A new study out of a Paris hospital suggests nicotine may help prevent infection and serious illness from coronavirus — but doctors caution against picking up a smoking habit.
"It is critical to distinguish smoking from nicotine replacement therapy. There is no safe level of smoking," Dr. Hilary Tindle, founding director of the Vanderbilt Center for Tobacco, Addiction and Lifestyle, wrote in an email.
Pending approval from French authorities, doctors hope to equip first responders and coronavirus patients with nicotine patches after finding a disproportionately low number of smokers among the coronavirus patient population at Pitié-Salpêtrière hospital, The Guardian reported. Looking at a group of 480 patients, researchers found that only 5.3 percent of the 350 with milder symptoms who were sent to recover smoked. That group had a median age of 44. Of those 130 who remained hospitalized only 4.4 percent smoked. Those patients had a median age of 65. Comparatively, about 40 percent of French people between the ages of 44 and 53 smoke, whereas about 9 to 11 percent of those between the ages of 65 and 75 smoke.
The data confirmed a similar study out of China, published in the New England Journal of Medicine, that found about 13 percent of a group of 1,000 patients were smokers, whereas smoking prevalence in China was about 28 percent as of 2015, according to a 2019 study.
The mechanism of protection, experts say, has less to do with tobacco products than it does with one operative ingredient: nicotine.
According to Dr. Tindle, researchers behind the French study suspect nicotine may guard against coronavirus infection and serious illness in two main ways. First, it may lower the expression of the enzyme believed to be the receptor for the novel coronavirus, thereby reducing the odds of infection. Secondly, through a series of complex mechanisms, nicotine may function as an anti-inflammatory agent, perhaps even countering the severe immune response known as a cytokine storm.
There is sufficient evidence to warrant a trial of medicinal nicotine products like patches, gum, or lozenges, which are proven to be safe and have a low potential for addiction, but Dr. Tindle emphasized that more research is needed from randomized clinical trials before nicotine can actually be recommended for prevention or treatment of COVID-19. She further stressed while medicinal nicotine could be helpful, this is not a reason to smoke.
"Today is a great day to quit," Dr. Tindle said.
That nicotine may have therapeutic benefits is not unheard of. Prior to the outbreak of coronavirus, scientists were already looking into the potential applications of medicinal nicotine for everything from Alzheimer's and Parkinson's diseases to depression and attention deficit hyperactivity disorder (ADHD), according to an article published in PLoS Biology.
Although nicotine's potential to protect against coronavirus seems at first glance to contradict earlier reports warning against the dangers of smoking during the pandemic, doctors insist that the drawbacks of smoking likely far outweigh the potential protective effects of nicotine.
In addition to causing inflammation, blood clots, and early death, smoking can heighten the risk of death and serious infection from coronavirus by causing the types of comorbidities that increase vulnerability long-term. It can lead to emphysema, chronic bronchitis, and cancer — all conditions that increase the likelihood of death and serious illness from coronavirus — and can exacerbate existing conditions like asthma, according to the Centers for Disease Control and Prevention. Plus, the World Health Organization says tobacco products kill about half of people who use them — which makes the mortality rate from tobacco use significantly higher than the known rate from the novel coronavirus.
But just as doctors are urging people not to take up smoking, French authorities are putting safeguards in place to ensure people don't panic buy nicotine-replacement products, the BBC reported. Authorities passed new rules preventing the purchase of smoking cessation products online, as well as limiting pharmacy purchases to one month's supply per customer.
They hope these actions will prevent consumers from unnecessarily self-administering nicotine — as happened with malaria drug chloroquine after President Trump touted its benefits — and will preserve access to these important smoking cessation aids for people who actually need them.