Commercial Tobacco and COVID-19

What do we know about smoking and lung infections?²

• In Minnesota, 13.8% of adults smoke cigarettes. People who smoke are generally at higher risk of getting lung infections, such as pneumonia and the flu. Smoking can also make an illness worse and last longer.
• Cigarette smoke contains more than 7,000 chemicals. These chemicals cause inflammation in lung tissue and change lung cells. This makes it easier for lung illnesses to take hold.
• Smoking can hurt the body’s system that fights infections and other diseases. Smoking can make it harder to fight illness.
• People with poor lung function, which smoking can cause, are at higher risk of extra problems if they get infected with lung illness. 

What do we know about e-cigarettes/vapes and lung infections?³

• The health effects of using e-cigarettes are still being studied. We do not yet know the long-term health effects of e-cigarettes/vapes.
• Early studies show that, like cigarette smoke, the aerosol from e-cigarettes may irritate people’s lungs.
• E-cigarette/vape aerosol can contain harmful substances, including: 
  • Nicotine
  • Cancer-causing chemicals
  • Volatile organic compounds
  • Ultrafine particles
  • Flavorings that have been linked to lung disease
  • Heavy metals, such as nickel, tin, and lead
• The percentage of students in Minnesota who use e-cigarettes/vape are: 11.1% in grade eight, 16.3% in grade nine, and 26.4% in grade 11. 

Are people who smoke at greater risk of getting COVID-19?⁴

• There is not yet enough scientific evidence to say whether smoking and the risk of getting COVID-19 are related.
• We know that people who smoke are at a higher risk of getting other lung and chest infections, like pneumonia and influenza.

Are people who smoke at greater risk of having serious problems if they do get COVID-19?⁵

• People who smoke cigarettes now, or who smoked in the past, are more likely to get very sick from COVID-19. See Smoking - Centers for Disease Control and Prevention.
• Scientific studies generally show that cigarette smoking increases how sick a person gets from COVID-19.
• Cigarette smoke damages the lungs and the body’s immune system, so that they do not work as well as they should. Smoking limits how well the body can recover from lung and other illnesses.
• People are at risk for serious problems related to COVID-19 if they have chronic lung disease, such as asthma and chronic obstructive pulmonary disease (COPD), which are caused by or made worse by smoking or being around commercial tobacco smoke.

Are people who use e-cigarettes/vape at greater risk of getting or having serious problems from COVID-19?³

• The relationship between the use of e-cigarettes, or vaping, and risk of COVID-19 is uncertain. More research is needed.
• A recent study found that among teenagers and young adults who were tested for COVID-19, those who had used e-cigarettes were more likely to be infected than those who did not vape. The study was representative of young people nationwide.
• Early studies show that, like cigarette smoke, the aerosol from e-cigarettes may irritate people’s lungs.
• E-cigarette/vape aerosol has heavy metals, fine particulates, flavorings and other chemicals that can attach to lung tissue.

What if I previously smoked or vaped? Am I at more risk of being infected with COVID-19?⁶

• People who smoke cigarettes now, or who smoked in the past, are more likely to get very sick from COVID-19. See Smoking - Centers for Disease Control and Prevention.
• More research is needed to understand the possible risks related to COVID-19 and smoking/vaping in the past.
• We do know that when people stop smoking, the lungs begin to heal in as soon as two weeks.

Where can I get support to stop smoking or vaping?⁷

• Free help is available from Quit Partner at 1-800-QUIT-NOW (1-800-784-8669) and QuitPartnerMN.com.
• Free support includes personalized coaching, email and text support, educational materials, and nicotine patches, gum, or lozenges delivered by mail.
• Counseling and quit-smoking products can more than double a person’s chances of quitting successfully.
• Minnesota has specialized quit programs for people living with mental illnesses or substance use disorders; American Indian communities (American Indian Quitline), people who are pregnant or who just had a baby, and youths age 13 to 17 (My Life, My Quit).
• Quitting smoking improves lung health in as soon as two weeks.
• Quitting smoking has many benefits other than those related to COVID-19, so it is always a good time to quit.

1

• American Lung Association and Centers for Disease Control and prevention. (2020). Lung Health and COVID-19: Updates with CDC [Webinar presentation].

