COVID-19 often affects the lungs, where it can cause lung damage. Does a history of smoking, vaping or exposure to smoke and air pollution affect the likelihood of COVID-19 — or of having more severe COVID-19 disease?

Panagis Galiatsatos at Johns Hopkins Bayview Medical Center is an expert on lung disease who sees patients with COVID-19. He explains the impact of smoking and other lung irritants on people at risk from — or infected with — the coronavirus.

Do vaping and smoking increase your risk of getting COVID-19?

Smoking and Coronavirus

The relationship between smoking and the coronavirus is still unclear. According to the Centers for Disease Control and Prevention (CDC), current smokers and people with a history of smoking may be at a higher risk for severe coronavirus disease.

Galiatsatos, a pulmonologist and critical care specialist who directs the Tobacco Treatment Clinic at Johns Hopkins Bayview Medical Center, observes those effects firsthand. He and his colleagues recently completed meta-analysis showing that smoking raises the risk of severe coronavirus disease.

“We are seeing worse cases of COVID-19 in smokers,” he says. “Your lungs, which are at the forefront of your immune system, are interacting with the environment with every breath.

“When you inhale cigarette smoke, germs or allergens, your lungs can get irritated, and that irritation unleashes the immune system to fight that irritation. A coronavirus infection on top of that means that your symptom response is going to be amplified.”

Though much more is to be revealed about the relationship between smoking and the coronavirus, there’s plenty we know now: Smoking is a proven risk factor for cardiovascular disease and lung disease, including lung cancer, which —along with other factors — can put you at higher risk for a severe case of COVID-19.

Does vaping increase your coronavirus risk?

It is possible. One study tested more than 4,300 young people for the coronavirus and found that those who vaped regularly were five to seven times more likely to test positive. There is evidence that vaping harms the lungs, which might increase the risk of coronavirus infection or a more serious case of COVID-19.

What You Can Do If You Smoke or Have a History of Smoking

• Quit smoking now if you haven’t already. Remember that many people quit successfully after several tries. Talk to your health care professional — counseling, apps and even medication can help support your commitment to quit smoking. “At the Tobacco Treatment Clinic, we understand that a person’s dependence on tobacco is a medical problem, and that’s how we approach it,” Galiatsatos says. “We believe in support and encouragement, not trying to scare patients or make them feel ashamed.”
• The same goes for vaping and using e-cigarettes: the coronavirus pandemic is a good time to stop. If you use vapes or e-cigarettes that contain nicotine, work with your doctor to break the habit.
• If you’re a former smoker or vape user, don’t pick up the habit again. Learn healthier ways to manage stress and improve wellness while the coronavirus pandemic keeps you from your normal activities.
• Get vaccinated. Several COVID-19 vaccines have been authorized for emergency use among specific age groups by the U.S. Food and Drug Administration (FDA). Johns Hopkins Medicine views all authorized COVID-19 vaccines as highly effective at preventing serious disease, hospitalization, and death from COVID-19.
  Learn more about coronavirus vaccine safety and what you need to know about the COVID vaccines.
• Be especially on alert for coronavirus symptoms and call your doctor if you feel sick.

Can smoking and vaping spread the coronavirus?

Possibly. Smokers and e-cigarette users alike have to take their face masks off when they smoke or vape. So even between puffs, if they’re unknowingly infected with the coronavirus, they might exhale contagious droplets and aerosols into the air, which could be inhaled by others nearby.

Secondhand cigarette smoke is known to cause health problems, and although there isn’t yet scientific proof that it can spread the coronavirus and cause COVID-19, at least theoretically it’s a possibility. “Secondhand smoke can propel viruses into the air from the nose and throat,” Galiatsatos says.

E-cigarettes also involve secondhand “smoke,” since users exhale potentially infectious vapors. “E-cigarettes create aerosols, so they might be even more of a problem than combustible cigarettes in terms of spreading the coronavirus,” Galiatsatos notes.

Smoking or vaping inside is even riskier. In a closed environment, infectious droplets and particles can build up in the air, putting others in the room at risk if there’s no ventilation.

How to Protect Yourself from Secondhand Smoke and E-cigarette Vapors

• Avoid people who are smoking conventional or e-cigarettes, or vaping.
• Practice physical distancing, avoid indoor gatherings and steer clear of people not wearing masks, especially indoors.

Wildfires and the Coronavirus

Wildfires, which can occur in hot, dry weather, release large amounts of smoke into the air, affecting not only local communities but entire states and even continents.

According to the CDC, wildfire smoke contains gas and particles of burned trees, vegetation and buildings. Breathing in smoke can cause coughing and irritation to your respiratory system. For older adults, pregnant women, people with lung disease, and those at risk for COVID-19 or recovering from it, inhaling wildfire smoke can be dangerous.

Human behavior during wildfires and other environmental crises could add another factor, Galiatsatos says. “If a fire or other natural disaster causes families to have to leave their homes and shelter in a community area, that’s putting a lot of people together indoors,” he explains. “That might make it hard to maintain at least 6 feet of physical distance, which could be a concern for people who are not fully vaccinated, especially if COVID-19 cases are increasing in that area.”  

What to Do If You Live in an Area with Smoke Pollution

Pay attention to local reports and those from the U.S. Air Quality Index, especially if you are at risk or recovering from COVID-19. When surrounding air is unhealthy due to wildfires or any other air pollution, stay indoors and follow these steps:

• Use an air filter and adjust your air conditioner or heating system to re-circulate air instead of drawing air from the outside.
• Do not smoke, especially inside your home.
• Avoid using your fireplace or lighting candles or incense.
• Hold off on vacuuming until air quality improves. (Vacuuming can re-circulate ash and particles that have settled on surfaces.)
• Follow your doctor’s recommendations if you have asthma or heart or lung disease.

If you must leave your home due to pollution, be sure to pack fresh masks and hand sanitizer in case you need to shelter in a community setting with others.