Coronavirus disease (COVID-19) is an infectious disease, caused by the most recently discovered coronavirus SARS-CoV-2- a member of a family of viruses that primarily affects the respiratory system. It was unknown before the outbreak began in Wuhan, China, in December 2019. It has already evolved into a pandemic spreading rapidly in 212 countries and areas across the globe.

Globally, tobacco causes more than 8 million deaths every year from cardiovascular diseases, lung disorders, cancers, diabetes, and hypertension. More than 7 million of these deaths are from direct tobacco use and around 1.2 million are due to non-smokers being exposed to second-hand smoke. In Bangladesh, the burden from tobacco is alarming: 35% of adults are currently using tobacco either in smoked and/or in smokeless form. Furthermore, 43% and 39% of adults are exposed to secondhand smoke at their workplaces and homes, respectively. Seven percent of youth aged 13 to 15 years use tobacco.Tobacco kills up to half of its users and causes premature mortality and morbidity, contributes to health inequalities and exacerbates poverty. Studies in various countries have found that middle-aged smokers have two to three times the mortality rate of non-smokers of similar age, reducing lifespan by an average of 10 years.

Tobacco use in any form is detrimental to health.It is a known risk factor for many respiratory infections and increases the severity of respiratory diseases. Tobacco use is causally linked to diseases of nearly all organs of the body. Tobacco is also a major risk factor for noncommunicable diseases like cardiovascular disease, cancer, respiratory disease and diabetes which put people with these conditions at higher risk for developing severe illness when affected by COVID-19.Tobacco use may increase the risk of suffering from serious symptoms due to COVID-19 illness. Early research indicates that, compared to non-smokers, having a history of smoking may substantially increase the chance of adverse health outcomes for COVID-19 patients, including being admitted to intensive care, requiring mechanical ventilation and suffering severe health consequences.

Available research suggests that smokers are at higher risk of developing severe disease and death.  A review of studies by public health experts convened by the World Health Organization (WHO) on 29 April 2020 found that smokers are more likely to develop severe disease with COVID-19, compared to non-smokers.

Previous studies have shown that smokers are twice more likely than non-smokers to contract influenza and have more severe symptoms,while smokers were also noted to have higher mortality in the previous MERSCoV outbreak. The virus that causes COVID-19 (SARS-CoV-2) is from the same family as MERS-CoV and SARS-CoV, both of which have been associated with cardiovascular damage (either acute or chronic).There is also evidence that COVID-19 patients that have more severe symptoms often have heart-related complications. This relationship between COVID-19 and cardiovascular health is important because tobacco use and exposure to second-hand smoke are major causes of cardio vascular diseases globally.Study from China showed that among those severely affected by the COVID-19, 16.9% were current smokers and 5.2% former smokers. Furthermore, among patients who were admitted to an intensive care unit, put on ventilation, or died, 25.8% were current smokers and 7.6% were former smokers.Similarly, data from Italy shows that a high proportion of COVID-19 patients had a history of smoking and high rates of chronic obstructive pulmonary disease and heart disease.

Smoking is also detrimental to the immunesystem and its responsiveness to infections, making smokers more vulnerable toinfectious diseases. Studies also suggested that the increased susceptibility to infection might be due to increase in the angiotensin converting enzyme 2 (ACE2) receptor, the main receptor used by the Cronavirus  (SARS-CoV-2) to gain entry to host mucosa and cause active infection. Current smokers have increased gene expression of ACE2, than previous smokers and nonsmokers.

Tobacco smokers (cigarettes, waterpipes, bidis, cigars, heated tobacco products) may be more vulnerable to contracting COVID-19, as the act of smoking involves contact of fingers (and possibly contaminated cigarettes) with the lips, which increases the possibility of transmission of viruses from hand to mouth. Smoking waterpipes, also known as shisha or hookah, often involves the sharing of mouth pieces and hoses, which could facilitate the transmission of the COVID-19 virus in communal and social settings. Using smokeless tobacco often involves some hand to mouth contact.  Another risk associated with using smokeless tobacco products, like chewing tobacco, is that the virus can be spread when the user spits out the excess saliva produced during the chewing process

Considering the well-established risks associated with tobacco use and second-hand smoke exposure; the World health Organization (WHO) recommends that tobacco users stop using tobacco. Now is a good time to quit completely. Quitting will help lungs and heart to work better from the moment of stop.  Within 20 minutes of quitting, elevated heart rate and blood pressure drop. After 12 hours, the carbon monoxide level in the bloodstream drops to normal. Within 2-12 weeks, circulation improves and lung function increases. After 1-9 months, coughing and shortness of breath decrease. Quitting helps to protect smokers’ loved ones, family members especially children and women, from exposure to second-hand smoke. Not only quit the use of tobacco, wash hands with soap and water or use hand sanitizer, use face mask and maintain physical distancing, and other instructions from the health authority. Protect yourself lesser risky from the contract of COVID-19.Proven interventions to help users quit include toll-free quit lines, mobile text-messaging cessation programmes, nicotine replacement therapies and other approved medications.

The Government of is well committed to make Bangladesh, a tobacco-free country by the year 2040, pertinent to achieve the sustainable development goals and to become a developed country. At this point in time, in addition to other tobacco control measures, further strengthening of the public awareness programme on tobacco uses including tobacco-free public places and protection of people from second-hand smoke, to protect from the risks for health and diseases including COVID-19 thus suggested.

The writer is a Public Health and Nutrition Specialist and Food Safety Expert, working at the Institute of Public Health (IPH), Dhaka