What to Know About Smoking and COVID-19

Table of Contents
View All
Table of Contents

Smoking cigarettes is a known risk factor for severe disease and death from many lung conditions. It is also a significant risk factor for both viral and bacterial infections of the respiratory system, with smokers being five times as likely to develop influenza and twice as likely to have pneumonia.

Not surprisingly, smoking has also been linked to increased severity of coronavirus (COVID-19), ICU admission, and death in those who are hospitalized for the disease.

Smoking and COVID-19 Risk

Verywell / Zoe Hansen

Smoking and COVID-19 Risk

One study included all patients tested for COVID-19 within the Cleveland Clinic Health system in Ohio and Florida—not all were hospitalized. While 84.8% of patients were non-smokers, 2.4% were current smokers and 12.8% were former smokers. The authors acknowledged that records on smoking status are not always accurate; but even with questionable smoking histories, a link was clear.

People who were currently or previously heavy smokers (smoking 30 pack-years or more) had a 2.25 times higher chance of requiring hospitalization for COVID-19 compared with those who never smoked, and were 1.89 times more likely to die from the disease.

Another large population study conducted in the U.K. specifically looked at the impact of current smoking on COVID-19 risk. This study also found that smoking increases the likelihood of symptomatic disease defined according to the presence of classic COVID-19 symptoms of fever, cough, and breathlessness. The authors of the study suggested that smoking may be expected to increase the risk of COVID-19 because of the repeat hand-to-mouth movements involved in smoking.

A meta-analysis also found that the risk of disease progression in those who currently smoke or previously smoked was higher compared with that of non-smokers. When the disease worsened, current or former smokers included in the study had more acute or critical conditions. 

How Smoking Affects You

Cigarette smoke contains a number of toxins that could lead to diseases like lung cancer and chronic obstructive pulmonary disease (COPD). As the smoke is inhaled, it can damage lung tissues permanently, and dangerously alter the balance of oxygen and carbon dioxide in the blood.

Cigarette smoke also reduces the efficiency of the tiny fibers and delicate tissues that line your airway to filter out pollutants, compromising the immune system and leaving smokers susceptible to a host of respiratory conditions.

The act of smoking alone—exhaling secondhand smoke, taking off masks to smoke, and sharing smoking tools—may increase the danger of spreading COVID-19 to both smokers and non-smokers.

Complications of Smoking and COVID-19

Smoking affects every system in your body. From lowering your immune function, to reducing lung capacity, to causing cancer, cigarette smoking is a risk factor for a host of diseases, including heart disease, stroke, lung cancer, and COPD.

Smoking also increases your chances of developing blood clots. The novel coronavirus can do even more damage to the body because the virus floods your body with inflammatory cells that thicken your blood.

COVID-19 has also been known to attack angiotensin-converting enzyme 2 (ACE2), a protein found in the lining of the lungs. This protein is more abundant in smokers, another link between smoking and more severe disease from COVID-19.

Frequently Asked Questions

Can COVID-19 Be Spread Through Secondhand Smoke?

Possibly. The novel coronavirus is transmitted by droplets in most cases, but it can also be airborne. Documented cases of transmission have occurred among choir groups, demonstrating that the virus can be released into the air by exhalation. The act of smoking and the blowing of secondhand smoke could put others around you at risk if you are infected with the virus.

Does Smoking Lead to a More Severe Case of COVID-19?

Yes. Research indicates that smokers were more likely to be hospitalized and become severely ill with COVID-19 than non-smokers. Additionally, smokers are more likely to develop a number of medical conditions like cancer and COPD, which increase the risk of severe illness with COVID-19.

Does Vaping Count?

Yes. Vaping is sometimes touted as being less damaging to the lungs than cigarette smoke, but there is evidence that the risk of COVID-19 is five times higher in young adults who use e-cigarettes. Vaping also involves hand-to-mouth contact with an e-cigarette, which could potentially increase the risk of COVID-19 transmission.

If I’m a Smoker, Is It Too Late to Quit?

It’s never too late to quit. There is never a bad time to quit smoking.

