smoke ’em if you got ’em?

Back on March 19, I posted “smokin’ corona” (https://wordpress.com/block-editor/post/theviewfromharbal.com/326).  Inspired by meeting some old girlfriends outside the hospital by the bus stop for a “break”, I had to wonder if their habit of periodically bathing their lungs with toxic tobacco smoke might even be protecting them from Mr. corona.  Ultimately I concluded alas no.  Patients with preexisting lung disease do worse once the virus gets hold of them, which stands to reason.  There is also a little molecular hanky panky going on, with the lungs of chronic smokers showing greater expression of a receptor for the MERS coronavirus (1).  Presumably the same thing goes on with COVID-19.  But the “more smokers are dying” data comes from China where 25% of the population smokes (maybe 50% of the men), so if 9% of those dying smoke compare to 4% of the survivors, does that mean much? (2)  In Europe, it doesn’t appear that smoking associates with worse outcome from coronavirus infection (3). Yet aren’t the smokers the ones with the crapped out lungs just waiting their doom?

The French have dared to say it: “pas si vite (not so fast)”. https://news.yahoo.com/france-testing-whether-nicotine-could-prevent-coronavirus-163120850.html.  They examined outcomes of COVID-19 infection at one of their top hospitals.  Of 343 severely affected patients and 143 patients with milder symptoms, 5% smoked.  The French do love their tabaç, with 35% of them smoking regularly.  Not as big as the Chinese, where over 50% of the men smoke (women not so much).  Data from a March New England Journal study found 12.6% of 1,000 infected were smokers. Do you detect an underrepresented population?

So let the trials begin!  One of the first will involve nicotine patches, which I predict will fail miserably as they totally avoid the pulmonary maelstrom where Mr. corona meets Mr. human.  There’s so much in the plume arising from your lit cancer stick, who knows who the active soldier might be.  Already warnings clang not to let this be an excuse to light up https://news.yahoo.com/coronavirus-people-warned-not-smoke-153142264.html

Nobody’s asked Dr. Fauci about it yet.  Even before this, British docs had been lamenting how the social isolation and boredom would get Brits lighting ‘em up all over, reversing decades of social education convincing them this was a bad thing to do.

Kathy and I probably won’t do anything with this.  I’ve not smoked (tobacco) since college.  Kathy chain smoked her way through college, winning 6 varsity letters and All-American honors in swimming (backstroke).  It took commitment to a dedicated stop smoking program once she hit Ann Arbor, and her breath was sweet by the time I met her.  But to my girlfriends at the bus stop, I take it all back and quote my title: “smoke ‘em if you’ve got ‘em”

references  

1. Seys LJM, Widagdo W, Verhamme FM, Kleinjan A, Janssens W, Joos GF, Bracke KR, Haagmans BL, Brusselle GG.  DPP4, the Middle East Respiratory Syndrome Coronavirus Receptor, is Upregulated in Lungs of Smokers and Chronic Obstructive Pulmonary Disease Patients.  Clin Infect Dis. 2018 Jan 6;66(1):45-53. doi: 10.1093/cid/cix741.

2.         Vardavas CI, Nikitara K.  COVID-19 and smoking: A systematic review of the evidence.  Tob Induc Dis. 2020 Mar 20;18:20. doi: 10.18332/tid/119324. eCollection 2020.

3.         Lippi G, Henry BM.  Active smoking is not associated with severity of coronavirus disease 2019 (COVID-19).  Eur J Intern Med. 2020 Mar 16. pii: S0953-6205(20)30110-2. doi: 10.1016/j.ejim.2020.03.014. [Epub ahead of print]

4.         Patwardhan P^.  COVID-19: Risk of increase in smoking rates among England’s 6 million smokers and relapse among England’s 11 million ex-smokers.  BJGP Open. 2020 Apr 7. pii: bjgpopen20X101067. doi: 10.3399/bjgpopen20X101067. [Epub ahead of print]

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