Friday, 30 April 2021

Smokers are the real virus, am I right?!

An absolute classic of the "COVID-19 shows that we should do what I've always wanted to do" genre on the Tobacco Control blog

As we reflect on COVID-19’s toll, the US must also act on the tobacco pandemic
Yes, I thought you might say that.

On February 22, 2021, the United States paused to honor the tragic milestone of 500,000 COVID-19 deaths, just one year and 16 days after the first fatality was recorded in California.  The peak of 5,427 new US deaths reported on Feb 12, 2021 exceeded the 4,414 Allied deaths at Normandy on D-Day. Over the 3 years and 8 months of US involvement in World War II, 407,316 US military servicemen and women were killed. The 407,000th US COVID-19 death came after just 11 months, as COVID-19 claimed American lives at a rate nearly 4 times faster than World War II.

However, there is one cause of preventable US death that surpassed the death rate of COVID-19. An estimated 480,000 Americans die annually from tobacco use, including more than 41,000 deaths from secondhand smoke exposure. 
Is this number ever going to go down? Anti-smoking campaigners were saying that smoking kills 440,000 Americans a year in the early 1990s. The smoking rate has halved since then and smoking has been banned indoors nearly everywhere. And yet the figure is now 480,000?
We have never shut down the economy, closed our schools, or sheltered in place to protect the public from the health hazards of Big Tobacco.  

That wouldn't work, would it? Even if it did, there would be no justification for depriving people of liberty to 'protect' them from themselves. Smoking is an enjoyable vice which carries well known health risks. Informed adults are be free to do it or not do it and it's nobody's else's business. Insofar as it affects other people via the much exaggerated effects of secondhand smoke, governments have taken draconian action by banning it all over the place.
A commonly witnessed sight during the pandemic is a smoker pulling their mask aside during a cigarette break outdoors. A more extreme example of nicotine addiction is a smoker who picks up a discarded cigarette butt from the street, and places it into their mouth. This particularly high-risk activity disregards the warnings to not touch one’s face or mouth, not to share items with others who might have Covid, and to avoid contact with items on the ground where the virus falls after someone has sneezed or coughed.
This is how you crowbar smoking into the pandemic, through the occasional homeless person picking up a tab end and smoking it? Seriously?  

Worldwide, tobacco use causes more than 7 million deaths per year, whereas the death toll from Covid-19 only crossed 3 million as of mid-April 2021.

This kind of false equivalence is smiley talk. There would be far more Covid deaths without the extreme social distancing measures that have been introduced. But it is not the number of deaths that makes Covid a public health issue. It is because it is a highly infectious disease which hospitalises so many people in a short space of time that health systems cannot cope. And that is why smoking is not, despite endless protestations to the contrary, really a public health issue.
Most studies have demonstrated that smoking is linked to transmission and developing symptoms of COVID-19, and leads to worse outcomes, including intubation and death
Actually they haven't. Most studies have shown smokers to be less likely to get COVID-19 and therefore less likely to die from it.
It is for this reason that some states chose to vaccinate current smokers ahead of schoolteachers and others, perhaps create a perverse incentive for non-smokers to begin smoking. 
Whilst it has been entertaining to see smokers get privileged treatment for once, the reasoning doesn't stack up. A few states have simply assumed that smokers are at high risk and anti-smoking activists have little reason to correct them.
An early silver lining from the pandemic is that up to 300,000 UK smokers may have quit smoking due to COVID-19 fears. 
This claim turned out to be based on a small survey and its estimate proved to be less than accurate.  
Unfortunately, the decades long decline in US cigarette sales ended in 2020, in part due to the anxiety and stress induced in smokers by the pandemic.
That's because anti-smoking fanatics spread unfounded fears about vaping and got the government to pull some of the most popular vaping products from the market. See how it works yet? They are substitute goods.
A major setback worldwide in the fight against Covid-19 may have resulted from the early and premature conclusions in spring 2020 based upon incomplete data suggesting nicotine and smoking protect one from acquiring COVID-19.
This finding has been replicated again and again, and it has a plausible biological mechanism. Even if it hadn't been, would it really have been a 'major setback' in the fight against Covid? 

Researchers in China and France amplified this incorrect belief about a potential benefit from smoking, which led to a temporary shortage of nicotine patches in France as non-smokers rushed to try this ineffective strategy to prevent Covid transmission.  The World Health Organization invested in educational programs to debunk this myth. The original researchers in Paris who perpetuated this misinformation have not published any prospective clinical data to support their theory, and likely should now issue a retraction, as has been done with a similarly confusing article.

This is a reference to a study of smokers in Mexico which has been retracted because two of the authors failed to disclose some indirect financial links to the tobacco industry. The journal didn't find anything wrong with the study and only a tobacco controller would find it 'confusing'. The journal simply has a policy of not publishing studies by anyone who has ever received money that has passed through the hands of anybody involved in the sale of tobacco. And so it was retracted.
I noticed that the Guardian leapt on this story despite not having covered any of the smoking-Covid studies since last spring. It fitted the narrative. The evidence itself doesn't. 
Tough action was taken against the vaping industry during the pandemic in the aftermath of the E-cigarette or vaping product use-associated lung injury (EVALI) epidemic that hospitalized thousands across America in 2019.  

And the following year, cigarette sales rose for the first time in ages! What could possibly explain this?

Similar pro-active action against Big Tobacco now could help curb both the US COVID-19 mortality and the annual death toll from smoking, which are interlinked.
Like what, exactly?
The Biden Administration should now follow the lead of other nations and also 1) finalize the long-awaited graphic warning levels on cigarette packs, and 2) ban menthol flavored e-cigarettes, as has been done in California.
Two policies that have already been tried in the EU to no effect. Yeah, that'll really move the dial. 
Earlier actions undertaken in other countries years before may have helped reduce their national COVID mortality. Valuable lessons were learned from South Africa’s ban on the sale of all tobacco and vaping products between March and August 2020.  

Are you kidding? Not only was tobacco prohibition in South Africa a predictable fiasco, but South Africa has had a worse Covid epidemic than any other African country. It accounts for nearly half the recorded deaths in the whole continent. Even the study you link to shows that it was a disaster, with 93% of smokers buying cigarettes from the black market. There is indeed a "valuable lesson" there, but it's not one that the chumps at Tobacco Control are ever likely to learn.

We turned the country upside down to fight COVID-19. If just half of our assets and energy were focused on simultaneously reducing smoking’s deadly toll, maybe we can also finally end Big Tobacco’s societal harm and reach the Tobacco Endgame.

Fighting a virus is different to fighting people, and the people you're going to war with are not in 'Big Tobacco' but are millions of your fellow citizens. The euphemistically titled 'endgame' is prohibition and you'd think that Americans, of all people, would realise that it isn't going to work.

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