Twice as many people completely quit smoking after the COVID-19 lockdown began in March as did before the restrictions, a study has found.
Researchers from University College London (UCL) analysed a series of surveys that are taken monthly to examine people’s smoking, drinking and quitting habits.
Twice as many people quit smoking — and tried to quit — after the the COVID-19 lockdown began in March as did before the restrictions, a study has found
‘The fact we saw rates of quit attempts and cessation increase after the start of lockdown is encouraging,’ said paper author and behavioural scientist Sarah Jackson of University College London.
‘It may be that the pandemic has made people more concerned about the effects of smoking on their respiratory health.’
The World Health Organisation has warned that smoking — which impairs lung function — may make people more susceptible to COVID-19.
However, a number of studies have suggested that incidence rates of SARS-CoV-2 may be lower among smokers than the rest of the population.
‘Stopping smoking brings immediate benefits to health, including for people with an existing smoking-related disease. Now is a fantastic opportunity to join the hundreds of thousands of other people quitting in England,’ Dr Jackson added.
‘Quitting may also have the added benefit of reducing demands on our NHS during these difficult times,’ she noted.
In their study, Dr Jackson and colleagues compared survey data collected as part of the ‘Smoking and Alcohol Toolkit Studies’ taken from April 2019–February 2020 with similar collected during April 2020, at which point the UK had entered lockdown.
On average, around 1,717 people participated in the monthly surveys before lockdown — while there were 1,674 respondents in April 2020.
The team found that the number of attempts to quit smoking — defined as any serious attempt to give up in the preceding 12 months — increased from an average of around 29.1 per cent before lockdown to around 39.6 per cent in April 2020.
Successful efforts to stop smoking, meanwhile, more than doubled going into lockdown — rising from 4.1 per cent before to 8.8 per cent after.
The survey result also revealed an increased uptake in remote cessation support by smokers during lockdown — with such coming in the form of apps, websites and quitting support telephone lines.
While lockdown appears to have increased the desire to quit smoking, it did not have the same kind of effect on drinking, however — with the prevalence of binge drinking having increased from 25.1 to 38.3 per cent.
Furthermore, use of evidence-based alcohol support was seen to decrease after the pandemic began — with no counteracting increase in the use of remote support.
The researchers also found that — while twice as many adults said they were trying to cut down on alcohol — nearly 40 per cent of Britons practiced risky drinking in lockdown
‘The observed increase in high-risk drinking is a serious cause for concern and requires a public health response,’ said paper author and behavioural scientist Jamie Brown, also of University College London.
‘The recent Commission on Alcohol Harm recommended investment in services and measures to reduce affordability,’ he added.
‘These findings also have a possible implication for the pandemic: excessive alcohol consumption may reduce vigilance around social distancing and adherence to other protective behaviours.’
With their initial study complete, the team are looking to expand their analysis to incorporate addition months after lockdown began.
The full findings of the study were published in the journal Addiction. The researchers are also recruiting smokers to take part in a larger study — more information on which can be found on their website.
SMOKING AND THE CORONAVIRUS
Many studies have shown a low prevalence of smokers in hospitals with COVID-19.
When smokers do get diagnosed with the virus, however, they appear to be more likely to get so sick that they need ventilation, two studies in the review showed.
If the findings are proven, scientists say it’s likely that it is not cigarettes – filled with thousands of harmful chemicals – that would offer a potential protection, but the nicotine that is beneficial.
A theory touted by scientists is that nicotine reduces ACE-2 receptors, which are proteins in the body the virus binds to in order to infect cells.
The coronavirus enters cells inside the body via the structures, which coat the surface of some cells, including in the airways and lungs.
If nicotine does lowers ACE-2 expression, it makes it harder for viral particles to gain entry into cells and therefore cause an infection.
On the other hand, other studies show that nicotine enhances the action of the ACE-2 receptor, which in theory, puts smokers at a higher risk of contracting the coronavirus.
Other scientists say low levels of ACE-2 expression as a result of nicotine may prevent worse damage from viral infection, and there is no evidence that says higher quantities of ACE-2 receptors increases the risk of SARS-CoV-2 infection in the first place.
Dr Konstantinos Farsalinos, from the University of West Attica, Greece, who queried whether nicotine could be a cure for COVID-19 in a paper published on May 9, said: ‘Up-regulation of ACE2, though seemingly paradoxical, may in fact protect patients from severe disease and lung injury.’
A 2008 study in mice found that getting rid of ACE-2 made the animals more likely to suffer severe breathing difficulties when infected with the SARS virus, which is almost identical to COVID-19.
Other scientists have turned their head towards nicotine’s ability to prevent inflammation, where evidence is more robust.
Nicotine has been shown inhibit the production of pro-inflammatory cytokines, such as TNF, IL-1 and IL-6, which are involved in promoting an inflammatory response.
A ‘cytokine storm’ is a phenomenon in which an abundance of cytokines are released in response to infection.
Doctors have previously said that it’s often the body’s response to the virus, rather than the virus itself, that plays a major role in how sick a person gets.
A cytokine storm can lead to respiratory failure and the attack of healthy tissues, causing multi-organ failure.
Therefore, the cytokine storm is being looked at as a target for COVID-19 treatment.
‘Nicotine has effects on the immune system that could be beneficial in reducing the intensity of the cytokine storm,’ Dr Farsalinos wrote in Internal and Emergency Medicine.
‘The potential benefits of nicotine…. could explain, at least in part, the increased severity or adverse outcome among smokers hospitalized for COVID-19 since these patients inevitably experience abrupt cessation of nicotine intake during hospitalization.
‘This may be feasible through repurposing already approved pharmaceutical nicotine products such as nicotine patches.’
Dr Nicola Gaibazzi, who recently published findings on MedRxiv of ‘very low’ numbers of smokers in Italian COVID-19 patients, speculates smoke exposure may bolster the immune system.
He said exposure to cigarette smoke reduces the body’s immune system over time, measured by lower inflammatory markers.
Therefore, when smokers are infected with a virus like SARS-CoV-2, their immune system is more ‘tolerant’ and does not overreact.
On the other hand, non-smokers may be more prone to having the sudden and deadly cytokine storm when they are infected with the virus.
Scientists have stressed that the evidence supporting nicotine as a medicine does not mean everyone should take up smoking.