Smoking and COVID - Setting the Record Straight

"Tobacco and e-cigarette companies are exploiting the COVID-19 crisis to advertise their harmful and addictive products on social media, undermine minimum age purchase restrictions meant to protect youth and make unproven and illegal health claims, according to new analysis published by the Campaign for Tobacco-Free Kids. The analysis includes tactics from big tobacco companies, e-cigarette makers and vape shops in 28 countries."
"On social media, Philip Morris International and British American Tobacco – the world's two largest tobacco companies – are appropriating popular "Stay at Home" hashtags promoted by governments and health authorities to instead market heated cigarette products like Glo and IQOS and e-cigarettes like Vype. In Spain, British American Tobacco has posted photos advertising Vype e-cigarettes accompanied by the hashtag #FrenaLaCurva (#FlattenTheCurve) and in Italy, Philip Morris has used #DistantiMaVicini (#DistantButClose) to advertise IQOS. The companies have also promoted at-home music series and launched exclusive music videos to promote tobacco products online."
Cision

"Few of those hospitalized with the coronavirus are smokers, and researchers are trying to understand why, according to VICE."
"One hypothesis is that nicotine, which has anti-inflammatory properties, may interfere with the way that COVID-19 causes an overreaction of the immune system."
"The hypothesis comes from Konstantinos Farsalinos, a cardiologist in Greece who focuses on tobacco-use reduction. Farsalinos noticed that few COVID-19 patients who were hospitalized in China were smokers, though about half of men in the country smoke."
"Farsalinos and colleagues wrote a new paper available as a preprint and scheduled to be published in Internal and Emergency Medicine. They found that among 13 studies in China with nearly 6,000 hospitalized COVID-19 patients, the rate of smokers ranged from 1.4% to 12.6%. No studies recorded e-cigarette use."
"'The results were remarkably consistent across all studies and were recently verified in the first case series of COVID-19 cases in the U.S.', the authors wrote, calling for an 'urgent investigation'."
"Of course, Farsalinos doesn't recommend that people should begin smoking simply to attempt to avoid a severe case of COVID-19. Smoking is still a leading cause of preventable death across the globe."
WebMD News Brief

In the never-ending annals of 'this does not compute' there are now contradictory reports going the rounds on the role of smoking and COVID-2. Initially, the World Health Organization put out a general alert that makes eminently good sense; smokers are more imperilled by the effects of the novel coronavirus than non-smokers. Who could conceivably contest that finding? After all, the virus goes on to play havoc with human organs, and its effect on the respiratory system is what ultimately takes the lives of sufferers. Smoking affects the lungs, other organs and certainly the respiratory system, setting smokers up for trouble down the road when a disease arrives targeting the respiratory system.

"Tobacco-leaf COVID-19 vaccine ready for human trials: World’s No.2 cigarette company British American Tobacco said on Friday it was ready to test its potential COVID-19 vaccine using proteins from tobacco leaves on humans, after it generated a positive immune response in pre-clinical trials."
"The maker of Lucky Strike cigarette said once it gets approval from the U.S. Food and Drug Administration (FDA) for the vaccine, it would progress to Phase 1 trials or testing on humans. The company raised eyebrows in April when it said it was developing a COVID-19 vaccine from tobacco leaves and could produce 1 million to 3 million doses per week if it got the support of government agencies and the right manufacturers. Drugmakers across the globe have been racing to develop a vaccine for COVID-19, caused by the new coronavirus, with some of the vaccines already in human trials. Experts have suggested that a COVID-19 vaccine could take 12-18 months to develop. On Friday, London-based BAT said it had submitted a pre-investigative new drug application to the FDA and that the agency had acknowledged the submission. BAT said it was also talking with other government agencies around the world about the vaccine."
Montreal Gazette

If the news from some sources can be credited current smokers were seen to have a markedly lower risk of COVID-19 death than do those who never smoked and former smokers, correcting for other variables. Smokers, current and former smokers are threatened with all the complications arising out of ingesting nicotine harming the body system, most notably the heart, lungs and respiratory system, quite apart from the issue of lung, esophagus, larynx, mouth, throat, kidney, bladder, liver, pancreas, stomach, cervix, colon, and rectum, cancers as well as acute myeloid leukemia.

