As suggested last week, adopting a healthy lifestyle can stave off chronic disease and boost a strong immune system — one that can fight off bacteria and viruses. As a recent example, a study by Harvard University published in January of people who were free of cancer, diabetes and cardiovascular disease at age 50 showed that they did not smoke, limited their alcohol intake, ate a healthy diet, maintained a healthy weight and exercised at least 30 minutes per day. Many participants in the study practice most, but not all, of these behaviors.
Because the current coronavirus targets the lungs, doctors and public health officials are adding new urgency to one healthy behavior in particular: quitting smoking. As reported by Live Science, mounting evidence suggests, “Compared with nonsmokers, people who smoke cigarettes face a higher risk of developing severe complications and dying from COVID-19 infections.” Those who vape or smoke cannabis are also urged to stop because smoking in general can compromise lung function. “Vaping may be particularly harmful,” Dr. Dean Drosnes, the medical director of Pennsylvania’s Caron Treatment Centers, tells U.S. News.
As pointed out in a U.S. News report, “A 2018 study in the European Journal of Public Health found that smoking increased the risk of influenza hospitalization … there is a large amount of research proving that smoking inflames the lungs and suppresses immune function. It also weakens the heart, another risk factor for severe disease.” One study cited and published online in the Chinese Medical Journal found that, “of 78 patients with COVID-19, those with a history of smoking were 14 times as likely to develop pneumonia.” Live Science added, “Smokers may be prone to severe COVID-19 infections, in part, because their lungs contain an abundance of entry points that the virus can exploit.”
As noted by Live Science, preliminary research suggests that lungs exposed to cigarette smoke accumulate abnormally large numbers of angiotensin converting enzyme 2, better known as ACE2, receptors, which may leave the organ vulnerable to damage inflicted by the coronavirus. Researchers in respiratory medicine conducted at University College London found that this ACE2 receptor hypothesis represents a “holistic, mechanistic link” between smoking and severe infection. They also compared the lungs of human smokers with those of nonsmokers and found that smokers’ lungs contained 40% to 50% more ACE2 receptors.
“If smoking does prove uniquely dangerous for COVID-19 patients, however, the study does offer a potential solution,” Jason Sheltzer, a research fellow at the Cold Spring Harbor Laboratory in New York, told Live Science. “We show that former smokers have lower levels of ACE2 than current smokers” by about 30%, Sheltzer says. “It’s conceivable that quitting smoking could be beneficial to decrease COVID-19 susceptibility.”
According to a New York Times report, pulmonologists suggest that combining two common methods — the nicotine patch plus either a nicotine gum or lozenge — can boost the chances of successfully quitting.
Granted, quitting is hard, especially now, amid the stress and boredom of shelter-in-place mandates. Yet, if you are a smoker, the idea that your habit is bad for your health should not come as a surprise. According to the Centers for Disease Control and Prevention, nearly 7 out of every 10 smokers reported in 2015 that they wanted to quit completely. Standing in the way is severe nicotine addiction. Yet so many others have shown it can be overcome. According to the Stop Smoking Foundation, “about half of all smokers who refuse to stop smoking cigarettes will end up dying from a smoking-related disease.” If you currently smoke, the threat of COVID-19 should be ample motivation to stop. Still, I know a lot of you will not quit, even after reading that it might be a death sentence. What is such thinking (or nonthinking) all about?
Professors of psychology Gretchen Chapman and George Loewenstein of Carnegie Mellon University are scholars who study health-related behavior change. They recently authored an analysis in The Conversation of how people are especially bad at taking protective measures, even in the face of impending need.
“This is true unless the change in probability leads to certainty that the event will not occur,” they write. Research by psychologists has shown that “people are not eager to engage in preventive behaviors unless they completely eliminate the risk … This probably has something to do with low rates of adherence to lifesaving medications.” As an example, they cite a study that shows that one year after hospitalization for a heart attack, nearly half of patients prescribed statins stop taking them. The study also shows that the rates of medication adherence for acute diabetics are similar.
In a larger sense, the current prescribed behavior of continuing to wash your hands and stay six feet away from others does not seem so hard for an individual to adopt and maintain. Not so, say Chapman and Loewenstein. “The problem is that people are unable to ‘see’ the benefits of their actions,” they explain.
They believe it is remarkable that efforts to promote hygiene have been as successful as they have, given that such measures are “the embodiment” of the types of protective measures people are especially bad at taking. They are inconvenient and require constant vigilance. “The costs of these behaviors are immediate, but the benefits are delayed,” they explain. So, the question posed is: “Can we sustain vigilance in the face of pervasive intangibility?”
I pray we are up to the task. The longer these behaviors are maintained, the more likely they will become habitual. Wouldn’t it be great if we all could take away from this experience new habits that keep our immune systems healthy in the new world that follows?