Nicotine Use and COVID-19

So far, there’s mixed evidence when it comes to how nicotine use affects one’s risk for COVID-19 infection, onset, and outcome. While it’s expected that smoking may lead to worse outcomes, as is usually the case for other acute respiratory infections, some studies are pointing to the contrary.

It’s still unclear whether these seemingly counterintuitive results are due to biases, misreporting, and flaws inherent in the studies or a potential for a protective effect of smoking on COVID-19 outcomes and whether it’s due to nicotine or something in tobacco products. Of course, it must be said that despite COVID-19, smoking is bad for health nonetheless.

Meanwhile, nicotine is known to be safe when consumed in other forms such as vaping. That’s why there are now studies being conducted to determine whether it affects onset of COVID-19. Finding this out may help us better understand the disease itself, how nicotine affects the body in the context of this pandemic, and even the small chance of finding a cure.

French Study

A study conducted in a French university hospital between March and April 2020 sought to determine if there’s a correlation between daily smoking and susceptibility to SARS-CoV-2 infection.

Researchers estimated the percentage of smokers among COVID-19 patients, compared them with the percentage of smokers in the French population, and categorized them according to sex and age.

They found 5.3% of COVID-19 patients were smokers, compared to 25.4% within the French population. This finding purports a lower probability of symptomatic or severe COVID-19 among smokers compared to the general population.

It must be said that this study only looks at the correlation between the percentage of smokers among COVID-19 patients and the general population of a specific country, so it may not reflect what’s happening in the rest of the world.

As it always is with science, correlation does not imply causation. More studies need to be conducted first to properly understand the relationship between tobacco use and COVID-19.

Farsalinos Study

In late March 2020, Greek cardiologist and e-cigarette researcher Konstantinos Farsalinos published a preliminary study looking into the role of nicotine in COVID-19 infection. The hypothesis supposes that nicotine can affect the angiotensin-converting enzyme 2 (ACE2) that coronaviruses bind to.

It has been suggested that poor COVID-19 outcomes in people who use tobacco may have been driven by nicotine withdrawal during illness. This may necessitate the use of nicotine patches or other delivery systems to continue supplementing nicotine in those patients.

The verdict was that nicotine may indeed have an impact on SARS-CoV-2 infection, but clinical significance has not been made clear yet. In the meantime, studies are being conducted regarding the use of nicotine replacement therapy as a therapeutic aid for COVID-19.

Legal Ramifications

Meanwhile, liabilities concerning the link between COVID-19 and vaping were filed in federal courts across the United States throughout the thick of the pandemic in 2020.

Multiple COVID-19 patients made claims that vaping put them at greater risk of serious health complications due to the disease, which were added to the multidistrict litigation case against Juul Labs.

However, with the appearance of peer-reviewed studies arguing the connection between vaping and how it may exacerbate COVID-19 infection and complications meant that those liability claims do not hold up in US courts just yet. Due to the current lack of viable information that can unequivocally prove causality, the most that can be asserted is merely plausibility.

That means as of right now, there’s no proof beyond speculation. The science is still being sorted out, so US federal courts can’t make judgements on these liability claims just yet. The most that can be asserted is the seemingly high probability of vaping placing people at higher risk of COVID-19 infection and/or subsequent complications.

If litigation is pushed against vape companies on these grounds right now, it will not yet have the appropriate medical evidence to stand on.

Race for Evidence

Farsalinos later published an update to his study, citing new data from various countries, including the United States and France (the aforementioned study) that showed low rates of infection among smokers.

He added to his hypothesis that aside from tobacco use being associated with changes in ACE2 receptors and decreased levels of ACE2 in multiple organs, it may also inhibit hyperinflammation and platelet reactivity, as well as prevent cytokine storms.

This suggests that not only does nicotine help prevent infection, but also reduce damage in already infected patients. Farsalinos has called for clinical trials of nicotine replacement therapy for COVID-19 patients.

Meanwhile, Pasteur institute biologist Jean-Pierre Changeux had already initiated such a clinical trial in France. An expert on the cholinergic system, which includes nicotinic receptors, Changeux saw the lower rates of smokers among COVID-19 patients and sought to find a link between nicotine and the disease.

However, the preliminary study authored by Dr. Changeux and his colleagues had only been published nearly a month after Dr. Farsalinos’ paper. These studies draw the same conclusions, follow almost the same methodology, and are now running in parallel. However, since Farsalino came out with his study first, it’s the one that’s more often cited.

Conclusion

Such instances are surprisingly common throughout the history of science. Even controversies regarding theft and plagiarism have been rife for ages. Hopefully, whoever gets credit for whatever discovery may crop up from these studies, everything is done to benefit the people.

However, tobacco control and public health interests will likely be against anything to do with nicotine as anywhere beneficial, especially with a disease like COVID-19. After all, decades of crusade against tobacco will likely not give way to nicotine suddenly being heralded as a medical boon, despite new things recently being discovered about its properties.

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