How to Stay Safe

In general, you can take several steps to reduce your chances of contracting COVID-19, including practicing good hand hygiene, wearing a mask when out and about, and social distancing from others (keeping a distance of at least six feet).

If you smoke, you can do several things to minimize your risk of getting COVID-19:

  • Be sure to wash your hands with soap and water or a hand sanitizer before touching and putting a cigarette in your mouth.
  • Avoid touching other surfaces when you are smoking to avoid contaminating your hands and cigarette.
  • Choose to smoke only while you are at home or in a sparsely populated outdoor space to minimize your risk of catching COVID-19.
  • Do not share devices like waterpipes and e-cigarettes.

You may also want to consider quitting smoking. The benefits continue a decade later when it comes to avoiding chronic illness. Quitting will help your lungs and heart to work better from the moment you stop: 

  • Within 20 minutes of quitting, elevated heart rate and blood pressure drop.
  • After 12 hours, the carbon monoxide level in the bloodstream drops to normal.
  • Within 2 to 12 weeks, circulation improves and lung function increases.
  • After 1 to 12 months, coughing and shortness of breath decrease.

Quitting will also help protect your loved ones, especially children, from exposure to secondhand smoke. 

A Word From Verywell

Smoking is the leading cause of preventable death in the United States. It not only increases your risk of developing heart disease, lung disease, and cancer, but it can also increase your risk of developing a more severe case of COVID-19, being admitted to the hospital for the disease, and dying from it. Take safety measures to reduce your risk of contracting and transmitting COVID-19, and consider quitting smoking to not only lower your COVID risk but also improve your overall health.

The information in this article is current as of the date listed. As new research becomes available, we’ll update this article. For the latest on COVID-19, visit our coronavirus news page.

10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Hopkinson NS, Rossi N, El-Sayed Moustafa J, Laverty AA, Quint JK, Freidin M, Visconti A, Murray B, Modat M, Ourselin S, Small K, Davies R, Wolf J, Spector TD, Steves CJ, Falchi M. Current smoking and COVID-19 risk: results from a population symptom app in over 2.4 million people. Thorax. 2021 Jan 5:thoraxjnl-2020-216422. doi:10.1136/thoraxjnl-2020-216422

  2. Lowe KE, Zein J, Hatipoglu U, Attaway A. Association of smoking and cumulative pack-year exposure with COVID-19 outcomes in the Cleveland Clinic COVID-19 registry. JAMA Intern Med. 2021 Jan 25:e208360. doi:10.1001/jamainternmed.2020.8360

  3. World Health Organization. Smoking and COVID-19.

  4. Samet JM. Tobacco products and the risks of SARS-CoV-2 infection and COVID-19. Nicotine Tob Res. 2020 Dec 15;22(12 Suppl 2):S93-S95. doi:10.1093/ntr/ntaa187

  5. Grundy EJ, Suddek T, Filippidis FT, Majeed A, Coronini-Cronberg S. Smoking, SARS-CoV-2 and COVID-19: a review of reviews considering implications for public health policy and practice. Tob Induc Dis. 2020 Jul 3;18:58. doi:10.18332/tid/124788

  6. Centers for Disease Control and Prevention. Health effects of cigarette smoking.

  7. Hamner L, Dubbel P, Capron I, Ross A, Jordan A, Lee J, Lynn J, Ball A, Narwal S, Russell S, Patrick D, Leibrand H. High SARS-CoV-2 attack rate following exposure at a choir practice - Skagit County, Washington, March 2020. MMWR Morb Mortal Wkly Rep. 2020 May 15;69(19):606-610. doi:10.15585/mmwr.mm6919e6

  8. Centers for Disease Control and Prevention. COVID-19: people with certain medical conditions.

  9. Gaiha SM, Cheng J, Halpern-Felsher B. Association between youth smoking, electronic cigarette use, and COVID-19. J Adolesc Health. 2020 Oct;67(4):519-523. doi:10.1016/j.jadohealth.2020.07.002

  10. American Cancer Society. Health benefits of quitting smoking.

By Rachael Zimlich, BSN, RN
Rachael is a freelance healthcare writer and critical care nurse based near Cleveland, Ohio.