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** 24 March 2020
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** International
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** Smokers appear to be at higher risk of severe COVID-19 symptoms (#1)
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** Coronavirus will not spread in vape clouds unless the e-cigarette user coughs when they exhale, scientists claim (#2)
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** Johan Cruyff in numbers (#3)
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** Parliamentary Activity
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** Parliamentary questions (#4)
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** International
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A leading expert has warned that smokers appear to be at increased risk of more severe COVID-19 symptoms, compared to non-smokers, suggesting that now could be a particularly good time to try and quit or cut down. “There’s not very much data at this point on COVID-19 in smokers, but we do know from reports from China, smokers seem to be over-represented in groups of people who have severe or critical COVID-19,” said J. Taylor Hays, M.D. Director of the Nicotine Dependence center at Mayo Clinic in Rochester, Minnesota and Professor of Medicine, Mayo Clinic College of Medicine.

Increasing evidence is suggesting that smokers are at higher risk of severe COVID-19 than those who don’t smoke. One study published in the New England Journal of Medicine in February looked at 1,099 patients in China with COVID-19, showing that of 173 patients who had severe symptoms, 16.9% of them were current smokers and 5.2% had previously smoked. Among the patients with less-severe symptoms, 11.8% were current smokers and 1.3% former smokers. More worryingly, the study showed that in a group of patients that either needed mechanical ventilation, admission to an intensive care unit, or ultimately died, 25.5% were current smokers, which was more than twice the rate of current smokers in a group of patients that did not have these severe adverse outcomes.

“These observations about more severe illness in smokers vs people who have never smoked seems to parallel what is seen in respiratory viruses such as respiratory syncytial virus and seasonal influenza, where smokers tend to do worse than non-smokers,” said Hays, also mentioning that no data is currently available on people who vape or use e-cigarettes. Studying other coronavirus outbreaks provides further suggestions that smokers may fare worse with these types of viral infections than non-smokers. In a study of a small number of patients with Middle-East Respiratory Syndrome (MERS) in South Korea, patients who smoked were less likely to survive than those who did not. There was also some evidence that smokers had higher levels of a protein called DPP4, a receptor which allows the MERS coronavirus to enter cells in the lung, which could make their lung cells more susceptible to attack from the virus. SARS-CoV2, the coronavirus responsible for the current outbreak, uses a different receptor
to gain access to lung cells called ACE2. However, the news here isn’t any better for smokers either. “The ACE2 receptor is up-regulated in the respiratory cells of smokers. This might be a mechanism by which it is more likely to cause severe illness,” said Hays.

“People who quit for even a short time see an improvement in lung health quite quickly. For most smokers who don’t already have serious lung injury, they will see immediate improvements in their health, and less opportunity for severe diseases including COVID-19,” said Hays. “People could look at this as an opportunity – a time of crisis is a time of opportunity. If you’ve been looking for an opportunity to quit, this is it,” he added.

Source: Forbes, 23 March 2020

See also:
New England Journal of Medicine - Clinical characteristics of coronavirus disease 2019 in China ([link removed])
International Journal of Infectious Diseases -
High fatality rates and associated factors in two hospital outbreaks of MERS in Daejeon, the Republic of Korea ([link removed](17)30054-1/fulltext)
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** Clinical Infectious Diseases - DPP4, the Middle East Respiratory Syndrome coronavirus receptor, is upregulated in lungs of smokers and chronic obstructive pulmonary disease patients ([link removed])
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Read Article ([link removed])


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A microbiologist sparked fears last week after claiming that inhaling someone else's e-cigarette vapour was like 'being spat in the face'. However, there is not enough evidence to prove that vape clouds carried enough germs to infect others, Dr Neal Benowitz, an emeritus professor of medicine at the University of California San Francisco has said, adding that the level of mucus and saliva in vapour is so minimal that it is unlikely to cause infection.

Dr Neal Benowitz said there is no data to support the theory COVID-19 could spread through e-cigarette vapour: "It is my understanding that exhaled e-cigarette vapour consists of very small particles of water, propylene glycol and glycerin and flavour chemicals, not droplets of saliva [...] The vaping aerosol evaporates very quickly, while particles that are emitted when coughing or sneezing are large particles that persist in the air for a relatively long period of time. Thus, I would not think that vapers present any risk of spreading COVID-19, unless they are coughing when they exhale the vapour."

Addressing the House of Commons during a briefing on coronavirus, Professor Chris Whitty, the Chief Medical Officer for England, said that if any smoker had considered quitting, now is the time to do it. He told MPs on 5th March: "To be clear on smokers, my recommendation is that they stop smoking. If you are going to give up smoking, this is a very good moment to do it [...] I'm just highlighting that as an additional vulnerability for people who are otherwise healthy." He did not reference vaping.

Source: Daily Mail, 23 March 2020
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Read Article ([link removed])


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On the anniversary of his death, the Press Association looks back on the life of Johan Cruyff, football icon, through the numbers which defined his career.

Included is the number '92' marking
the year, 1992, when Cruyff returned to Barcelona as manager, guiding the team to a first European Cup success – just a year after undergoing major heart surgery which prompted him to stop smoking.

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** As the Goal.com article linked below details, following Cruyff's surgery "The Camel cigarettes were famously replaced by lollipops and Cruyff kicked the habit, even juggling a cigarette pack 16 times and booting it into touch in an awareness advert sponsored by the Catalan Department of Health. Back on the pitch, a golden era began. Positive results reduced tension and the next four seasons brought four Liga titles, as well as a maiden European Cup. The 'Dream Team' was born. Barcelona were 'smoking' but, crucially, Cruyff was not."
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**
Source: Glasgow Times, 24 March 2020
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** See also:
Goal.com - How Johan Cruyff quit smoking to save his life and help create today's legendary Barcelona ([link removed])
Video - Johan Cruyff, 'No Tobacco' campaign ([link removed]) (cited above)
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Read Article ([link removed])


** Parliamentary Activity
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** Asked by Luke Pollard MP, Plymouth, Sutton and Devonport
To ask the Secretary of State for Environment, Food and Rural Affairs, what assessment he has made of the adequacy of his Department's powers to require the tobacco industry to take steps to limit littering from its products.

Answered by Rebecca Pow, The Parliamentary Under-Secretary of State for Environment, Food and Rural Affairs
The Government would like to see the tobacco industry delivering on the commitment given by the Tobacco Manufacturers’ Association to tackle the litter created by its products and their users. We support ongoing efforts by the environmental organisation Keep Britain Tidy to work in partnership with the tobacco industry to devise a voluntary scheme through which the industry can contribute to the clean-up of cigarette related litter, and we are watching this space with interest.

Clause 48 in Section 3 of the Environment Bill grants powers to introduce extended producer responsibility (EPR) schemes. In the Resources and Waste Strategy, we committed to looking into and consulting on EPR for five new waste-streams by 2025, and consulting on two of these by 2022. Waste tobacco filters were not included in this list of priorities but progress on the industry's voluntary approach to litter reduction will be monitored.

Tobacco packaging is covered by the current producer responsibility regulations, which require companies to recycle a proportion of the packaging waste they place on the market. Producers of tobacco packaging will be subject to the forthcoming EPR scheme for packaging which will cover the full net costs of managing packaging at its end of life. In our consultation we proposed that producer fees should cover the full cost to local authorities of dealing with littered and fly-tipped packaging waste.

Source: Hansard, HC Deb, 23 March 2020
Link: [link removed]
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ASH Daily News is a digest of published news on smoking-related topics. ASH is not responsible for the content of external websites. ASH does not necessarily endorse the material contained in this bulletin.

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