Smoking and COVID 19 – an update

Blog Post created by NDC_Team on May 20, 2020

I have recently spoken with two patients, and a few other folks, who had heard or read that smoking was ‘good’ for COVID.  Not true!  Maybe you’ve heard similar misinformation?  I thought I would share with you an update on what we know about the association and talk some about the genesis of the misinformation.


As of today, SARS COVID 19 has infected almost 5 million people.[1] The majority of people who contract the virus recover without the need for hospitalization or intensive interventions.[2]  However, people who smoke are more likely to die or need critical care interventions than people who don’t, and may be more likely to contract the COVID virus. [3],[4]


There has been confusion that has been popularized in media that smoking may be preventative for COVID.[5]  As headlines tend to do, these headlines have taken more complex information out of context and unfortunately have caused some people to ‘leap to’ wrong conclusions.  (A patient I spoke with yesterday actually relapsed to tobacco use after reading such a headline and suffered from a subsequent heart attack.)


The headlines have been extrapolated from two types of studies. One type looked at the number of people with COVID who reported that they smoke and compared that percentage of patients to the percentage of people in that country who smoke based upon survey research.  There are a number of potential problems to this type of analysis and more recent studies are finding that the correlation does not hold and there is likely under-reporting of smoking by those with severe COVID complications. 


The other type of study is from cell biology and in particular studies that show a complex interaction between compounds in cigarette smoke and receptors by which the COVID virus attaches to human cells.  Some studies have described a ‘down-regulation’ of COVID receptors and others an up-regulation that may be associated with nicotine.  The most recent study4 seems to show most definitively that cigarette smoke increases the susceptibility to COVID at a cellular level. It also shows that  quitting has an immediate and positive effect on reducing that risk. 


One must keep in mind that it is a long leap from ‘cell reaction’ to human susceptibility, and that the relationship is complex.  For example different compounds in cigarette smoke have different effects in cell biology.  All in all though, the evidence is clear. Stopping smoking is the most beneficial thing a person can do for themselves.  Not smoking decreases the severity of COVID symptoms and is likely to reduce the risk for infection.  If you have stopped, stay tobacco free. If you are smoking, stopping can only help.


Michael V. Burke, Ed.D

Program Director and NDC Counselor/ CTTS


[1] https://coronavirus.jhu.edu/map.html (accessed May 20, 2020 7 AM)

[2] (Wu, Z., and McGoogan J.. JAMA. 2020;323(13):1239–1242. doi:10.1001/jama.2020.2648)

[3] (Patanavanich, R., and Glantz, S.A. (2020).[3] Smoking is Associated with COVID-19 Progression: A Meta-Analysis. MedR;


Zhao, Q., Meng, M., Kumar, R., Wu, Y., Huang, J., Lian, N., Deng, Y., and Lin, S. (2020a). The impact of COPD and smoking history on the severity of Covid-19: A systemic review and metaanalysis. J. Med. Virol).

[4] Joan C. Smith,Erin L. Sausville,Vishruth Girish,Monet Lou Yuan,Anand Vasudevan,Kristen M. John,Jason M. Sheltzer Cigarette smoke exposure and inflammatory signaling..Developmental Cell Available online 16 May 2020

[5] https://theconversation.com/does-nicotine-protect-us-against-coronavirus-137488   Accessed May 20, 2020