If that isn't sufficient, in and of itself, to cure anyone of the idea that smoking is a non-harmful and enjoyable habit, not at all an addiction leading to dreadful health outcomes, what could possibly convince anyone of its dread toll? Until COVID-19 arrived, and suddenly smokers can feel justified in resisting the best advice of the medical community to do everything possible to wean themselves away from addiction to nicotine. The conflicting messages of smoking avoidance versus nicotine providing protection against the effects of COVID has created confusion for some, a sense of triumph for smokers.

A study out of the U.K. Biobank had reported that "regular smokers" appear to have lower incidents of  contracting the novel coronavirus. Among the Biobank study participants 580 took part with a significant ratio in favour of smokers avoiding the virus. In a much larger, in fact huge study released in early May, a collaboration between the University of Oxford and the London School of Hygiene and Tropical Medicine, anonymized records of 17 million adults were used from the U.K.'s National Health Service.

The idea was to create a list of various risk-factors for COVID-19 deaths, and what brought this to the attention of the public were peculiar numbers seeming to imply that smokers of current vintage less frequently died of the novel coronavirus than non-smokers or former smokers. "The media immediately picked it up and ran with the idea that smoking is protecting people from dying from COVID, [along with other] really strong causal claims, which were not at all the goal of the paper", pointed out Eleanor Murray, of Boston University.

"The reason it's getting play is I think it's sort of feeding into things that people kind of wanted to be true. I'm seeing them report just the prevalence of smoking in the COVID patients and the prevalence of smoking in the general population. But for most areas, COVID patients are much older than the general population."
"The life expectancy among smokers is lower than among non-smokers. And so it's entirely possible that if you're looking at a sample that's mostly older individuals, you might just expect any sample like that to have fewer smokers than the overall general population."
“If smokers already have decreased lung capacity, they may not notice the milder symptoms of COVID, for example, and they may not [be] getting tested as much."
"Taking the conclusion from [preliminary studies] that there's some protective effect of nicotine is probably wishful thinking, just because there's really no clear evidence here either way of whether smoking is at all protective [against] COVID,"
Eleanor Murray, assistant professor of epidemiology, Boston University 

Delivering Nicotine : Diagnosing Lung Disease

"I think people will be sensitive and there will be a heightened awareness [resulting from American research linking vaping to lung disease]."
"[The situation in Canada is] like the wild west [currently, for vaping]. What is troubling is the complete absence of any form of regulation."
"[The epidemic of respiratory illnesses now recognized in clusters in the U.S. will result in] a whole new generation of addicts, many of whom will turn to nicotine products."
Dr.Andrew Pipe, Ottawa Heart Institute

"The Government of Canada will continue to monitor all available data sources for indications of similar issues in Canada and will take action, as appropriate, to protect the health and safety of Canadians."
Maryse Durette, spokesperson, Health Canada

"These [lung illnesses discovered in the U.S. with people vaping contaminated THC-based products] are fundamentally different from the nicotine vaping products that millions of people worldwide have been using in place of lethal cigarettes."
David Sweanor, chair, advisory board, Centre for Health Law Policy and Ethics, University of Ottawa

"[Non-smokers and young people should not vape] However, vaping is a less harmful option than smoking for Canadians who already smoke tobacco products."
"Smokers who switch completely to vaping can significantly reduce their exposure to many toxic chemicals found in tobacco smoke."
Health Canada

Vaping Nam Y. Huh / THE ASSOCIATED PRESS

In 2017, one quarter of high school students in Ottawa have claimed they experimented with e-cigarettes, and the general consensus is that since then that number has likely increased. According to Robert Schwartz, executive director of the Ontario Tobacco Research Unit, professor at the University of Toronto Dalla Lana School of Public Health, research indicates a clear link between advertising and promotion and e-cigarette use. The current promotion and advertising with JUUL Labs as an example, is geared toward youth.

