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What we know about the association of smoking with the COVID-19 virus, and how we in the PHA can support smoking cessation during the pandemic

Dr Claire Neill, Specialty Registrar in Public Health Medicine, Elaine Wilmot, Health Intelligence Manager, and Kelly McCartney, Health Improvement Manager, Public Health Agency

Our knowledge about COVID-19 is constantly on the increase, thanks to ongoing research in this area. Early evidence suggested that smokers may be more susceptible to serious illness from COVID-19, and may also be at increased risk of contracting the virus if they are exposed, due to repeated hand to mouth movements giving the virus more opportunities to enter the body.[i]  We explore some of the emerging evidence in this area, and explain why there has never been a more important time to give up smoking and how we, in the Public Health Agency (PHA), can help support this.

What does the evidence say about COVID-19 and smoking?

The World Health Organization (WHO) has completed an analysis of 35 peer reviewed studies on the association of smoking with COVID-19.[ii]  The review found that smokers are more likely to develop severe disease from COVID-19 than non-smokers, and in hospitalised patients with COVID-19, smoking was also associated with increased severity of illness and death.

A smaller study, quoted by Public Health England (PHE) in response to the findings, suggested that smoking was a significant predictor of disease severity, with smokers being 14 times more likely to develop severe respiratory disease than non-smokers.[iii]

An additional review comparing current smokers with both ex-smokers and non-smokers included 19 studies and a total of 2,473 people with COVID-19 infection.[iv]    The review found that current smokers are more likely to develop severe complications associated with the infection, when compared with former smokers and people who have never smoked.

It is an important time to consider giving up smoking, not only to reduce your risk of contracting COVID-19, but also to reduce the risk of severe disease associated with the infection.

How can we support smoking cessation during the COVID-19 pandemic?

Stopping smoking can be difficult, and we know that this is particularly the case during times of stress. Additionally, face-to-face support for smoking cessation has not been as accessible during lockdown, and the associated loss of routine or boredom may even exacerbate relapses for ex-smokers, or increased smoking behaviour in those who smoke. 

The PHA commission approximately 600 specialist ‘Stop Smoking’ services across Northern Ireland, and smokers can access these services via a range of local settings including GP practices, pharmacies, hospitals, and community or voluntary groups. These services are specifically designed for smokers who are motivated and ready to quit, and who are prepared to set a quit date.

Services are provided by specialist practitioners who have received specific training to carry out this role.  Smokers can avail of intensive treatment over the course of 6-12 weeks through a combination of pharmacotherapy and behavioural interventions which have proven to be the most effective mechanism to help smokers to quit. 5

Smokers are more than four times more likely to quit using this approach and to date the provision of specialist Stop Smoking Services in Northern Ireland has supported nearly 300,000 smokers to quit smoking.

In addition to specialist support, smokers interested in quitting are able to access support through involvement of smokers and ex-smokers to support people in their quit attempt. The site has information on the benefits of quitting, stop smoking aids and the current support available.

Please visit www.stopsmokingni.info for more information and to have the best chance of success in becoming smoke free.

[i] World Health Organisation. Q&A: Tobacco and COVID-19. Available from: https://www.who.int/news-room/q-a-detail/q-a-on-tobacco-and-covid-19

[ii] World Health Organisation. Smoking and Covid-19. Available from: https://www.who.int/publications-detail/smoking-and-covid-19

[iii] Public Health England. Smokers at greater risk of severe respiratory disease from COVID-19. Available from

https://www.gov.uk/government/news/smokers-at-greater-risk-of-severe-respiratory-disease-from-covid-19

[iv] Patanavanich R and Glantz SA. Smoking is associated with COVID-19 progression: a meta-analysis. Nicotine & Tobacco Research. https://doi.org/10.1093/ntr/ntaa082

5   Department of Health.  Health Survey (NI): First Results 2018/2019.  Department of Health: Belfast, January 2020.

To view our complete series of COVID-19 blogs, click here.

Welcome to the first of what will be a series of blogs intended to help develop understanding around the management, impact and epidemiology of the COVID-19 pandemic in Northern Ireland.

The blog will also feature articles and advice on looking after your physical and mental health for the public and key audiences in this difficult time.

Professionals from the PHA and beyond will contribute their expertise, and we will also welcome ideas from our readers!

I started my new role as Director of Public Health/Executive Medical Director in the PHA just as the pandemic was hitting the province, so it has been somewhat a baptism of fire, dealing with the single biggest public health challenge of our times. 

But I have been impressed by the response of the professionals in health and social care in Northern Ireland to rise to the challenges and the tremendous support we have experienced from our communities and the general public.

I hope through this series of blogs that we can help the reader to become better informed and knowledgeable about COVID-19 and also that we can provide some guidance on making the best of things.

I also hope we can:

• encourage support for the response by Health and Social Care and our partners;
• reduce fear and misinformation;
• help people stick to public health advice; and
• help people take positive steps about sustaining and improving our wellbeing.

The topics areas will be varied, covering the breadth of work of the Public Health Agency including nursing, allied health professionals, service development, health protection, health improvement and screening. Readers can expect to find articles and commentary on:

• Surveillance data;
• Questions and answers about the disease ­– for example how it spreads, variation in reaction among the population and seasonality observed between the Southern Hemisphere and Northern Europe;
• Testing regimes/policies;
• Health influencing behaviours – addressing your physical and emotional wellbeing;
• Service development related issues – for example what does it mean for people with long-term conditions such as organ donors;
• The science behind the policy; and
• How can the digital world help now and in the future? For example, app technologies to help with contact tracing and, where required, individually tailored messaging and advice.

As we continue to learn from challenges and experiences of managing the pandemic the nature and content of the blogs will evolve. This gives us a unique opportunity to share the insight of public health professionals and help explore how the pandemic has impacted on mortality, socio-economic factors and inequalities and more importantly what can be done to change how we address future pandemic and any public health crisis in the future.

To view our complete series of COVID-19 blogs, click here.