GILBERT (not his real name) was just 17 when he started smoking. By the time he was in his early 20s, he was smoking five to six packets of cigarettes a day.

The sales executive tried to quit smoking but found it tough. He finally managed to kick the habit last year at the age of 35, mainly due to the fear of contracting COVID-19. Knowing that smokers faced a higher risk of developing complications in the event of an infection, Gilbert started by cutting down on the number of cigarettes he smoked daily and before the year ended, he got rid of the habit.

"I saw many cases of healthy people contracting COVID-19 and ending up in the ICU (intensive care unit). Even though they were non-smokers, they were classified as category four and five patients.

"Since smoking can affect the respiratory system, I realised I could become extremely sick (if I got infected by the coronavirus)," he told Bernama.

A study conducted by the Ministry of Health, alongside the National Institute of Health, International Islamic University Malaysia and Universiti Putra Malaysia, on 5,889 COVID-19 cases nationwide from Feb 1 until May 31 last year found that 791 of them were smokers.

Their research also revealed that 19.2 percent of the smokers infected by the virus also faced kidney infections. Among these cases involving smokers, 112 did not require breathing assistance while 35 needed breathing assistance. Another 13 were in critical condition.

Universiti Teknologi Mara Private Specialist Centre lung consultant Prof Dr Mohammed Fauzi Abdul Rani said smoking increases the chances of being infected by the COVID-19 virus through the mouth whilst smoking cigarettes or using other tobacco products.

"Tobacco users (who smoke cigarettes, water pipes, bidis, cigars or e-cigarettes) may be more vulnerable to contracting COVID-19 as smoking involves contact of fingers (and possibly contaminated cigarettes) with the lips, all of which will increase the possibility of transmission of the virus from hand to the mouth.

"Smoking water pipes, also known as shisha or hookah, often involves the sharing of mouthpieces and hoses, which could facilitate the transmission of the COVID-19 virus in communal and social settings," he told Bernama recently.



DAMAGE THE LUNGS

Dr Mohammed Fauzi said during the smoking process, smokers injure the lining of their airways and lungs and make themselves more susceptible to the virus.

"The effect of COVID-19 can be worse for people using tobacco. If smokers become infected with COVID-19, they face a greater risk of severe infection as their lung health is already compromised because of smoking.

"Nicotine is said to have some deleterious impact on the virus, but the benefit is eliminated by the injury to the lungs due to smoking," he explained.

Malaysian Women's Action for Tobacco Control and Health (MyWATCH) medical director Dr Zarihah Mohd Zain said smokers may face a number of serious health problems, including a higher risk for blood clots and weakening of the body's immune system.

"In fact, smoking cannot protect against COVID-19 as it reduces the immune response of the body which, in turn, makes antibodies disappear faster," she said.

She also said that smoking does not only increase the risk of cancer but can also massively increase the risk of developing many cardiovascular diseases such as heart attack and stroke, and impotence or erectile dysfunction in men.

"Furthermore, due to smoke inhalation, the lungs can also become damaged, leading to chronic obstructive pulmonary disease and pneumonia, as well as exacerbate pre-existing respiratory conditions, including asthma, bronchitis and the common cold," she added.

She said there have been cases of smokers developing very severe symptoms after contracting COVID-19 and in many cases, the long-term effects like breathlessness have persisted longer in smokers.

She said the ongoing pandemic is the best time for smokers to get rid of smoking to reduce their risk of getting infected by the dreaded virus.

Dr Mohammed Fauzi agreed, saying that the movement restrictions imposed by the Movement Control Order and the reduced selling hours will help limit access to cigarette purchase and, thus, facilitate smokers to quit the habit.

He also warned that if smokers infected by the COVID-19 virus smoke in a public area, healthy people inhaling the smoke have a high chance of getting infected as well.

"Studies have shown that saliva droplets travel further and remain suspended in the air longer with cigarette smoke. So, the one-metre social distancing rule will not be enough if you are in the company of a COVID-19-infected smoker," he said, adding that a face mask will provide some protection, particularly double face masking or an N95 mask.



COVID-19 VACCINE AND SMOKERS

Meanwhile, can smoking lessen the impact of the COVID-19 vaccine?

According to Dr Mohammed Fauzi, smoking can impair the body's ability to produce neutralising antibodies against COVID-19 due to the negative impact of the smoke on some antibody-producing cells.

Smoking, in general, can also cause blood clots to form, he said, adding that smokers should "take this opportunity to quit smoking and refrain from falsely attributing the risk exclusively to vaccination".

Dr Chong Chin Pin, who is an Immunisation Advocacy Chapter committee member at the Malaysian Pharmacists Society, said the risk of getting a blood clot from smoking is a whopping 2,500 times higher than from the COVID-19 vaccine itself.

"To date, there has been a study that demonstrated that people who smoke produced lesser antibody titres after the COVID-19 vaccination. Although there is limited data on the impact of smoking on the COVID-19 vaccine, we can also look into existing scientific evidence on others (impact of smoking on other types of vaccines).

"Take the influenza vaccine as an example... studies on smokers and non-smokers who received the influenza vaccine revealed that smokers showed 18 percent lower effectiveness in preventing hospital admission. And, the influenza antibodies declined more rapidly in the smokers," said Chong, who is also a lecturer in pharmacy practice at the International Medical University.

He said it is believed that smoking is associated with a dysfunctional immune system, resulting in a reduced response to the vaccine.

"I would advise smokers to cease smoking to lower the risk of (COVID-19) infection and preserve the effectiveness of the vaccine," he added.



-- BERNAMA