With a rapid surge in the number of COVID-19 patients, Turkey has recently implemented a series of measures to stem the spread of the virus, including a nationwide smoking ban in public spaces.
World Health Organization (WHO) experts and president of the anti-addiction group, Turkish Green Crescent, welcomed the ban but warned smokers about the likelihood of experiencing more severe symptoms from the deadly virus compared to non-smokers.
In a circular to governors in the nation's 81 provinces, the Interior Ministry said Nov. 11 that a smoking ban would be introduced in "areas like avenues, streets and stops where citizens are crowded."
The head of WHO European Centre for Preparedness for Humanitarian and Health Emergencies, Irshad Ali Shaikh, said the "action is unpopular, but inaction is deadly." The doctor told Anadolu Agency "it is only prudent to look at those factors" that may potentially slow the pace of virus spread.
With masking, personal hygiene and social distancing already implemented globally and in Turkey, Shaikh said experts are now "looking at any plausible factor that may contribute to further spread." While telling that the research on smoking and COVID-19 relation is ongoing, he said the movement of virus particles may be much further through the air that comes out of smokers.
He cited a case in the US where a member of a choir in early March unknowingly infected more than 55 people from the group. He said the "laws of physics" would explain the super spread at that choir practice. Similarly, from the choir practice, smokers exhale with an extra force as compared to regular breathing.
"Thus, looking at physics, you'd assume that when smokers exhale, the [virus] particles/droplets will come out and with any force, they would travel much more than normal breathing," he said.
He noted there is "an etiological and physiological pathway connecting smoking with many respiratory viruses in the past." Stressing that doctors have seen doubled the numbers of flu and Middle East Respiratory Syndrome (MERS), a viral respiratory illness, with smokers, Shaikh said, the process affects the immune capacity within lung tissues.
Underscoring research at the population level is accumulating, he said evidence by the WHO suggests in hospitalized COVID-19 patients, "smokers are more likely to get a severe disease and even the probability of dying was higher in smokers compared to non-smokers."
He praised Turkey's efforts in tackling the virus, and said the country is "doing good in the population level." With Turkish Health Minister Fahrettin Koca continuously calling on everyone to abide by measures and be responsible, Shaikh said "repeated and regular emphasis by ministers shows the leadership from the front."
"The continuous emphasis by the minister [Koca] and President [Recep Tayyip Erdogan] talking about the precautionary measures shows you that they do not want us to let our guard down," he said. "The virus is waiting for more opportunities to infect."
He applauded the level of compliance for masking at the population level and said wearing masks at home even with close family members and having fresh air circulation at home will further minimize the spread of the virus, especially with the holiday season approaching in many parts of the world.
Echoing Shaikh, WHO Noncommunicable Diseases and Life-Course officer, Toker Ergüder, said, "when blowing cigarette smoke, your lungs blow with a little more pressure."
"In other words, due to that blowing, you can spread virus particles further from the required social distance of 1-2 meters (3-6 feet). Another person could be infected as soon as he detects this smoke," said Ergüder.
Reiterating that there is no concrete evidence to this theory, Ergüder said the smoking ban is "a sound decision" by Turkish officials. He said another reason why the ban is wise is due to people lowering their masks.
"As those smokers constantly lower their masks under their chin, they are also infecting their masks too. They would be touching the cigarette pack, pull out their lighter if they have one or ask someone else and ultimately ruin the usability of the mask," he said.
Ergüder said smokers experience COVID-19 symptoms 14 times more severe than those of non-smokers and second-hand smokers also experience damage to their lungs and have immune system collapse.
"A total of 8 million people each year die due to tobacco use. More than 7 million of those deaths are the result of direct tobacco use while nearly 1.2 million are the result of being exposed to second-hand smoke," he said.
With COVID-19 measures, Ergüder said people who mask throughout the day would be exposed to less tobacco and perhaps even quit smoking and stressed it is important to inspect measures as much as enforcing them.
Green Crescent President Mucahit Öztürk also told Anadolu Agency that the smoking ban is "a sound decision" and underscored the risks of second-hand smoking to direct tobacco use.
"At this point we are today, every decision taken and every step taken to combat the virus is very important. Decisions that would reduce the risk of contamination should also be adopted by citizens and everyone should do their part in this struggle," he said.
While the ban could potentially strengthen awareness about the dangers of tobacco use, Öztürk believes such a move could also "motivate" people to quit smoking.
Analogously to Shaikh and Ergüder, the head of the Turkish Green Crescent Society said "smoking and coronavirus are linked in terms of both affecting the spread of the virus and causing difficulty in the treatment process."
With smokers letting their guards down by lowering their masks, Öztürk said such action also prevents proper use of masks.
"While tobacco and tobacco products adversely affect the general body health and the functions of all our organs, tobacco smoke suppresses the immune system and impairs its functions," he said.
"In addition, smoke blocks the cough reflex in the lungs, making it easier for viruses and bacteria, which could cause serious infections, to hold in the respiratory tract and lungs," said Öztürk.
Urging all smokers to use the measure as a chance to quit smoking, he said doctors believe the ban would create motivation to quit smoking and expects it to become more widespread globally.
According to recent research by the anti-addiction group, COVID-19 increased the motivation to quit smoking while 1 in every 10 people quit smoking due to the pandemic in the last six months.
The study was conducted on approximately 2,500 people aged 15 and older from 26 provinces in Turkey, 62% were men and 38% women. In the study, 95% were active smokers and 5% were those who quit smoking.
"In a study conducted in 2017, the rate of those who wanted to quit smoking was about 37 percent, while in this study the rate increased to 58 percent," said Öztürk.
Meanwhile, Shaikh and Ergüder expect the virus to be with us until the second or third quarter of next year. Despite the number of candidate vaccines being introduced, Shaikh said "even when the vaccine does become available, there will be a serious shortfall between demand and supply."
But there is still light at the end of the tunnel, he said. "We may be tired from the virus but it is not tired of us to infect."