Sharon Cox: Risky smoking practices and the coronavirus: A deadly mix for our most vulnerable smokers 

Coronavirus in on the rise, both the incidence and the distribution of the virus are growing across the UK, Europe and similarly in the US. Rates of illness and death from China, the worst affected area, are testament to the importance of containing the spread of the virus. We have heard repeatedly that coronavirus is particularly dangerous for those with underlying health conditions and for the elderly. This is because it effects the respiratory system causing breathing difficulties. 

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. A higher percentage of smokers, compared to non-smokers, have health conditions like COPD, heart disease and asthma which are made worse by smoking and exacerbated by illness. For these smokers, catching the virus increases their risk of developing complications and is potentially fatal. 

The Department of Health and Social Care have provided clear guidance on what to expect to happen in the context of the UK and how to prepare if things change. The NHS and others have outlined the behavioural elements that are responsible for spreading the virus, and leading behaviour change experts have outlined the behaviour change techniques that can prevent the spread of the virus. For example, hand washing with soap for the correct time with the right method, using hand gel when needed, and implementing social distancing when appropriate. Many smokers will be in a good position to enact the required behaviours that can prevent the spread of the virus. Access to the required products, such as soap and disinfectant, and access to information on what to do and when to do it, will also be readily available for many smokers. For some smokers this may also be seen as an opportunity to quit smoking, to improve their health, and so will make contact with the NHS Stop Smoking Services (SSS). 

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. The changes in behaviour required to stem the spread of the virus requires conscious, effortful, reflexive thinking, implementing the required changes may be lost within the context of stressful and hard lives. 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. 

What can be done? We have good evidence of the behaviours that can be targeted to optimise health benefits, but while evidence exists at a population level, we also need to be considering what advice is required to specific groups. 

Access to information 

It is urgent that those working within the third sector start to discuss the virus and the risk it poses with their service users and especially their smokers, to highlight how sharing cigarettes and any other products, even drinking from the same bottles or cans, can spread the infection and also increase their own risk. We need public health bodies to reach out to their local charities, homeless centres, substance use services, and identify ways that they can support positive behavioural changes that are specific to the target population.

Access to stop smoking support

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. 

Access to products 

Hand cleaning and access to wipes and gel is going to be vital for those who are sharing cigarettes or other items. For those living rough or between accommodation, access to the products to prevent the spread of the virus and protect themselves will be scarce. Current levels of panic buying will make it harder for those who are having to wait on receiving an income from their benefits before buying products. Food banks need help and some priority over essential items that can reduce the risk of spread of the infection. 

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. 

Sharon Cox, Senior Research Fellow, London South Bank University. Twitter: @Sharon_ACox

Competing interests: Sharon Cox provides expert consultancy to providers of UK life insurance. She has no links to the tobacco, e-cigarette or pharmaceutical industry.