections. One study even found that e-cigarettes suppress immune cells in your nose. They also destroy the cilia in your lungs. Cilia are tiny, hair-like structures that trap viruses and debris and sweep them out of your airways. They're one of your body’s main defenses against infection. When they're damaged, they're less able to prevent the virus from settling into your lungs.

The new coronavirus enters cells in your lungs by binding to things called ACE2 receptors. Researchers found that cigarette smoke increases your ACE2 levels, though it’s not clear what effect this might have on your chances of getting COVID-19.

Are Smokers at High Risk of Severe COVID-19 Infections?

If you smoke, you may already have lung problems. They make you more likely to get very sick from COVID-19 as the coronavirus attacks your lungs.

When smokers’ lungs are exposed to flu or other infections that affect their airways, they can get much sicker than nonsmokers. If your lungs are already damaged, they may not be able to provide you with enough oxygen or to use oxygen the way they should. Damage to the cilia in your lungs can also make it harder for them to clear out things like mucus.

Smokers are more likely to get serious lung conditions such as pneumonia. They're also at higher risk of a complication called acute respiratory distress syndrome (ARDS), in which fluid builds up in the tiny air sacs in your lungs. This means your lungs can't fill with enough air. Less oxygen gets to your bloodstream and organs. This can lead to organ damage or even death.

One Chinese study of people who had COVID-19 and were hospitalized with pneumonia found that the odds that the disease would get worse were 14 times higher for those with a history of smoking.

People who smoke are more likely to have chronic obstructive pulmonary disease (COPD) and heart and blood vessel disease, which raises their risk of serious complications.

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Are Vapers at High Risk of COVID-19?

People who use vapes or e-cigarettes -- no matter what’s in them -- may be more likely to get the coronavirus for many of the same reasons as smokers, such as having lower immunity and touching their faces more.

Research also suggests that the aerosols from e-cigarettes irritate and hurt lung cells. This may make it harder for them to fight infection.

Are Marijuana Users at High Risk of COVID-19?

Smoking is what damages your lungs and causes other respiratory problems. When it comes to the coronavirus, it’s safer to consume marijuana through edibles and tinctures. But remember that it’s harder to track the drug’s strength and dosage with edibles than with marijuana cigarettes or vapes. So you might have trouble knowing when to stop, based on how you’re feeling.

Some research shows that the cannabis in marijuana can cause your body to make fewer inflammatory proteins called cytokines. Too many cytokines may lead to some of the more severe complications of COVID-19. But the studies are still limited, and this is just one of many factors in your body’s response to infection.

Can Secondhand Smoke Spread the Coronavirus to Others?

Early studies have found that the coronavirus can attach to particles in secondhand smoke and secondhand aerosols from e-cigarettes. This may make it spread farther in smokers’ homes. These particles with the virus can also linger in dust and on surfaces for days.

How Can Smokers Lower Their Coronavirus Risk?

Quit smoking and vaping if you can. Active smokers and vapers both may be at higher risk of health problems from the virus.

Experts aren’t sure whether former smokers or vapers are more likely to get COVID-19 than those who never smoked.

If you’re a former smoker or vaper, you probably have a lower risk of complications from COVID-19 than current users.

Your lungs heal after you quit smoking. Many people report less coughing and shortness of breath within a few weeks or months. Your cilia begin to regrow and heal quickly. You’re more likely to be able to fight off a respiratory infection if your cilia are healthy.

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If you need help to quit smoking or vaping:

  • Ask your doctor about strategies.
  • Call 800-QUIT-NOW to be connected to your state's quit line sponsored by the National Cancer Institute.
  • Download a smartphone app at smokefree.gov/tools-tips/apps.

To cut your risk of catching COVID-19, always follow the safety steps recommended by public health officials:

  • Stay away from others who may have been exposed to the virus.
  • Wash your hands well and often.
  • Try not to touch your nose, mouth, and eyes.
  • Disinfect surfaces in your home that get touched a lot.
WebMD Medical Reference Reviewed by Arefa Cassoobhoy, MD, MPH on April 27, 2020

Sources

SOURCES:

World Health Organization: "Q&A on smoking and COVID-19."

Mayo Clinic: "What smokers should know about COVID-19."

American Lung Association: "Learn About ARDS,” “Marijuana and Lung Health.”

UCSF Center for Tobacco Control Research and Education: "Reduce your risk of serious lung disease caused by corona virus by quitting smoking and vaping."

Chinese Medical Journal: "Analysis of factors associated with disease outcomes in hospitalized patients with 2019 novel coronavirus disease." February 28, 2020.

National Institute on Drug Abuse: "COVID-19: Potential Implications for Individuals with Substance Use Disorders."

American Journal of Physiology: "E-cigarette use results in suppression of immune and inflammatory-response genes in nasal epithelial cells similar to cigarette smoke."

CDC: "How to Protect Yourself," "Frequently Asked Questions (FAQ) about 1-800-QUIT-NOW and the National Network of Tobacco Cessation Quitlines."

BMJ: “What are the respiratory effects of e-cigarettes?”

bioRXiv: “Cigarette smoke triggers the expansion of a subpopulation of respiratory epithelial cells that express the SARS-CoV-2 receptor ACE2.”

World Health Organization Regional Office for the Eastern Mediterranean: “Tobacco and waterpipe use increases the risk of suffering from COVID-19.”

University of Washington Alcohol & Drug Abuse Institute: “Respiratory Effects of Marijuana.”

National Academies of Sciences, Engineering, and Medicine: “The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research.”

The Rheumatologist: “Don’t Forget the Host: COVID-19 Cytokine Storm.”

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