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SA’s COVID-19 tobacco ban was ill-advised – Cardiologist

The six-month COVID-19-induced ban in South Africa on selling tobacco products could have had “potentially disastrous consequences”, says Professor Konstantinos Farsalino, a public health cardiologist in Greece. He argued at an international summit that the ban would have had no impact on COVID-19 prognoses, writes Chris Bateman for MedicalBrief.

In fact it probably did more harm than good, said Farsalino, a research fellow at the Onassis Cardiac Surgery Centre in Athens and expert on tobacco harm reduction. The only real beneficiary was likely the illicit cigarette trade.

He was speaking at the 3rd Scientific Summit on Harm Reduction: Novel products, research & policy, a virtual international event organised in Greece and held on 24 and 25 September 2020. Benefits of harm reduction were debated along with risks associated with the use of alternative tobacco products such as e-cigarettes, heat-not-burn products and snus.

Nicotine ‘mitigates cytokine storm’

Cyber conference delegates from around the world heard South Africa singled out as the only country to have banned the sale of tobacco products during the COVID-19 pandemic.

Farsalino conducted a global review of 13 coronavirus studies of hospitalisation data that classified patients into more and less severe disease status.

He found that far from aggravating COVID-19 symptoms, nicotine [as opposed to tobacco] had certain positive anti-inflammatory effects, especially during the severe overreaction of the body’s immune system to C-19 known as the ‘cytokine storm’.

“During that storm, the immune system over-reacts in response to an infection, say in the lungs, and they can become overly inflamed, leading to substantial tissue damage. Nicotine might be able to at least dampen that intensity,” he averred.

In South Africa, nicotine addicts admitted to hospital (and others) suffered severe psychological and physical stress – especially those with pre-existing psychiatric conditions.

By failing to provide nicotine replacement therapy or at least less harmful products like e-cigarettes, the government may have caused real harm to the population, despite having good intentions in expecting people to quit, he added.

The tobacco ban was thus unsuccessful and overall it simply forced people to look to the illicit market to find a product.

Stressing that he was not advocating smoking or the use of any tobacco-related products, Farsalino said the South African government’s reasoning was based on smoking’s undeniable links to heart attacks, cancer and lung disease. [Government spokespeople also cited widespread sharing of cigarettes in impoverished communities].

The government quoted selected studies showing that when smokers were hospitalised with C-19 they might be at a higher risk of negative and-or a severe progression of symptoms. However, Farsalino said, government assessment failed to take into account smokers’ severe nicotine withdrawal symptoms when in hospital.

Few Chinese smokers hospitalised

Turning to his counter-intuitive research findings, he said that when COVID-19 began its relentless march around the globe earlier this year, “I was struck by one apparently paradoxical statistic that kept standing out in the blizzard of new data emerging from China, Ground Zero of the disease”.

In China, where 26.6% of all adults’ smoke (about 50% among men), very few of those hospitalised seemed to be smokers, Farsalino continued.

“This appeared, to conventional wisdom, to be counter intuitive, or even counter factual. C19 affects the lungs and airways; smoking is not and should not be associated with anything opposite when it come to the human respiratory systems.

“My comprehensive and systematic review of all the data, just published, is the world’s first peer reviewed study into the subject. It concludes that pharmaceutical nicotine should be considered as a potential treatment for COVID-19 patients.

“There’s no doubt that smoking cannot be used as a protective measure and people should never take up smoking in order prevent themselves from contracting the virus. It’s unwise for a plethora of health reasons already settled by overwhelming science. However, we now believe is nicotine may be a protective mechanism against C-19,” Farsalino concluded.

* The 3rd Scientific Summit on Harm Reduction: Novel products, research & policy was organised by the University of Thessaly’s Department of Biochemistry-Biotechnology and the University of Patras’s Laboratory of Molecular Biology and Immunology, in collaboration with the Department of Public and Community Health at the University of West Attica in Athens and the Medical School at National and Kapodistrian University of Athens.

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