"If you’re thinking about quitting or changing your behavior in some way, NOW is the time to do it. ... Ending tobacco or e-cigarette addiction now will improve your health and could possibly reduce your risk from this virus."
Paul Brunetta, MD
Co-author of "Learning to Quit"
COVID-19 and smoking

We’re all watching in horror as this global COVID-19 tragedy unfolds. The crisis directly impacts almost everyone. A global respiratory virus pandemic has caused pneumonia in over 140 countries. Coronavirus has infected more than 189,000 people in the US, and the real impact is likely many, many times this number. New reports from Italy and China suggest that more men than women are having serious lung infections. One theory behind this difference points out that smoking rates are much higher in men versus women in China, and are also higher in Italy

We don’t yet understand if risk of COVID-19 pneumonia is actually higher in smokers, and the emerging data on coronavirus infections should tell us. Anytime is a good time to think about ending cigarette or e-cigarette use to improve your health. NOW…April 2020, may be your time if you sense your motivation rising.


This new infection devastated China. A group of lung, ICU and radiology doctors at the Central Hospital of Wuhan published a study of 78 patients in January 2020 in the Chinese Medical Journal. All patients in the study had COVID-19 pneumonia, and approximately 15% worsened during their hospital stay. The group that worsened was compared to those who improved. Being older and having a history of smoking were determined to be two major baseline risk factors associated with increased severity.

A second interesting paper was published this February from the University of South Carolina. In order for the COVID-19 or SARS virus to get into lung cells to cause pneumonia, it needs to attach to a specific receptor on lung cells. An investigator evaluated the presence of the COVID-19 receptor in a large database of lung tissue samples (doi:10.20944/preprints202002.0051.v1). This analysis showed that a specific receptor, called ACE2, was higher in smokers versus non-smokers. In other words, smoking may make it easier for the coronavirus to bind to and infect the lungs of smokers compared to non-smokers.

A recent review (released March 20) of all available published data concluded that “smoking is most likely associated with the negative progression and adverse outcomes of COVID-19.”

Cigarette and e-cigarette impact on lung defenses

Taken together, these recent reports suggest a real possibility that smoking can make COVID-19 pneumonia worse. Smoking clearly makes outcomes much worse for people with regular flu infection. Smoking also increases the risk of hospitalization for pneumonia from influenza, at least in older people. 

Want to know why smoking increases your risk for infection? The nicotine in cigarettes reduces the motion of the hair-like cilia in your airways that help clear mucus from your lungs. Tar in your airways and airsacs causes immune cells to be occupied with trying to get rid of the tar and less able to respond to normal infections. Smokers produce more mucus and are at higher risk for both acute and chronic bronchitis compared to non-smokers.

Switching to vaping won’t help you either. Adolescents that use e-cigarettes have more respiratory symptoms than those that don’t use them. Vaping is associated with increased risk of asthma and bronchitis development. E-cigarettes have been shown to alter immune cells in the lungs, and the inhaled metal vapors directly harm cells lining the airway.

What to do to reduce your risk

If you’re thinking about quitting or changing your behavior NOW is the time to do it. The pandemic and the risk of COVID-19 will go on for many months. Ending tobacco or e-cigarette addiction now will improve your health and could possibly reduce your risk from this virus. Learning To Quit has many free resources, free chapters, a quit guide and other information. Every state has a free 1-800 number for people to call, as does the NCI (1-800 QUIT-NOW). Stopping cigarette smoking (and e-cigarette use) may be the most important thing you ever do for your health.

If not for yourself, think about quitting for someone else. Find inspiration in the selfless actions of others, especially people in the healthcare profession that are working every day to improve the health of the many sick people being tested and treated now. The truth is that your health and my health can have a direct impact on the health of other people. Stay safe!

by Paul Brunetta, MD

Co-author of Learning to Quit.

Dr. Paul Brunetta had his first cigarette at the age of nine and was able to quit just prior to medical school. He struggled through numerous quit attempts – determined not to be “that doctor who smokes.”

While working together at the UCSF Chest Clinic, Brunetta and Suzanne Harris discovered they shared a common mission: to prevent tobacco-related diseases by giving as many smokers as possible the tools they need to quit. In 1999, they founded the Fontana Tobacco Treatment Center at UCSF. Their program is now available to anyone in the new edition of Learning to Quit.

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