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Does Smoking Increase the Risk of Severe COVID-19 Illness?


Editor's Note: This story was updated on Oct. 26, 2021, to accurately reflect the number of U.S. deaths from COVID-19. 

While there is no definitive proof that smoking makes someone more susceptible to contracting COVID-19, Cedars-Sinai experts say smokers could have increased risk for being hospitalized or being placed on a ventilator if they get the virus.

Illnesses that smokers often develop impact many of the same major organs as COVID-19. Doctors and researchers have noted that the lungs, heart and the vascular system are particularly vulnerable when a person becomes infected with the coronavirus SARS-CoV-2.

“Smokers often have serious heart and lung health problems already. Add COVID-19 to the mix and you are likely to get a very sick patient; they just don’t have the physiological reserves to deal with the massive inflammatory attack brought on by the coronavirus,” said Joseph E. Ebinger, MD,  a cardiologist with the Smidt Heart Institute at Cedars-Sinai.

Each year, 480,000 people in the United States die from smoking-related illnesses, including heart attacks, stroke and the slow suffocation brought on by emphysema, one of the chronic obstructive pulmonary diseases (COPD.) The Centers for Disease Control and Prevention (CDC) reports that currently 16 million Americans live with a disease caused by smoking.

COVID-19 has claimed more than 730,000 deaths in the U.S., according to the CDC, but so far researchers have not found a cause-and-effect relationship between smoking and an elevated risk of getting COVID-19 or dying from it.

“If getting through COVID-19 is like running a 100-meter dash, smokers are having to carry sandbags with them while trying to finish the race,” Ebinger said.

In addition to compromised immune systems, many smokers and vapers already have lung problems that leave them more vulnerable to getting the flu, pneumonia or bronchitis. Smoking produces higher levels of ACE2 receptors – a protein – on the surface of the lung cells and those receptors make it easy for a viral invasion to take hold.

“The virus that causes COVID-19 could get into the lungs and normally might be destroyed by the protective epithelial cells. But in people who smoke, the virus may be able to latch on to all those extra ACE2 receptors often found in smokers. This allows the virus to overwhelm and destroy healthy lung cells and then multiply quickly inside the patient,” said Zab Mosenifar, MD, pulmonologist and the Geri and Richard Brawerman Chair in Pulmonary and Critical Care Medicine at Cedars-Sinai.

Mosenifar advises smokers that now may be the right time to finally quit.

“Stop smoking today, if not today, tomorrow. It might be too late to stop smoking once you contract COVID-19.”

But is the middle of a pandemic the optimum time to try and stop smoking? Some cessation experts observe that patients are more hesitant to quit now, given the added stressors caused by the global health crisis.

“During the current pandemic, the barrier to quitting for most of my patients has been the added stress, anxiety and uncertainty that is relieved by smoking or vaping,” said Ndinda Domingos, PharmD, a clinical pharmacist and smoking cessation expert at Cedars-Sinai. “The long-term effects of smoking and vaping can be more detrimental now since smoking compromises the immune system, leaving smokers more vulnerable to serious complications if they get an infection.”

Help is available to those who feel there is no time like the present to put down the cigarettes or the vaping pen. Cedars-Sinai’s Smoking Cessation Program, led by clinical pharmacists, can be a helpful resource for people who want to quit. Additionally, there are medications that can be part of a successful cessation program, including the nicotine patch, Chantix, bupropion and nicotine gum or lozenges for breakthrough cravings. Patients should consult their healthcare provider about the smoking cessation options that would be right for them.

Domingos recommends that smokers work on tapering their smoking and vaping instead of quitting "cold turkey."

“I tell my patients to take it one day at a time and to not quit abruptly. Write a tapering schedule on a calendar and set a quit date. If you relapse don’t be discouraged. This is a major life change for most people. Start over and continue working on your important health goals.”

Additional resources include:

• 1-800-QUIT-NOW (CDC’s help line for smokers)
• 877-44U-QUIT (National Cancer Institute for Smokeless Tobacco)
• 1-800-NOBUTTS (California Smokers’ Helpline)
• 1-844-8-NO-VAPE (California Smokers’ Helpline for vaping cessation)