By Riccardo Polosa: 意大利卡塔尼亚大学内科教授，世界著名的减少烟草危害研究人员

这不是什么新闻，吸烟对人体健康有害，也是许多心脏病和癌症的主要危险因素。它还会降低免疫力，使人们更容易呼吸道感染。

但是研究人员最近发现，吸烟者可能更不容易受到新型冠状病毒（COVID-19）引起的感染或疾病的感染。但是，据意大利卡塔尼亚大学内科教授，世界著名的减少烟草危害研究人员里卡多·波洛萨（Riccardo Polosa）称，仍然存在积极的研究领域，并且对于这一说法尚无定论。

波洛萨与《埃及每日新闻》坐下来就这个关键问题进行了进一步交谈。

您是否认为吸烟者最容易感染COVID-19？

与任何病毒感染一样，症状和症状的严重程度通常取决于两个关键因素：病毒载量和宿主的免疫能力。对于非典（SARS-CoV-2），大约80％的感染人群似乎能够充分应对仅表现为无症状形式或轻度症状性疾病的病毒感染。

但是，有20％的人会继续发展为严重的症状形式的疾病，要么是因为他们暴露于高度升高的病毒载量（例如在医院工作人员中），要么是由于免疫防御能力低下（例如在老年人中）有合并症的人。

吸烟者似乎不更容易感染冠状病毒引起的感染或疾病，而且令人惊讶的是，科学证据表明，吸烟可能对COVID-19具有保护作用，相反。这仍然是一个活跃的研究领域，评审团仍在进行中。

吸烟者是否会出现更严重的症状？使用电子烟产品或电子烟的人受感染的可能性较小吗？

吸烟者感染SARS-CoV-2的可能性较小，而最终感染冠状病毒的可能性较小。没有电子烟使用者的数据，但是，鉴于电子烟的毒性比烟草香烟低得多，因此，有根据的猜测是，抽烟极不可能成为感染和/或疾病的危险因素。

吸烟者比非吸烟者更容易通过感染吗？

除了认为吸烟者较不易感染SARS-CoV-2的观念外，目前尚无数据可证明该病毒的传播速度。

您认为抽烟的替代品有哪些？

吸烟的第一种选择是不吸烟！但是戒烟并不容易，许多吸烟者喜欢香烟。对于无法戒烟或不愿戒烟的吸烟者，有另一种选择，它正在转向危害较小，无燃烧的产品，例如电子烟或加热的烟草产品。无烟尼古丁传递产品的毒理学数据平均比无烟香烟有害90％至95％。此外，在雾化产品设计方面的快速创新可能会进一步降低其残留的毒理学风险。促进人们获得危害较小的无燃烧尼古丁传递产品（如烟草卷烟替代品）的广泛使用，可能有助于加速吸烟率的下降。

电子烟比香烟危害小是正确的吗？

没有什么可疑的！雾化产品比烟草香烟危害小。英格兰公共卫生认识到，电子烟替代可燃香烟可减少危害，使电子烟的危害性降低多达95％。英格兰的电子烟可以在医院内出售，家庭医生可以建议患者改用电子烟以戒烟。

您是否认为由于世界范围内的困难情况，吸烟率会下降吗？

卡塔尼亚加速减少危害卓越中心（CoEHAR）对1,825名参与者的最新调查显示，在COVID-19封锁期间，卷烟消费量略有下降。但是，另一方面，同一受访者表示，他们储存香烟和电子液体，其行为类似于在封锁期间储存食品的公民的行为。尽管媒体开展了戒烟运动，但COVID-19期间吸烟率没有下降的迹象。

您是否认为电子烟可以帮助吸烟者戒烟？

是。人口调查，随机对照试验和观察研究表明，电子烟可用于帮助吸烟者戒烟。功效是可变的，具体取决于产品与用户之间的互动。

吸烟者应戒掉哪些不良习惯？

吸烟者必须停止吸烟。如果不能，则至少应尝试改用无燃烧的尼古丁输送产品。通过戒烟，他们将大大减少使自己和旁人暴露于烟草烟雾中的有毒物质的机会。

谣言四起，表明COVID-19与吸烟之间存在联系。您认为吸烟公司必须减少有害产品的产生吗？

烟草香烟会杀死人，因此，毫无疑问，应该花大力气开发创新的香烟替代品，以提供最佳的吸烟体验，但又不会损害烟草烟雾中的有毒物质。这些产品可能不是没有风险的，但是，不管电子烟对COVID-19的潜在影响如何，它们对人体健康的危害可能要比传统香烟少得多。