2

• • Minnesota Department of Health. Tobacco NUMBRS. Available at: https://www.health.state.mn.us/communities/tobacco/data/index.html#adultciguse. Accessed on: March 24, 2020.
  • U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.
  • U.S. Department of Health and Human Services. Smoking and Overall Health Fact Sheet. Available at: https://www.cdc.gov/tobacco/data_statistics/sgr/50th-anniversary/pdfs/fs_smoking_overall_health_508.pdf. Accessed on: March 24, 2020.
  • Global Burden of Disease (GBD) Tobacco Collaborators. Smoking prevalence and attributable disease burden in 195 countries and territories, 1990–2015: a systematic analysis from the Global Burden of Disease Study 2015. Lancet 2017; 389: 1885–906
  • Wong J, Magun BE, Wood LJ. Lung inflammation caused by inhaled toxicants: a review. Int J Chron Obstruct Pulmon Dis. 2016 Jun 23; 11:1391-401. doi: 10.2147/COPD.S106009. eCollection 2016.
  • Arcavi L, Benowitz NL. Cigarette Smoking and Infection. Arch Intern Med. 2004; 164 (20): 2206-2216. doi: 10.1001/archinte.164.20.2206
  • Rom O, Avezov K, Aizenbud D, Reznick AZ. Cigarette smoking and inflammation revisited.Respir Physiol Neurobiol 2013; 187:5–10.2
  • Lu Q, Gottlieb E, Rounds S. Effects of cigarette smoke on pulmonary endothelial cells. Am J Physiol Lung Cell Mol Physiol. 2018 May 1; 314 (5): L743-L756. doi: 10.1152/ajplung.00373.2017. Epub 2018 Jan 4. Review.
  • McEvoy JW, Nasir K, DeFilippis AP, Lima JA, Bluemke DA, Hundley WG, Barr RG, Budoff MJ, Szklo M, Navas-Acien A, Polak JF, Blumenthal RS, Post WS, Blaha MJ. Relationship of cigarette smoking with inflammation and subclinical vascular disease: The multi-ethnicstudy of atherosclerosis. Arterioscler Thromb Vasc Biol. 2015 Apr; 35(4): 1002-10. doi: 10.1161/ATVBAHA.114.304960. Epub 2015 Mar 5.
  • Tonnesen P, Marott JL, Nordestgaard B, Bojesen SE, Lange P. Secular trends in smoking in relation to prevalent and incident smoking-related disease: A prospective population-based study. Tob Induc Dis. 2019; 17 (October). doi:10.18332/tid/112459.
  • Zhou Z, Chen P, Peng H. Are healthy smokers really healthy? Tob Induc Dis. 2016; 14 (November). doi:10.1186/s12971-016-0101-z.
  • Luetragoon T, Rutqvist LE, Tangvarasittichai O, Andersson BÅ, Löfgren S, Usuwanthim K, Lewin NL. Interaction among smoking status, single nucleotide polymorphisms and markers of systemic inflammation in healthy individuals. Immunology. 2018 May; 154(1): 98-103. doi: 10.1111/imm.12864. Epub 2018 Jan 2.
  • Lee SW, Sharma L, Kang YA, Kim SH, Chandrasekharan S, Losier A, Brady V, Bermejo S, Andrews N, Yoon CM, Liu W, Lee JY, Kang MJ, Dela Cruz CS. Impact of cigarette smoke exposure on the lung fibroblastic response after influenza pneumonia. Am J Respir Cell Mol Biol. 2018 Dec; 59 (6): 770-781. doi: 10.1165/rcmb.2018-0004OC.
  • Kianoush S, Bittencourt MS, Lotufo PA, Bensenor IM, Jones SR, DeFilippis AP, Toth PP, Otvos JD, Tibuakuu M, Hall ME, Harada PHN, Blaha MJ. Association between smoking and serum GlycA and high-sensitivity C-reactive protein levels: The multi-ethnic study of atherosclerosis (MESA) and Brazilian longitudinal study of adult health (ELSA-Brasil). J Am Heart Assoc. 2017 Aug 23;6(8). pii: e006545. doi: 10.1161/JAHA.117.006545. Erratum in: J Am Heart Assoc. 2017
  • Groskreutz DJ, Monick MM, Babor EC, et al. Cigarette smoke alters respiratory syncytial virus-induced apoptosis and replication. Am J Respir Cell Mol Biol 2009; 41: 189–98.
  • Lee SW, Sharma L, Kang YA, Kim SH, Chandrasekharan S, Losier A, Brady V, Bermejo S, Andrews N, Yoon CM, Liu W, Lee JY, Kang MJ, Dela Cruz CS. Impact of cigarette smoke exposure on the lung fibroblastic response after influenza pneumonia. Am J Respir Cell Mol Biol. 2018 Dec; 59 (6): 770-781. doi: 10.1165/rcmb.2018-0004OC.

3

• Minnesota Department of Health. E-cigarettes and Vaping: Data and Statistics. Available at: https://www.health.state.mn.us/communities/tobacco/data/ecigarettes.html#youthecigs. Accessed on March 24, 2020.
• Minnesota Department of Health. E-cigarettes and Vaping: Resources for Parents. Available at: https://www.health.state.mn.us/communities/tobacco/ecigarettes/parents.html. Accessed on: March 24, 2020.
• Centers for Disease Control and Prevention. About Electronic Cigarettes. Available at: https://www.cdc.gov/tobacco/basic_information/e-cigarettes/about-e-cigarettes.html. Accessed on: March 24, 2020.
• Lappas AS, Tzortzi AS, Konstantinidi EM, Teloniatis SI, Tzavara CK, Gennimata SA, Koulouris NG, Behrakis PK. Short-term respiratory effects of e-cigarettes in healthy individuals and smokers with asthma. Respirology (2018) 23, 291–297. doi: 10.1111/resp.13180
• Higham A, Bostock D, Booth G, Dungwa JV, Singh D. The effect of electronic cigarette and tobacco smoke exposure on COPD bronchial epithelial cell inflammatory responses. Int J Chron Obstruct Pulmon Dis. 2018 Mar 23; 13: 989-1000. doi: 10.2147/COPD.S157728. eCollection 2018. PMID: 29615835 Free PMC Article
• Miyashita L, Suri R, Dearing E, Mudway I, Dove RE, Neill DR, Van Zyl-Smit R, Kadioglu A, Grigg J. E-cigarette vapour enhances pneumococcal adherence to airway epithelial cells. Eur Respir J. 2018 Feb 7;51 (2). pii: 1701592. doi: 10.1183/13993003.01592-2017. Print 2018 Feb. PMID: 29437942 Free Article
• Aug A, Altraja S, Kilk K, Porosk R, Soomets U, Altraja A. E-Cigarette affects the metabolome of primary normal human bronchial epithelial cells. PLoS One. 2015 Nov 4; 10 (11): e0142053. doi: 10.1371/journal.pone.0142053. eCollection 2015. PMID: 26536230 Free PMC Article
• American Lung Association and Centers for Disease Control and prevention. (2020). Lung Health and COVID-19: Updates with CDC [Webinar presentation].