The colourful, playful packaging, the youth-oriented flavours are all attractants specifically for a young market. And that market is responding with enthusiasm. Research by the Ontario Tobacco Research Unit demonstrates exposure to advertising to be sky-high in Ontario: "Just about everybody is exposed", stated Mr. Schwartz. And with that exposure, rates of vaping among youth who have never before smoked is increasing in Ontario as well as in other provinces, a situation concerning to school officials and health authorities alike.

Evidence of harm from vaping, including its negative effects on the lining of the respiratory system leading to young people accustomed to vaping, coughing and wheezing twice as frequently as non-users is pointed to by Dr. Schwartz. Tens of thousands of young people who have vaped are now becoming addicted to nicotine, thanks to the flavours attractive to teens. Now that the news of hundreds of instances of severe lung disease in the U.S. flagged as linked to vaping has alerted Canadian health authorities, a new spotlight on vaping has emerged.

Most lung illness cases now under investigation in the United States, a death included, involved youth and young adults, leading Canadian health experts like Dr. Andrew Pipe to calling out for more stringent rules on advertising and packaging and promotion of e-cigarettes. In the United States, certain flavours of the JUUL products have been banned on the basis of their appeal to children and teens, whereas no such preventive action has been taken in Canada.

There is little research into the long-term effects of vaping. Phil Noble / REUTERS

Dr. Michael Siegel, a professor in the Department of Community Health Sciences at Boston University School of Public Health points out that in each instance of lung disease, oil-based THC and not the alcohol-based liquids in most e-cigarettes has been identified. He takes exception to the U.S. Centres for Disease Control advising youth and young adults to avoid e-cigarettes altogether, insisting this bias places lives at risk by not singling out the specific product causing harm; instead causing general alarm that will result in moving people away from a safer alternative to smoking.

Dr. Pipe, on the other hand is concerned with evidence pointing to some e-cigarette products delivering greater amounts of nicotine into the system than cigarettes. Where a pod -- the system that JUUL uses to deliver nicotine and flavour -- contains the equivalent of 20 cigarettes' nicotine content. With reports of teens vaping an entire pod at a time, this rings alarm bells for him.

A man poses for a picture as he vapes at a vape shop.

Daniel Becerril | Reuters

Tea, Coffee, Anyone?

"Considering the public health importance of obtaining quality sleep and the widespread use of alcohol, nicotine, and caffeine, relatively few studies have thoroughly investigated the association between evening substance use and sleep parameters."
"This study represents one of the largest longitudinal examinations of the associations of evening use of alcohol, caffeine and nicotine with objectively measured sleep outcomes."
"A night with use of nicotine and/or alcohol within four hours of bedtime demonstrated worse sleep continuity than a night without."
"We did not observe an association between ingestion of caffeine within four hours of bed with any of the sleep parameters. These findings support the importance of sleep health recommendations which promote the restriction of evening nicotine and alcohol."
Dr.Christine Spadola, assistant professor, Phyllis and Harvey Sandler School of Social Work, Florida Atlantic University

Study suggests coffee before bed does not disrupt sleep   Photo: Irish Times

"In fact, heavy use of alcohol can permanently damage the genes involved in healthy sleep and wake cycles."
"A brain in withdrawal from nicotine may wake you up to satisfy its craving. Because of its effect on the lungs and blood vessels, nicotine can increase breathing disorders that impact sleep, such as asthma and sleep apnea."
"Vaping may not involve the inhalation of smoke, but may deliver more powerful stimulant effects than smoked nicotine, disrupting sleep even further."
Rose MacDowell, chief research officer, Sleepopolis

A recently-completed research study published in the journal Sleep came to some unexpected conclusions with respect to the effect of caffeine consumption and sleep patterns. Researchers from Florida Atlantic University, Harvard Medical School and several other colleagues undertook with the help of 785 volunteers to record how much caffeine, alcohol and nicotine the study subjects consumed, comparing their recorded sleep diaries and wrist sensors to evaluate the results.

