As more Americans eagerly await their turn to receive the COVID-19 vaccine, people are finding that smokers are one of the priority groups for vaccination.
Some do not agree with the guidance and have expressed their frustrations on social media. But health experts say the justification is clear.
“I could see why people would think this would be unfair, but people who are smokers are generally at greater risk of becoming ill when they develop COVID-19,” said Dr. Samuel Kim, a chest surgeon at Northwestern Medicine in Chicago.
A study, published on January 25 in the scientific journal JAMA Internal Medicine, found that people who smoke or who have smoked in the past are more likely to be hospitalized or die of COVID-19 than people who have not smoked.
“The finding that smoking is associated with an increased risk of poor results with COVID-19 is not surprising,” said study co-author Dr. Joe Zein, a pulmonologist at the Cleveland Clinic. “Smoking induces structural changes in the respiratory tract and compromises people’s ability to mount adequate immune and inflammatory responses (against infections).”
Smokers are also more likely to have other illnesses, such as hypertension, coronary artery disease and chronic obstructive pulmonary disease, or COPD, which further increases the risk of poor results, he added.
The Cleveland Clinic study found that patients with COVID-19 who smoked more than 30 pack-years (a number derived from multiplying the number of packs per day by years of smoking) were 2.25 times more likely to be hospitalized and 1, 89 times more likely to die than those who never smoked.
Zein said it is difficult to capture the link between smoking and the worst results of COVID-19 because electronic medical records can misclassify patients. Instead of placing a patient as an “ex-smoker”, they are sometimes classified as “never smokers”.
Researchers at the University of California, Los Angeles, found how smoking worsens COVID-19 infections in a smoker’s respiratory tract in a study published in November in the journal Cell Stem Cell.
The group infected cultures exposed to cigarette smoke and identical cultures that were not exposed and saw between two to three times more infected cells in the cultures of smokers.
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Smoking is a significant risk factor for bacterial and viral infections. Zein said that smoking is associated with a 2 to 4 times greater risk of invasive pneumococcal infection. The risk and severity of influenza disease are also significantly higher in smokers than in non-smokers and, in developing countries, smoking has been associated with an increased risk of tuberculosis.
“If you think of the airways as the high walls that protect a castle, smoking cigarettes is like creating holes in those walls,” said Dr. Brigitte Gomperts, professor of pulmonary medicine and a member of the UCLA Jonsson Comprehensive Cancer Center. “Smoking reduces natural defenses and this allows the virus to install itself.”
Kim of Northwestern Medicine said that some studies have found that smoking can also affect the immune system, so that the body cannot clear the infection as well as a normal person would. If COVID-19 infection progresses to severe disease and lung injury, some patients need lung transplantation.
“When you take a look at these lungs,” he said of the extreme cases of COVID-19, “they are worse than any other lung disease I have ever seen.”
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This article was originally published in USA TODAY: CDC prioritizes smokers for the COVID vaccine. Health experts explain why.