Smoking Enigma in Coronavirus Disease 2019: A Tug of War between Predisposition and Possible Way Out

Abstract

Background: The recent global inclination for smoking during the Coronavirus Disease 2019 (COVID-19) pandemic has drawn attention to the impact of smoking on COVID-19. While smoking increases susceptibility to common respiratory pathogens including the closely related coronaviruses, COVID-19 causing Severe Acute Respiratory Coronavirus 2 (SARS-CoV-2) being a respiratory pathogen intrigues the possible association between smoking and viral pathogenicity. Smoking and COVID-19: The gender dependence of COVID-19 infection rates and a higher prevalence of smokers among males made the scientific world assume smoking to be a confounding variable in sex predisposition to COVID-19. Conversely, the controversial findings of discrepant morbidity and mortality rates of COVID-19 among smokers questioned the credibility of this hypothesis. More importantly, nicotine in smoking has been hypothesized to downregulate Interleukin-6 (IL-6) which plays a role in COVID-19 severity and to interfere with the Angiotensin-Converting Enzyme 2 (ACE2), the receptor of SARS-CoV-2 led the scientists to experiment nicotine patch prophylactically against COVID-19. Besides, interaction between spike protein and nicotinic acetylcholine receptors (nAChRs) supports the nicotinic cholinergic system dysregulation hypothesis in COVID-19 pathophysiology leading to its therapeutic use. However, despite the contradictions in the direct impact of smoking, it surely acts as fomites for viral transmission. Conclusion: Irrespective of the role nicotine in COVID-management, compassionate use of smoking against SARS-CoV-2 cannot be recommended until the therapeutic value gets proved and therapeutic form becomes available.

Prevalence, Persistence, and Factors Associated with SARS-CoV-2 IgG Seropositivity in a Large Cohort of Healthcare Workers in a Tertiary Care University Hospital in Northern Italy

“…As already reported in several studies, we found a lower risk of seropositivity among active smokers [31,33,47,48], as well as lower levels of IgG among seropositive current smokers; conversely, we observed a higher risk of seropositivity among former smokers compared to never smokers. Some hypotheses have been put forward to explain the apparent lower incidence of SARS-COV-2 infection among active smokers [47,49,50], including a downregulation caused by nicotine on Interleukin-6 (IL-6), which plays a role in COVID-19 severity and interferes with the Angiotensin-Converting Enzyme 2, or an increased concentration of nitric oxide in the respiratory tract that could alter virus replication. However, until robust evidence from further investigations of the interaction between smoking and SARS-COV-2 infection becomes available, public health recommendations other than smoking banning cannot be proposed [49].…”

Using mindsets to boost health: how construal level and goal pursuit shape health message effectiveness on cessation behaviors

“…Despite its well-known health risks, smoking and excessive drinking are still major current public health issues worldwide (Rakhi and Biswas, 2021;Simpson et al, 2019;Strebel and Terry, 2021). Indeed, smoking and excessive drinking account for several public policy consequences (e.g., passive smoking, road accidents, domestic violence) along with elevated public healthcare costs estimated at US$ 1.4 trillion per year for the global economy (WHO, 2021a).…”

“…Despite its well-known health risks, smoking and excessive drinking are still major current public health issues worldwide (Rakhi and Biswas, 2021; Simpson et al , 2019; Strebel and Terry, 2021). Indeed, smoking and excessive drinking account for several public policy consequences (e.g.…”