Some 40 percent of the study group consumed caffeine on one night of the study at least, but the caffeine appeared to have no effect on their sleep patterns. On the other hand, nicotine and alcohol were seen to disrupt sleep; a nighttime cigarette had the effect of awakening the study subjects 42 minutes earlier than should have occurred for insomniacs. The researchers hardly anticipated that caffeine would be seen to have no effect, since caffeine blocks sleep-promoting brain chemicals.

It was previously found that 70 percent of adults in Britain sleep less than seven hours nightly, according to a report by the Sleep Council. Over a quarter of the population sleep poorly on a regular basis, leading the National Health Service to recommend consuming less tea, coffee, energy drinks or cola during the evening hours, since caffeine has always been thought to interfere with the sleep process, playing a significant role in preventing deep sleep.

Previous research demonstrated that the use of caffeine close to bedtime seemed to increase the time taken to fall asleep, and it was always assumed that caffeine consumption in the late hours stirred people to awaken from sleep earlier than would be the case had they abstained from caffeine-hosting products. Most other studies, point out the researchers, involved fewer participants who were given caffeine tablets to mimic the effects of coffee or tea drinking before bed.

In the new study, volunteers incorporated study parameters into their normal lifestyles with t he results indicating evening nicotine use as opposed to a night without led people to awaken six minutes earlier than would otherwise occur.

An evening cigarette is worse for sleep than a late coffee, this study finds. Photo: Sebastianosecondi iStock

"As confirmed in this research, caffeine actually has less of an effect on our sleep than many people worry about."
"As long as you don’t drink pitchers and pitchers of coffee just before bed, caffeine is unlikely to have a major negative impact on sleep."
"If we wake during the night and consume nicotine — perhaps in an attempt to help us relax — we can actually make it more difficult to fall back to sleep. I suggest trying to avoid smoking at least two hours before you plan on going to bed and to avoid smoking if you wake during the night."
"Limiting alcohol consumption to one or two glasses of wine or beer with dinner, three to four hours before bedtime will help minimize any sleep disruption."
Martin Reed, certified clinical sleep health educator, founder, Insomnia Coach

Evening coffee drinkers may not be wrecking their sleep after all.  iStock

"African Americans have been underrepresented in studies examining the associations of nicotine, alcohol, and caffeine use on sleep. This is especially significant because African Americans are more likely to experience short sleep duration and fragmented sleep compared to non-Hispanic whites as well as more deleterious health consequences associated with inadequate sleep than other racial or ethnic groups."
"There is no reason to think that these findings are not generalizable to other racial or ethnic groups. This is one of the largest investigations of the impact of alcohol, caffeine and nicotine to date with more than 5,000 nights of data."
Dr.Christine E. Spadola, study lead author

That Nicotine Buzz

"A kid can inhale it and get a good nicotine buzz."
"Is this a fad or is it the beginning of primary nicotine addiction?"
"We think most users are  using it a few times a month. But there are clearly some who are using it every day."
Dr. Neal Benowitz, San Francisco

"Perhaps it will be a passing fad. We don't know."
"But, when kids come to you and tell you that half the kids are JUULing, it's a valuable piece of information."
"Obviously, there's a certain allure, and that's interesting and worrisome."
Robert Reid, deputy chief, division of prevention and rehabilitation, University of Ottawa Heart Institute

"To me, these are products that are really appealing to kids. ... Millions of kids are trying these e-cigarette products. Studies show that one in five eighth-graders that currently use tobacco products got there by starting with e-cigarettes."

