UW-CTRI Director of Research Dr. Tim Baker recently served as the discussant for an international half-day webinar on COVID-19 and smoking featuring esteemed researchers from the Society for Research on Nicotine and Tobacco.
Presenters included Dr. Suchitra Krishnan-Sarin (Yale), Dr. Jonathan Samet (Colorado), Dr. Neal Benowitz (UC-San Francisco), Dr. Olga Perski (London), Dr. Geoffrey Fong (Waterloo), Dr. Joseph Cappella (Pennsylvania), Dr. Anupreet Sidhu (Pennsylvania), Dr. Kamran Siddiqi (York).
Baker participated in the discussion panel that included Dr. Pebbles Fagan (Arkansas) and Dr. Andrea Villanti (Vermont). Baker made three observations on the presentations.
First, Baker said he is impressed by what a “caricaturist” COVID-19 is. “It is a magnifying glass that has amplified key features of our pre-COVID world,” he said. We all know that smoking is dangerous because it is a causal factor in so many diseases, and COVID-19 has magnified the impact of such illnesses (as per Dr. Benowitz’s and Dr. Samet’s talks)—or at least made those impacts more imminent. Thus, diseases such as heart disease, cancer, and pulmonary disease—the usual suspects—can increase COVID mortality by 50 percent or more.
“We also know that those who are impoverished and who have few resources are more prone to a host of health threats—and certainly COVID has amplified such health disparities,” Baker said. Research shows that minority individuals often face higher health risks—data from the Williamson study of 17 million in England show almost a doubling of mortality amongst the minority persons in their study—and data from the US are consistent with this. In addition, low- and middle-income countries often suffer disproportionately from tobacco’s ill effects because of a lack of resources. “Dr. Siddiqi’s talk reminds us that, because of fewer smoking treatment and health resources, COVID has amplified such vulnerability,” Baker said. “We all know the vulnerabilities that come with advanced age—forgive me for arguing my own case—COVID has clearly revealed those vulnerabilities.” Those over 80 have about a 20-fold increased risk of death relative to “youngsters” who are “only” 50 to 59 (Williamson et al., 2020).
Therefore, COVID has not only magnified the effects of pre-COVID vulnerabilities, Baker said, but it has also magnified, or at least clarified, the importance of reducing poverty, inequities, and tobacco use.
Second, Baker observed that researchers are very impressively leveraging modern data-gathering techniques and resources to capture the course and effects of COVID-19 in record time. He noted the work by Drs. Silver, Perski, Fong, and colleagues as emblematic of how researchers are using state-of-the-art resources and strategies to understand and combat COVID-19 with historically unparalleled speed.
Third, Baker reacted that humans still have much to learn about COVID-19 and smoking. “In fact, we know very little about the role of smoking or other tobacco-product use in COVID,” he said. “Yes, smoking-related disease worsens COVID-19 outcomes but, beyond that, how does smoking per se affect those outcomes? While it seems likely that it does, we don’t really know.”
Because of limitations in the data available in most EHRs, researchers still have a huge amount to learn about COVID and how nicotine and smoking influence it. “Clearly, we need to learn much more about how COVID severity and progression are related to smoking heaviness, the duration of abstinence among former smokers, and the use of alternative nicotine delivery systems.” Baker concluded though, that while we have much to learn, “we do know enough today to share with the public the message that, despite the welter of conflicting information they may hear about COVID-19, quitting smoking is still the most important thing they can do to protect their health.”
For a fact sheet on smoking and COVID-19, click here.