COVID puts spotlight on tobacco use in India

Experts sound alarms over heightened health risks associated with smoking amid pandemic

Campaigns against tobacco smoking in India have seldom been as loud as they are today, amid the country's grim pandemic battle.

For World No Tobacco Day on May 31, anti-smoking groups have reminded people of the enormous health risks associated with tobacco and the potential harm it can do to society, people's health and the economy.

The World Health Organization has chosen "Commit to Quit" as this year's theme – particularly relevant given smokers are much more prone to serious disease and death from COVID-19, said Judith Mackay, a Hong Kong-based senior policy advisor for the WHO and world-leading tobacco control advocate.

Mackay has been actively working with virtually every government involved in Asia's anti-smoking movements since 1984 and is one of the biggest foes of the highly profitable tobacco industry.

According to her, there are huge populations of smokers, mostly male, in China, India and Indonesia. Currently, half the world's tobacco is grown and consumed in Asia – obstacles to tobacco control there are like those around the world, Mackay said.

The Indian government has imposed higher taxes on tobacco products, and bans on smoking at work and public places, as well as smoking visuals in movies and advertisements. But experts said the situation on the ground remains unhealthy.

"Alarming is the fact that smoking is catching up with women. Even a few years ago very few women would smoke because of social taboo, which now seems to have gone," said pulmonologist Sameer Arbat, adding it is a matter of grave concern.

India is among WHO-identified "high-burden countries" housing the majority of the world's tobacco users. Other "burden countries" include the United States, Germany, Russia, Pakistan, Bangladesh, Nigeria, Vietnam, Brazil, Iran, Indonesia, the Philippines, South Africa and China.

WHO research indicates tobacco smokers are at higher risk of developing severe COVID-19 infections as smoking involves contact of fingers (and possibly contaminated cigarettes) with the lips, increasing the possibility of hand-to-mouth virus transmission.

Smokers are up to 22 times more likely to develop lung cancer in their lifetime, compared with non-smokers, said Arbat. Of the 56.9 million annual deaths, 8 million are caused by tobacco.

"One million deaths are caused due to second-hand smoke exposure," the pulmonologist from Nagpur, a city in India's Maharashtra province said. "Second-hand smoke is smoke emitted from the burning end of a cigarette or from other smoked tobacco products, usually in combination with smoke exhaled by the smoker."

Tobacco smoking and exposure to second-hand smoke are major risk factors for lung cancer, chronic obstructive pulmonary disease or COPD, tuberculosis and asthma, he said.

Children are at grave risk. "Even before they learn to walk, children may begin suffering the effects of exposure to tobacco smoke. Infants born to mothers who smoke, or to women who are exposed to second-hand smoke during pregnancy, are likely to suffer reduced lung growth and function," Arbat said.

"Chemicals found in tobacco smoke during critical stages of development in the womb have long-lasting, damaging effects on the lungs. Smokers' children suffer reduced lung function, which continues to affect them in the form of chronic respiratory disorders in adulthood."

Arbat shared the "story" of an unnamed young man, who told him: "I started smoking when I was 14 years old, but quit when my father died due to cardiac arrest."

Heart consultant Debabrata Mitra said smoking is also a form of extreme dependence. "Forget health issues, smoking also harms the environment and increases spending in healthcare which in turn hits the economy," said Mitra, once a chain smoker himself.

Retired railway employee Sandip Banerjee "finally bade goodbye" to cigarettes in the past few months. "Finally, I have done it," said the 60-year-old Kolkata native, who has been diagnosed with COPD. He spent more than 10 days in hospital in "extreme agony" after contracting COVID-19 last year.

Banerjee admitted that he had earlier made several unsuccessful bids to quit smoking. "There was a time when I would smoke 30 sticks a day, and I wasn't quite aware of the harm it was causing to my cardiovascular system.… that it was also damaging the lungs of others, including my near and dear ones, around me," he said.

Arbat said it is never too late to quit. "Lung function starts improving within just two weeks of quitting tobacco use," he said. "Quitting smoking after a diagnosis of lung disease is associated with better treatment outcomes and improved quality of life," he said.

But for Prodyot Saha, 62, things do not work that way. The retired banker in Kolkata still smokes at least 50 bidis – home-grown tobacco flakes and hand-rolled in temburni leaf – even if he is aware of the harm it causes, saying he is unable to quit "no matter how hard I try".

WHO Director-General Tedros Adhanom Ghebreyesus said about 780 million people want to quit, but only 30 percent of them can access the tools for success.

"We must invest in services to help them be successful," said Ruediger Krech, the WHO's health promotion director who also called for divestment from the tobacco industry. The WHO is creating digital communities where people can find the social support they need to quit.

Pulmonologist Arabat said that to quit smoking, one needs to follow a cessation plan. "It requires strong motivation and inner drive. One needs to decide a quit date and plan a set of strategies," he said.

"Medical treatments include nicotine replacement skin patches, lozenges, gum, inhalers or nasal sprays. It is advisable to take these with a doctor's prescription according to individual dosage," he said.

It also helps if one enrolls in a support group to share and understand experiences related to smoking and quitting, he said, adding it is also important to list "smoking triggers".

"Identifying patterns can help you determine when you will most likely need support or some kind of distraction. Let family, friends and co-workers know about your quit day. Make them your allies. They can provide moral support. Ask friends who smoke not to smoke around you or offer you a cigarette," he said.