COVID-19 and Tobacco – Two Global Health Crises Collide

The novel coronavirus disease (COVID-19) has killed nearly 600,000 people worldwide and over 138,000 in the U.S. in 2020 (as of July 17, 2020), according to the Johns Hopkins Coronavirus Resource Center.

COVID-19 is a global beast of epic proportions. While we band together to fight this pandemic, we view this as a wake-up call for our “other” global health and economic crisis impacting us not just in 2020, but for the last 100+ years: Tobacco Use.

In stark contrast to COVID-19, tobacco caused an estimated 3,000,000 deaths world-wide and 200,000 in the U.S. so far in 2020 (WHO, CDC based on prior year data). While we haven’t yet seen significant leveling off of COVID-19 cases or deaths, we will, fortunately, vanquish the virus at some point via testing, physical distancing, vaccination, herd immunity, and novel treatments. But let’s be clear. When we finally get COVID-19 under control, we will undoubtedly be continuing to fight the global tobacco use crisis, which causes an estimated 7,100,000 deaths every year.

Why help people quit tobacco now during COVID-19?

Tobacco use contributes to many of the health conditions known to elevate the risk for COVID-19 complications, such as lung disease, heart disease, hypertension, and diabetes. Furthermore, cigarette smoke causes inflammation in the respiratory tract, as well as impairment of the immune system, making it harder for a tobacco user to avoid infection should they be exposed to the novel coronavirus and other viruses, like influenza.

“…we should agree that it’s more urgent than ever to help people quit tobacco NOW.”

There is also evidence that smoking increases a population of receptors on respiratory cell surfaces (ACE2), to which coronavirus binds and enters the cells (Sheltzer, et al., Cold Spring Harbor Laboratory). Evidence from China suggests that COVID-19 patients who currently or formerly smoked tobacco were more likely to be classified as “severe disease” and had a higher likelihood of ICU admission, ventilation requirement, and death (Guan et al., NEJM 2020).

Given these facts, we should agree that it’s more urgent than ever to help people quit tobacco NOW.

If you use tobacco and if you have ever thought about quitting, you are not alone. 70% of people who smoke want to quit and 55% try every year (CDC). This is a great time to ask your physician, health plan, or employer about quitting.

If you are a health care provider, health plan, policymaker, employer, state health official, political leader, hospital system, or anyone else involved in the delivery of tobacco cessation services and the health and welfare of our population, here is a rallying cry:

1. Don’t wait, people are dying: Fast track scalable evidence-based tobacco cessation programs today. COVID-19 is a reason to accelerate, not delay, action.
2. Provide services at no cost to the user: Tobacco cessation should be provided two times per year, as mandated by the ACA.
3. Invest in your organization: Tobacco cessation is a “dominant” intervention, it provides a return on investment to health plans and employers.
4. Get to scale: There are 36 million tobacco users in the U.S. We can’t get to everyone with telephonic coaching and classes. Scalable preventive services must be delivered digitally through the smartphone and web, especially during COVID-19.
5. Think differently: Most quit programs are like going to the DMV. Instead, offer programs with modern consumer expectations in mind, modeled after Apple or Facebook or Nike. It’s the only way to engage this population effectively.

“…after COVID is gone, tobacco use will REMAIN the same problem it is now… killing over 7,100,000 adults globally every year. Unless we act now.”

COVID-19 is a monster that has brought our country and the globe to its knees. We don’t know how many people will ultimately die. We don’t know when and how it’s going to end. But we DO know that COVID-19 will be under control some day. And when that finally happens, tobacco use will REMAIN the same problem it is now… killing over 7,100,000 adults globally every year. Unless we act now.

This is our wake-up call.

Fifteen people in the U.S. died of a smoking-related illness while you read this. Another 1,300 will die in the U.S. today, and tomorrow, and the next day.

David S. Utley, M.D. is a former member of the surgical faculty at Stanford, where he focused on caring for patients with cancers of the head and neck related to tobacco use. He currently is the CEO of Carrot Inc., a digital health company that created Pivot, an evidence-based digital health solution to help people quit tobacco using proven behavioral change techniques, community support, coaching, FDA approved medication, and a wearable device to help a user learn how smoking affects their health.