Smoking or vaping while infected with COVID-19 is highly discouraged by public health experts worldwide. Inhaling any foreign substance into already stressed and infected lungs significantly raises the risk of developing a more severe illness and poor outcomes. This risk applies to all forms of inhalation, including traditional tobacco products, e-cigarettes, and cannabis. Understanding the biological mechanisms behind this heightened danger is essential for anyone who uses these products and tests positive for the virus.
How Smoking Escalates Acute COVID Symptoms
Smoking directly exacerbates the active COVID-19 infection by fueling inflammation in the respiratory system. The chemical components in smoke trigger a massive release of pro-inflammatory factors, such as cytokines, which can contribute to a dangerous “cytokine storm.” This excessive inflammatory response is a primary cause of acute respiratory distress syndrome (ARDS), a severe complication of COVID-19.
Smoke inhalation introduces carbon monoxide into the bloodstream, competing with oxygen to bind to hemoglobin. This reduces the blood’s capacity to transport oxygen, worsening the hypoxia, or low oxygen levels, often associated with severe COVID-19 pneumonia.
Cigarette smoke also compromises the body’s immediate immune response by blocking interferons, which are messenger proteins that trigger infected cells to fight the virus. By weakening this defense, smoking allows the SARS-CoV-2 virus to replicate more aggressively and spread further within the airways. Studies using human airway tissue models exposed to smoke showed two to three times more infected cells than non-exposed tissue.
Smoking’s Pre-Existing Damage to Respiratory Defenses
The chronic effects of smoking create a vulnerable respiratory environment before the COVID-19 infection begins. Smokers have a compromised mucociliary clearance system, which includes tiny, hair-like projections that sweep mucus and trapped pathogens out of the lungs. When these airways are damaged, the virus can settle deeper and remain longer, increasing the likelihood of a protracted infection.
Long-term exposure to smoke increases the number of entry points the virus uses to invade cells. Current smokers have higher levels of the Angiotensin-Converting Enzyme 2 (ACE2) receptor in their airway cells, which the SARS-CoV-2 virus uses to enter human cells. This up-regulation provides the virus with an abundance of targets for cellular entry and replication.
Smokers often have underlying conditions such as Chronic Obstructive Pulmonary Disease (COPD), which significantly compounds the risk of severe respiratory failure if they contract COVID-19.
Vaping and Cannabis: Are They Different
The misconception that non-combustible inhalation methods are harmless during a respiratory infection is incorrect. Vaping, whether it contains nicotine or not, involves inhaling aerosols, flavorings, and chemical compounds that cause significant irritation to the respiratory lining. This irritation creates inflammation, similar to tobacco smoke, and makes the lungs more susceptible to viral damage.
Vaping and cannabis smoke introduce fine particles and foreign substances into the delicate lung tissue, compromising pulmonary defenses. This constant irritation worsens the respiratory symptoms of COVID-19 and increases the risk of complications. The act of deep inhalation often associated with cannabis use can also introduce viral particles deeper into the lungs.
Regardless of the substance—nicotine, THC, or flavorings—the physical act of introducing a hot, foreign aerosol into an infected respiratory system is harmful. Concurrent use of e-cigarettes and cannabis is associated with a higher reported likelihood of COVID-19 symptoms.
Immediate Steps for Quitting and Symptom Management
The period of illness is an opportune time to pursue immediate cessation, as the body begins to recover quickly. Within eight hours of stopping, the blood’s oxygen levels begin to return to normal, which immediately helps the tissues and blood vessels. Quitting smoking is a direct action that improves the body’s ability to fight the virus.
To manage nicotine withdrawal while sick, individuals should immediately switch to a non-inhaled form of nicotine replacement therapy (NRT). Over-the-counter options like nicotine patches, gum, or lozenges are safer alternatives that deliver nicotine without the harmful byproducts of smoke or vapor. These products help stabilize the body through withdrawal without further irritating the lungs.
For managing the physical and mental aspects of quitting, professional support is readily available, often through a national quitline. Trained counselors can provide a personalized quit plan and behavioral support. Focusing on symptom relief, such as using prescribed cough suppressants or fever reducers, should replace the ritualistic habit of smoking during this recovery period.