I read with interest Representative Krishnamoorthi’s opinion piece on banning electronic cigarette sales during the pandemic (FDA can boost the coronavirus battle by pausing the sale of e-cigarettes 4/29/20). It might strike some readers as odd that he did not include traditional combustible cigarettes in his call to action, since our understanding of the harm to the lungs and other organs of cigarette smoking far surpasses that for electronic cigarettes. But Mr. Krishnamoorthi is no doubt aware that Congress explicitly forbade the banning of “traditional” tobacco sales at the federal level when it gave the FDA authority over tobacco products in 2009. However, that same law explicitly allows states to do so.
As a society, we should be deeply concerned about tobacco for two reasons. First is the co-morbidity between COVID-19 and smoking. It is too early to be definitive, but data so far suggests that people who smoke are significantly more likely to require hospitalization should they contract the virus. In addition to the preliminary data, we also have common sense – coronavirus predominantly attacks the lungs; damaged lungs present increased risks from COVID-19; and smoking damages the lungs. People who smoke should take extra precautions against exposure in the same way as other at-risk groups, such as the elderly and those with diabetes or cardiovascular disease. They should also ensure their families are not exposed to secondhand smoke, which can be difficult when most of us are stuck at home.
Second, our current main tool to mitigate the harm from coronavirus is to “flatten the curve” to avoid overwhelming healthcare systems, and part of this is shutting down non-essential activities in order to increase social distancing. Nothing could be further from ‘essential’ than tobacco products, and yet no state has even temporarily stopped production, distribution or retail sales (some states have banned sales in tobacco only stores). Factory and warehouse workers, clerks and customers alike are put at increased risk in order to maintain the free flow of a product that kills nearly half a million Americans per year. Meanwhile, businesses offering goods or services that do not kill most of their customers are being told to keep their workers at home. Those that have been forced to shutter their stores and lay off employees should be outraged that the smoke shop next door is doing brisk business.
While we have been blind to the problem here in the U.S., some foreign governments have taken action. Botswana, India, Israel and South Africa have deemed tobacco non-essential during shutdowns and forbidden production and sales. France, Italy and Spain have taken the opposite approach, explicitly deeming tobacco essential.
The tobacco industry has, of course, been lobbying vigorously behind the scenes to keep their business open. The industry’s greatest fear is a massive drop in nicotine addiction that would result from several weeks or months of shutdown. Publicly, they have been relatively silent, and it is no wonder. For years, Big Tobacco has likened nicotine addiction to being a chocoholic, insisting it is easy to quit. The truth, of course, is that it is more akin to cocaine, heroin or opioids. But the only possible argument that tobacco is essential rests on addiction and the withdrawal that people who smoke will suffer.
Fortunately, nicotine withdrawal can be ameliorated. Cessation support in the U.S. is open for business (1-800-QUIT-NOW). In addition to counseling and support, FDA-approved nicotine replacement therapies (NRTs) are proven to help in quitting. Many pharmacies are doing home delivery, some NRTs are over the counter, and it’s hard to imagine doctors refusing over-the-phone prescriptions.
Few public health professionals have advocated for an immediate ban on tobacco sales, preferring a phased approach to taking tobacco off the market. But these are extraordinary times, and governments are facing a binary choice – is tobacco essential or not? Every activity deemed essential undermines social distancing and puts all of us at greater risk. We need food, medicine, utilities, health care, and first responders, among others. We do not need tobacco.
Deputy Director for Policy
Action on Smoking and Health