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** 25 March 2020
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** UK
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** BMJ Blog: Risky smoking practices and the coronavirus: A deadly mix for our most vulnerable smokers (#4)
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** BMJ Blog: Can we improve the NHS’s ability to tackle covid-19 through emergency public health interventions? (#1)
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** Coronavirus: Vape shops ordered to close (#2)
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** International
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** India: Uttar Pradesh considers banning oral tobacco amid coronavirus outbreak (#3)
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** UK
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** Sharon Cox, Senior Research Fellow at London South Bank University outlines the risks that coronavirus poses to already vulnerable groups who often disproportionately experience higher smoking rates:
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"Smokers are one group of adults who are at particular risk if they catch the virus. Many smokers already present with poor respiratory health caused by years or even decades of smoking [...] However, there exist a group of smokers for who the coronavirus poses a greater risk, these are the homeless, those will a serious mental illness or learning needs, and those presenting with drug or alcohol dependence. Smoking rates are disproportionately high amongst these groups, up to four times the national average. These smokers require particular attention because their lives open up several routes to being exposed to the virus and risk increasing the spread of infection between other vulnerable adults [...] It is these smokers that need protection and advice now.

"One particular vulnerability is the common act of sharing cigarettes. Sharing cigarettes, or “going twos”, is incredibly common amongst our most disadvantaged smokers, and this behaviour risks spreading the virus between person to person. The cigarette or roll up, acts as a vessel for viruses, and the hand and mouth exposure means saliva and droplets can be easily and repeatedly taken from one smoker to the next. Similarly, smoking discarded cigarette ends, another behaviour which is common especially amongst the homeless population, risks exposing the smoker to infections (even beyond the coronavirus). Smoking is already one of the leading causes of health inequalities in the UK, the coronavirus outbreak risks worsening this divide.

"There is an urgent need to work with our most disadvantaged smokers – but now is the time to really help smokers make better choices. It is important that stop smoking services and the third sector recognise this outbreak as an opportunity to work together to provide our most disadvantaged smokers with the support needed to protect themselves and others. These smokers may need licensed cessation medications to help them resist the urge to share cigarettes in between being able to purchase their own, they may require an e-cigarette, to help with the behavioural aspects of smoking rather than reaching for one that has been left on the pavement. Importantly, smokers from vulnerable and disadvantaged groups do show a real desire to quit, this may be an opportunity to change someone’s relationship with smoking in the long term.

"Now would be a good opportunity for the third sector and other organisations which serve the most vulnerable to shine a light on the impact smoking is having on their lives beyond the risks associated with tobacco related disease. Providing regular support to smokers now to reduce and eradicate risky smoking practices will reduce the burden of the virus in real time and minimise the impact of health inequalities."

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** Source: BMJ Blog, 20 March 2020
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** Sunil Bhopal (NIHR academic clinical lecturer in population health paediatrics at Newcastle University and honorary assistant professor London School of Hygiene & Tropical Medicine), Guppi Kaur Bola (public health researcher & strategist), Robert Hughes (clinical research fellow at London School of Hygiene and Tropical Medicine), Anya Gopfert (public health registrar), and Anand Bhopal (PhD, University of Bergen), explore the role public health interventions could have in 'flattening the curve' of the COVID-19 outbreak in their BMJ blog:

"The UK is currently attempting to prevent its acute healthcare services from becoming overwhelmed by covid-19 in the coming weeks. So far, the major focus has been on both 'flattening the epidemic curve' and scaling up intensive care capacity. It remains to be seen whether these measures will be sufficient. However, there is a third major approach with potential benefits: 'reducing the baseline' demand for NHS acute services through the rapid introduction of public health policies.

"These policies—by addressing major drivers of acute healthcare demand, including trauma, cardiopulmonary disease, and falls in the elderly—now merit urgent attention from the government and its advisers, and provide three concrete examples to open this discussion. The bold and creative leadership needed from across the government to implement these measures is in line with the unprecedented action recently taken to close all schools, cafes, pubs, gyms, restaurants, leisure centres, cinemas, theatres, and nightclubs.

"[...] Similarly, tobacco smoking is responsible for nearly half a million hospital admissions per year, representing 22% of all admissions for respiratory diseases. If the UK accelerated its considerable current commitment to tobacco control plans, it may well yield quick results. After all, in the aftermath of Scotland’s introduction of legislation outlawing smoking in enclosed public places, we saw a rapid 20% drop in hospital admissions for acute coronary syndrome in men over 55 years and women over 65 years. The World Health Organization has also indicated that tobacco use may be a risk factor for developing more serious symptoms from covid-19.

"[...] We encourage Public Health England and equivalent bodies in other nations, chief medical officers, and the Scientific Advisory Group for Emergencies (SAGE) to examine these and other emergency public health measures to reduce the burden of non-covid-19-related disease on the NHS. We are aware of other groups undertaking detailed modelling of these proposed strategies, yet awaiting the findings should not halt decisive action."
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Source: BMJ Blog, 24 March 2020
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** Stores selling “non-essential goods” were told to close in a national TV address by Boris Johnson on Monday 23rd March 2020. Vape shops were not included on the government’s list of essential shops exempt from the order to close, meaning they will now have to close their doors to the public.

Both the Independent British Vape Trade Association (IBVTA, representing vaping companies independent from the tobacco industry) and the UK Vaping Industry Association (UKVIA, representing vaping companies including the tobacco industry) said they were reviewing the decision and would issue a statement in response.
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The IBVTA said in a tweet: "We know the announcements this evening will be worrying for #vape stores and their customers. The IBVTA will be considering the details of the policy once they become available, and we will issue a statement in due course."
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Source: Better Retailing, 24 March 2020
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** International
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** The Government of Uttar Pradesh, India's most populous state - home to roughly 200 million people, is considering banning the manufacture and sale of two of the most popular forms of oral tobacco in response to coronavirus: paan masala (typically containing tobacco, seeds, quenched lime, spices, and areca nut enfolded in betel leaf) and gutkha (typically containing slaked lime, areca nut, chewing tobacco, spices, and catechu packed in tins or pouches).
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Chief Home Secretary of Uttar Pradesh, Avanish Awasthi, said that since coronavirus has been found to be active in saliva, the government could ban the use of paan masala and gutkha as people tend to spit it out, potentially posing a risk for transmission of the virus.
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** Source: British Asia News, 24 March 2020
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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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