Sheikh Umar Ahmad

Poor Lung Health among majority of Elderly Population in Kashmir owing to Hookah smoking & increased chances of contracting COVID-19: A theoretical consideration

Poor Lung Health among majority of Elderly Population in Kashmir owing to Hookah smoking & increased chances of contracting COVID-19: A theoretical consideration
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Smoking cigarettes or vaping affects one's lungs, thereby increasing the chances of a smoker developing serious condition on contracting the infection

Sheikh Umar Ahmad

Almost everyone’s grandfather starts his day with hookah smoking in Kashmir. It is not a new normal, but exists in Kashmir since times immemorial. Not so to everybody’s surprise, our majority elderly population suffers from metabolic disorders including obesity, cardiovascular problems, diabetes among various others that put them at greater risk in developing other associated comorbidities. Smoking of any form significantly reduces the lung hygiene, immunity & put one at a greater risk of developing cancer & other infective disorders. This might be the best time for smokers to try and quit or cut down smoking, because the World Health Organisation (WHO) suspect positive correlation of smoking and contracting COVID-19 disease and that people with smoking habits are more prone to coronavirus infection. And the reason is simple, smoking cigarettes or vaping affects one’s lungs, thereby increasing the chances of a smoker developing serious condition on contracting the infection.

The WHO, in its FAQ’s section on coronavirus infection have put forth that smokers are likely to be more vulnerable to COVID-19 as the act of smoking greatly increases the possibility of transmission of the virus from hand to mouth and afterwards when a person touches anything that later on comes in contact to other uninfected person. Moreover, as it is already known that smoking reduces the lung function or its capacity which increases the inflammatory markers hence greatly increasing the risk of serious illnesses & the chances of getting infections thus in case coronavirus it becomes more complicated, reveals Dr. Adarsh Pratap Singh, Senior Resident and President, Resident Doctors’ Association, All India Institutes of Medical Sciences (AIIMS). So, in cases where people are infected with the coronavirus, the chances of those with a history of smoking or an existing habit may lead to the development of a severe infection & may be the reason why there is both high contraction & high mortality rate among elderly population world over. Furthermore, the oxygen exchanger alveolar cells in the lungs of smokers are already damaged to quite an extent, depending on the degree and frequency of their smoking habit, making them more predisposed at developing more severe symptoms on getting infected to COVID-19.

This might be the best time for smokers to try and quit or cut down smoking, because the World Health Organisation (WHO) suspect positive correlation of smoking and contracting COVID-19 disease and that people with smoking habits are more prone to coronavirus infection.

As per Quit, a cancer program run by the Cancer Council Victoria in association with the Australian Department of Health state, that smokers are generally at higher risk of respiratory tract infections like those of lung and chest but currently there is not enough evidence & more studies are required to establish & to be certain that people who smoke are at higher risk of being infected by coronavirus. However, it is a concluding fact that people with poor lung function as a result of smoking or anything else, may be at higher risk of complications if they are exposed to the virus.

Furthermore, Dr. Stanton A Glantz, Professor of Medicine at the Center for Tobacco Control Research and Education quotes in an article in the Scientific American, that stopping smoking in the current circumstances while also avoiding secondhand exposures would be a sensible thing to do as we don’t have much details available yet as to how the pre-dated exposure to smoking greatly impacts the respiratory health, contributing in disease contraction & poor prognosis. Hypotheses and associations are being drawn between the infections and smoking; it is important that there is no evidence yet that points to causation. This means that while smoking may act as a risk factor or increase the chances of a COVID-19 patient developing a severe infection, but given the fact that there is no established cause and effect relationship between the two, we can predict on theoretical considerations that smoking may have an impact in pushing it further, the COVID-19 disease.