"So these e-cigarettes are also a gateway for traditional tobacco use for many young kids.There are warnings on the labels of some vape liquids containing nicotine that are pretty clear: 'Nicotine is an addictive chemical; For use by adults 18 and older'." 

Joseph Allen, assistant professor of exposure assessment science, Harvard T.H. Chan School of Public Health

"Our main concern is adults having the tools that they need to quit smoking. Young adults, if they are not smokers, they absolutely should not start using a nicotine product."

"Spend some time in a vape shop and see the customers that come in for these wildly named products. They are adults. They are over 25 years old, and they are the same type that watches 'Family Guy' on Sunday nights."

"It's something that is a little lurid, appeals to adults. We're not a country of serious, uptight people that just want straightforward products."

American Vaping Association President Greg Conley

 

"I definitely think about ... how it affects what I'm putting into my lungs, because I don't really know too much about it. ... I'm not even sure how it turns into vape. ... But I haven't been too concerned about it, obviously, because I'm still using it [since first starting to vape in her teens]."

"It [warning label on her JUUL box, read for the first time] says 'California Proposition 65 warning: This product contains chemicals known to the state of California to cause cancer or birth defects, or other reproductive harm.' OK, I never read that before. Doesn't make me feel great, but that's what it says, so, I guess, yeah, that is the only warning. But that's probably the only warning that needs to be on there."

"[Did the warning change her mind about vaping?] No, definitely not."                      Bella Kacoyannakis, 20, East Longmeadow, Massachusetts

Twenty-year-old Bella Kacoyannakis started vaping when she was still in her teens

According to the company that produces the "Apple of vaping" -- the device that has spread through high schools in the U.S. and Canada as well as university dorms -- headquartered in San Francisco, it has one interest only, to improve the lives of smokers, to aid them in their determination to stop smoking cigarettes, nothing more, nothing less. Dr. Benowitz, whose clinic happens to be located several blocks from the JUUL headquarters, notes when he met the company founders three years earlier his message to them was: "You have to make sure this doesn't spread through high schools."

Spread it has; like the proverbial firestorm of popular acclaim for a product whose allures has taken young people always on the lookout for the latest cool attraction, by storm. The past decade has seen a notable decrease of young smokers, a situation that has gone into reverse with the introduction of e-cigarettes and vaping devices causing health authorities to pose hard questions, according to Dr. Benowitz, an expert on nicotine toxicology, speaking at a national conference on smoking cessation held in Ottawa, Ontario.

Students outside West Carleton Secondary School in Ontario hold e-cigarettes. (Hallie Cotnam/CBC)

A recent survey of teens and substance abuse throughout the province found ten percent of Ottawa high school students had vaped in 2017, in comparison to six percent who said they had smoked. The recent nature of this phenomenon means that little is as yet understood about whether young users do so socially, or whether as time goes on they will become confirmed cigarette smokers, becoming lifetime users of nicotine. This is an issue identified as worrisome by physician and University of California professor, Dr. Benowitz.

Admittedly, the hit of nicotine delivered through e-cigarettes is acknowledged to be less harmful than that from cigarettes. Public Health England points out that e-cigarettes are 95 percent less harmful than cigarettes, and some British and French jurisdictions have enlisted vape store personnel as advisers for smoke cessation. The danger rests in the smoke, according to research. Sweden, with its high use of snuff-like smokeless tobacco, "snus", lists a low rate of lung cancer.

Concerns remain, however, that devices like JUUL differ from those first-generation e-cigarettes since JUUL uses nicotine salts, diminishing that harsh taste but delivering high nicotine content. Flavours used for vaping products such as mango and creme brulee may appeal to adult smokers but these are flavours that young smokers also respond positively to. And while vaping may be less harmful than smoking, concerns abound about nicotine's effects on the still-developing adolescent brain.

A vape trick video has over eight million views on YouTube. (Posted to youtube by vAustinL)