During a recent walk outside of the confines of my COVID-19 quarantine in Baltimore, I passed by someone resting on their marble front steps. As our eyes met, I could sense our shared heaviness, confirmed through our silent nods. An all-too-common exchange these days. The woman lit her cigarette, took a deep drag and exhaled. And I exhaled too.

    I don’t enjoy smoking all that much, with the exception of a cigarette or two a year. Ideally on a summer patio. My dislike of cigarettes, or nicotine for that matter, isn’t because I listened during DARE class or have a will of steel. It’s just that my anxiety and amped-as-all-hell tendencies drag me towards vices with much more sedating properties (think Cheetos, beer and a specific herb that is legal in some states). But this week, maybe more than ever, I very much understand the need for a brief moment of forgetting delivered by a substance that can give me a pause on life and quickly, but not permanently, take the edge off. For some people that is a cigarette.

    And as I continued my sluggish walk around the neighborhood, it occurred to me that our current circumstancesa global pandemic driven by a highly contagious respiratory illness that is steamrolling societymake it particularly difficult time to be a smoker.

    On the one hand, it seems more urgent than ever to protect ourselves and our lungs from what is turning out to be a very dangerous virus that is pushing our healthcare system to capacity. This thinking has prompted some researchers to write a piece for the British Medical Journal asking current smokers to consider stopping smoking in response to COVID-19 concernswhat is often referred to as a “teachable moment” by tobacco cessation specialists.

    Missing from these headlines is the reality of what many people are also balancing.

    In response to media coverage on the topic, the UK-based organization Action on Smoking and Health has clarified that while smoking cigarettes is a risky decision and could “make the impact of coronavirus worse”, it is also the case that “Smokers who have switched to vaping should be reassured that this is better for them than smoking.”

    If you have managed to look at any COVID headlines recently (I am on a 15-minute cycle these days), many of them tell you what you should and should not think about smoking. Some scientists suggest smoking is associated with COVID-19 (even if the data they are examining are low in quality). While others, using the same data/studies, suggest that current smoking might even be protective if you are exposed to COVID-19.

    More confusing is that these warnings have begun to expand to include nicotine vaping. At least one article has suggested that doing either in the time of COVID-19 could be a death sentence. Other clinicians and scientists remind us that vaping is less harmful than smoking and vape clouds will not transmit COVID. (There is, to be clear, no evidence that vaping makes people more vulnerable.) Feeling confused yet?

    But the context that is missing from all of these headlines is the reality that many people who might be struggling with whether to keep smoking cigarettes are also balancing isolation from friends and family, getting laid off from work (or overhauling their whole routine in order to work remotely), caretaking children due to school cancellations, the obligation to lock down within a troubled relationship, and much more. Low moods, lack of sleep and stress are not the best emotional and physiological cocktail to produce a motivation to quit right now.

    You do have other options if you don’t want to completely stop.

    In defense of those media sources, scientists and healthcare providers telling you to stop smoking: Smoking cigarettes is one of the most harmful things you can do to your respiratory system. But in defense of a larger argument, there are lots of other things we do to our bodies that are very unhealthy. Drinking alcohol in large quantities is horribly unhealthy. I thought I would cut back on drinking while on quarantine, but here I am, with no shortage of wine bottles in my recycling bin. We all have to get through this however we can.

    You aren’t alone. And you do have other options if you don’t want to completely stop drinking, or smoking, or vaping, or whatever else you do.

    If you are currently smoking and just can’t find it in you to stop smoking, that’s okay! You can reduce how much you smoke, you can substitute smoking with gum, nicotine replacement therapy, or nicotine vaping products. Or you can simply be aware of your smokingtry to log how many cigarettes you get through and make goals for adjusting. Maybe you will get to a point when you just decide you don’t want to smoke anymore. Or maybe, you will try out a new vape product and find out you feel much better and haven’t picked up a cigarette in a week. Or maybe the best you can do is just try each day, go to sleep, wake up and try again.

    You can also check out this tweet clinic hosted by British expert Louise Ross (@grannylouisa) on Twitter with the hashtag, #QuitforCovid. It starts on April 1, and you can tweet her questions about smoking, stopping, switching, vaping or staying stopped.

    Try a variety of options and keep in mind, there is no one-size-fits-all for any behavior change. There is a reason there hasn’t been a medication approved to stop smoking since 2006. It’s hard, so go easy on yourself and I will try to do the same. 


    Photo by Helen Redmond

    • Dr. Annie Kleykamp is a research associate professor of Anesthesiology and Perioperative Medicine at the University of Rochester School of Medicine and Dentistry, as well as the communications director of the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION). ACTTION is a public-private partnership with the FDA with the goal of expediting the discovery and development of treatments for pain and addiction.

      Annie is trained as an experimental psychologist and studied the effects of various drugs (nicotine, opioids, alcohol) on human cognition and behavior. Prior to her current position she worked as a scientist at the healthcare consulting firm Pinney Associates (2014-2018) and as medical analyst at the health technology assessment company Hayes, Inc (2011-2018). During her time at Pinney Associates she provided consulting advice on non-combustible tobacco products to the e-cigarette company NJOY and the tobacco company Reynolds American Inc. Her work was prohibitive of any consulting related to traditional, combustible cigarettes. She has also held teaching appointments at the University of Maryland College Park, United States Naval Academy and Goucher College.

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