As we know, severe COVID-19 infections often feature pneumonia, an infection in the lungs that causes swelling and sometimes difficulty breathing and some of the cases even worsen further and produce acute respiratory distress syndrome (ARDS) in which fluid in the lungs blocks breathing, requiring intensive care and sometimes leading to death. Earlier research in this line has shown that smokers tend to be more prone to pneumonia, including its most severe and deadly forms. There is fairly strong evidence that air pollution increases the risk of acute low respiratory infections and is thought of that it may have contributed to the extent of the outbreak in Wuhan & this potential link between air quality in Wuhan and the novel coronavirus outbreak requires further studies to establish the fact. As of now, we can predict on theoretical considerations that there may be both short term & long term effects associated with smoking that could be negatively affecting the treatment prognosis of patients contracting COVID-19 as well as the differential contraction of disease among younger & elderly population, given the fact that elderly population is associated with other long term disease conditions including metabolic syndrome among others. Similarly, smoking leads to heart and lung disease, which also leaves one predisposed towards worse COVID-19 outcomes but doesn’t establish directly that smoking/air pollution worsens COVID-19 and would need to be evaluated in further studies.

As majority of our population in Kashmir is in the senior age group and as most of them are addicted to hookah smoking presents a grim picture that most of our elderly population could be affected by the coronavirus disease & may present more severe symptoms on contracting the disease.

Now, taking the curious case of Kashmiri. We are well aware of the fact that hookah smoking among elderly population is all time high in Kashmir & cigarette smoking among younger population is even higher than the national average. Previous studies conducted have shown that about one sixth of the population aged 74 years in Kashmir has Stage I or higher chronic airflow limitation (CAL), but that only 0.73% report doctor-diagnosed COPD, (Chronic Obstructive Pulmonary Disorder). Further, previous peak flow meter-based survey reported a prevalence of chronic bronchitis in Kashmir of 7.7%, with higher prevalence among smokers and those living in poorly ventilated houses. The single most important cause of airflow obstruction has been reported to be mostly due to smoking, particularly due to traditional hookah smoking among the older population. It has also been reported earlier that hookah smoking confers a higher risk of lung cancer compared to cigarette smoking which may be an important contributory factor in causing chronic airflow limitation as well.

People with poor lung hygiene representing the elderly population in any population group, have been found to be more predisposed at contracting coronavirus disease and are also found to develop more severe pneumonic symptoms that has greatly contributed in increasing the mortality rate among elderly population.

These earlier studies conducted so far with regard to assessing the poor lung health among elderly population in Kashmir addicted to hookah smoking has revealed interesting facts that majority of the population in Kashmir are used to Hookah smoking more so, our elderly population. The lung hygiene among the same population group concerned is very poor & most are suffering due to chronic airflow limitation that ultimately lead to chronic obstructive pulmonary disorder & thereby reducing the functional capacity of lungs. Given the facts as have been revealed from small preliminary studies and as released by WHO from time to time, since the coronavirus pandemic has swirled across globe. People with poor lung hygiene representing the elderly population in any population group, have been found to be more predisposed at contracting coronavirus disease and are also found to develop more severe pneumonic symptoms that has greatly contributed in increasing the mortality rate among elderly population. As majority of our population in Kashmir is in the senior age group and as most of them are addicted to hookah smoking presents a grim picture that most of our elderly population could be affected by the coronavirus disease & may present more severe symptoms on contracting the disease. It may also slightly change the mortality curve if we consider the prevalence of hookah smoking in Kashmir and its positive correlation with coronavirus mortality rate as predicted from preliminary findings. Before we see anything like that in Kashmir if it takes an epidemic shape & in absence of any scientific proof available yet regarding the correlation of smoking & contracting coronavirus disease among elderlies, it is imperative that we strictly adhere to health advisories issued time to time by WHO as well as by our local healthcare authorities to reduce the chances of infection. It is clear to a certain degree that previous active history of smoking greatly impacts the disease outcomes, what we can do meanwhile is to avoid rush, avoid gatherings, stay at our homes, so that anything worst can be prevented from happening in absence of any well off healthcare facilities available at our disposal.

P.S: This is a theoretical prediction based on key scientific findings available on the subject; original facts may be different as more things are unrevealed in the times to come.

Author is a researcher at IIIM Jammu and can be reached at biotechumar@gmail.com

Disclaimer: Views expressed are author’s own and do not reflect the stand or policy of Oracle Opinions.

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