根据您的研究和专业知识，电子烟的危害是否比香烟小，它们具有相同的长期效果吗？

这是一个重要的问题。没有关于电子烟对健康的长期影响的数据，但是，鉴于电子烟的毒性比烟草香烟低得多，因此，有根据的猜测是，与传统香烟相比，电子烟极不可能是造成重大健康影响的危险因素。有新的研究针对于一生中从未吸烟的电子烟民，但数据将无法使用很多年。因此，关于电子烟对健康的长期影响尚无定论。

曾有针对电子烟的示威游行导致死亡。您能估算出电子烟与吸烟相比造成的死亡百分比吗？

明确一点，电子烟不会杀死人。令人遗憾的是，媒体误导了2019年秋季在美国爆发的急性严重肺损伤和死亡病例。数月以来，无数报纸、电视和广播报道都将商业化的雾化产品归咎于这种疾病和死亡。

尽管可以从美国疾病预防控制中心网站上获得数据，但媒体未能报道82％的病例（其中66％是男性）是使用非法THC弹药的用户，其中不包括可能未承认其非法活动的未成年患者。美国食品和药物管理局（FDA）通过“蒸气锁”行动关闭了44个非法的THR线上电子烟网站，随后新病例暴跌。

随着新病例降至接近零，并确定了维生素E乙酸酯（一种与蒸发剂一起食用的非法/黑市THC液体中的增稠剂），是爆发的罪魁祸首，疾病预防控制中心于2020年2月25日停止报告这种呼吸道疾病。

媒体很少关注这些重要的事态发展以及疫情仅限于美国黑市供应链这一事实，在欧盟或世界其他地方的使用者中没有报告肺部疾病的病例。而且，媒体并没有努力去纠正错误信息。

您对吸烟者有什么建议？

我对吸烟者的建议是尝试戒烟，戒烟永远不会太晚！如果您不能或不希望放弃香烟，请考虑尝试使用无燃烧替代产品。为吸烟者提供有效尼古丁输送的替代方法，这意味着他们可能更喜欢其中一种产品而不是香烟，最终将产生更好的效果。

Smokers not more susceptible to COVID-19 infection: Researchers

t’s not news that smoking is bad for human health and the leading risk factor for many heart problems and cancers. It also reduces immunity, and makes people more likely to respiratory infections.

But researchers have found recently that smokers might not be more susceptible to infection or illness caused by the novel coronavirus (COVID-19). However, according to Riccardo Polosa, Professor of Internal Medicine at Italy’s University of Catania and a world-renowned researcher into tobacco harm reduction, there is still an area of active research and the jury remains out on the claims.

Polosa sat down with Daily News Egypt to talk further on this critical issue.

Do you think that smokers are most vulnerable to COVID-19?

As with any viral infection, the symptoms and severity of symptoms generally depend on two key factors: the viral load and the immuno-competence of the host. For SARS-CoV-2, about 80% of the infected population seems to deal adequately with the viral infection developing only asymptomatic forms or slight symptomatic disease.

However, there are 20% of individuals that will go on to develop a severely symptomatic form of the disease, either because they have been exposed to a highly elevated viral load, as in hospital staff, or due to depressed immunologic defences, as in elderly people with comorbidities.

Smokers do not seem to be more susceptible to infection or disease caused by the coronavirus, and, quite surprisingly, the scientific evidence suggests the opposite, that smoking may be protective against COVID-19. This is still an area of active research and the Jury is still out.

Are smokers likely to have more severe symptoms? Are those using vaping products or e–cigarette less likely to be affected?

Smokers are less likely to get infected with SARS-CoV-2, or to end up in hospital with the coronavirus. No data is available for e-cigarette users, but, given that e-cigarettes are much less toxic than tobacco cigarettes, a consequential educated guess is that vaping is highly unlikely to be a risk factor for infection and/or disease.

Do smokers pass infection faster than non-smokers?

Besides the notion that smokers are less susceptible to SARS-CoV-2 infection, currently there is no data to argue about the propagation speed of the virus.

In your opinion, what are the alternatives to smoking cigarettes?