4

• • American Lung Association and Centers for Disease Control and prevention. (2020). Lung Health and COVID-19: Updates with CDC [Webinar presentation].
  • U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.
  • U.S. Department of Health and Human Services. Smoking and Overall Health Fact Sheet. Available at: https://www.cdc.gov/tobacco/data_statistics/sgr/50th-anniversary/pdfs/fs_smoking_overall_health_508.pdf. Accessed on: March 24, 2020.
  • Global Burden of Disease (GBD) Tobacco Collaborators. Smoking prevalence and attributable disease burden in 195 countries and territories, 1990–2015: a systematic analysis from the Global Burden of Disease Study 2015.Lancet 2017; 389: 1885–906.

5

• • Centers for Disease Control and Prevention. People with certain medical conditions. 2020. Available from: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html
  • American Lung Association and Centers for Disease Control and prevention. (2020). Lung Health and COVID-19: Updates with CDC [Webinar presentation].
  • Singhal T. A review of coronavirus disease-2019 (COVID-19). Indian J Pediatr. 2020; 87 (4): 281–286. doi:10.1007/s12098-020-03263-6 
  • Sun P, Lu X, Xu C, Sun W, Pan B. Understanding of COVID-19 based on current evidence. J Med Virol. 2020 Feb 25. doi: 10.1002/jmv.25722. [Epub ahead of print] Review.
  • Guan WJ, Ni ZY, Hu Y, et al., Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020 Feb 28. doi: 10.1056/NEJMoa2002032. [Epub ahead of print]
  • Ruan Q, Yang K, Wang W, Jiang L, Song J. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Med. 2020 Mar 3. doi: 10.1007/s00134-020-05991-x. [Epub ahead of print]
  • Stein R. COVID-19 and rationally layered social distancing. Int J Clin Pract. 2020 Mar 14: e13501. doi: 10.1111/ijcp.13501. [Epub ahead of print]
  • Park JE, Jung S, Kim A. MERS transmission and risk factors: a systematic review. BMC Public Health. 2018; 18(1):574. doi: 10.1186/s12889-018-5484-8.
  • Alraddadi BM, Watson JT, Almarashi A, Abedi GR, Turkistani A, Sadran M, et al. Risk factors for primary Middle East respiratory syndrome coronavirus illness in humans, Saudi Arabia, 2014. Emerg Infect Dis. 2016; 22(1): 49–55. Cited in Park et al 2018.
  • Nam H-S, Park JW, Ki M, Yeon M-Y, Kim J, Kim SW. High fatality rates and associated factors in two hospital outbreaks of MERS in Daejeon, the Republic of Korea. Int J Infect Dis. 2017; 58:37–42. Cited in Park et al 2018.
  • Sherbini N, Iskandrani A, Kharaba A, Khalid G, Abduljawad M, Al-Jahdali H. Middle East respiratory syndrome coronavirus in Al-Madinah City, Saudi Arabia: demographic, clinical and survival data. J Epidemiolo Glob Health. 2017; 7 (1): 29–36. Cited in Park et al 2018.

6

• U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.
• U.S. Department of Health and Human Services. Smoking and Overall Health Fact Sheet. Available at: https://www.cdc.gov/tobacco/data_statistics/sgr/50th-anniversary/pdfs/fs_smoking_overall_health_508.pdf. Accessed on: March 24, 2020.
• Global Burden of Disease (GBD) Tobacco Collaborators. Smoking prevalence and attributable disease burden in 195 countries and territories, 1990–2015: a systematic analysis from the Global Burden of Disease Study 2015. Lancet 2017; 389: 1885–906.
• Centers for Disease Control and Prevent. Health Effects of Smoking. Available at: https://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/effects_cig_smoking/#respiratory. Accessed on: March 24, 2020.

7

• U.S. Department of Health and Human Services. What You Need to Know About Quitting Smoking: Advice from the Surgeon General.
• Centers for Disease Control and Prevention. Quitting Smoking. Accessed on: March 30, 2020.