The first alternative to smoking is to not smoke! But stopping smoking is not easy, and many smokers like cigarettes. For smokers who cannot or do not want to quit, there is an alternative, which is switching to much less harmful, combustion-free products such as e-cigarettes or heated tobacco products. Toxicological data of combustion-free nicotine delivery products are on average 90% to 95% less harmful than combustion cigarettes. Moreover, rapid innovation in vaping product design is likely to further reduce their residual toxicological risk. Promoting wider access to much less harmful combustion-free nicotine delivery products, such as tobacco cigarettes substitutes, may contribute to accelerating the decline of the prevalence of smoking.

Is it correct that vaping is less harmful than cigarettes?

There is nothing to be suspicious about! Vaping products are less harmful than tobacco cigarettes. Public Health England recognises the reduced harm caused by e-cigarettes as an alternative to combustible cigarettes, with e-cigarettes being up to 95% less harmful. E-cigarette in England can be sold inside hospitals, and family doctors can advise their patients to quit smoking by switching to e-cigarettes.

Do you think that smoking rates will decline due to harder circumstances worldwide?

A recent survey of 1,825 participants by the Center of Excellence for the Acceleration of Harm Reduction (CoEHAR) in Catania, showed a slight decrease in cigarette consumption during the COVID-19 lockdown. But, on the other hand, the same respondents stated that they stockpiled cigarettes and e-liquids, a behaviour similar to that of citizens who stocked up foodstuffs during the lockdown. In spite of the media campaign promoting smoking abstinence, there has been no sign of a decline in smoking rates during COVID-19.

Do you think that that e-cigarette helps smokers to quit?

Yes. Population surveys, randomised controlled trials and observational studies have shown that e-cigarettes can be used to help smokers quit. Efficacy is variable depending on the specific product-user interaction.

What bad habits smokers should quit?

Smokers must stop smoking. If they cannot, they should at least try switching to combustion-free nicotine delivery products. By quitting or switching, they will massively reduce the chances of exposing themselves and bystanders to toxic substances in tobacco smoke.

Rampant rumours suggest a link between COVID-19 and smoking. Do you think smoking companies have to create less harmful products?

Tobacco cigarettes can kill, so there is no doubt that most efforts should be spent in developing innovative cigarette substitutes that provide the best smoking-like experience but without the harm of the toxic substances of tobacco smoke. These products may not be risk free, but their impact on human health is likely to be substantially less damaging than conventional cigarettes, regardless of any potential effect of smoking on COVID-19.

Based on your studies and expertise, are vaping and e-cigarette less harmful than cigarettes, do they have the same long-term effects?

This is an important question. No data is available for the long term health effects of e-cigarettes, but, given that e-cigarettes are much less toxic than tobacco cigarettes, a consequential educated guess is that vaping is highly unlikely to be a risk factor for significant health effects compared to continuing smoking. New studies are being performed on exclusive vapers who have never smoked in their life. Data will not be available for many years. Therefore, the jury is still out on long-term health effects of e-cigarettes.

There have been demonstrations against e-cigarettes which have caused deaths. Can you estimate the percentage of deaths by e-cigarette compared to cigarette smoking?

Let’s be clear, e-cigarettes do not kill people. Sadly, the media misrepresented the outbreak of acute severe cases of lung injury and deaths in the US in the fall of 2019. For several months, commercial vaping products were blamed for the illnesses and deaths in numerous newspapers, TV, and radio stories.

Although the data was available on the US CDC website, the media failed to report that 82% of cases (of which 66% male) were among users of illegal THC cartridges, not including underage patients who may not have admitted to their illegal activities. The US Food and Drug Administration (FDA) shut down 44 illegal THR online vape sites with Operation Vapor Lock and subsequently the number of new cases plummeted.

With new cases down to near zero and having identified Vitamin E acetate, a thickening agent in illegal/black market THC liquids consumed with vapourisers, as the culprit of the outbreak, the CDC stopped reporting on this respiratory condition on 25 February 2020.

The media gave little attention to these important developments and to the fact that the outbreak was confined to the US black market supply chain, with no cases of lung illness being reported among users in the European Union or elsewhere in the world. Moreover, no appreciable effort was spent by the media in rectifying the misinformation.

What do you recommend for smokers?

My advice to tobacco smokers is to try to quit, it is never too late to quit smoking! If you cannot or do not wish to give up your cigarettes, please consider trying substitute combustion-free products. Giving smokers an alternative with efficient nicotine delivery means that they might prefer one of these products over cigarettes and in the end this will produce better outcomes.