1. Ada
  2. COVID
  3. COVID-19: Smoking and Nicotine

COVID-19: Smoking and Nicotine

Written by Ada’s Medical Knowledge Team

Updated on

Overview: smoking and the risk of severe COVID-19

  • Smoking puts you at risk of severe COVID-19 complications
  • Smoking decreases lung function, creates circulation problems, and impairs the immune system
  • Exposure to second-hand smoke may also increase the risk of severe COVID-19 symptoms 

Smoking and COVID-19 are two topics that have been heavily discussed in the context of the ongoing pandemic. There’s increasing evidence that smokers may be at a higher risk of experiencing severe symptoms due to an infection with the coronavirus. This article will explore the relationship between COVID-19 and smoking and its impact on your risk profile. 

COVID-19 and smoking: what is the risk?

COVID-19 can affect anyone, but several factors, including smoking, heavily impact the progression and outcome of the disease. In assessing your risk, it's essential to understand that there's a distinction between a risk of getting COVID-19 and a risk of getting very sick from COVID-19.

Whether or not you’ll get COVID-19 depends on some factors that have to do with the exposure to the virus, such as: 1

  • Length of time: the longer you are in contact with an infected person, the higher the possibility of getting infected too. 
  • Coughing or heavy breathing: if the person you’re with is infected with COVID-19 and is coughing, breathing heavily, shouting, or singing, you are at a higher risk of getting COVID-19 as there’s more probability that the virus is spread. 
  • Symptoms: if the person you’re with is infected and experiencing symptoms of COVID-19, the odds of you getting COVID-19 increase significantly.
  • Masks: the best situation is for both you and the person you’re with to wear masks. If neither of you is masked, the risk of infection increases. 
  • Ventilation: The better the ventilation in the room, the slighter the odds of getting infected. Meeting others outdoors is preferred. 
  • Distance: the further away someone is, the lesser the chance of getting infected. 

To assess how ill you might get from an infection with the coronavirus, it’s important to know your risk profile. This depends on your situation and includes factors such as: 2

  • Older adults and elderly
  • Chronic conditions of the lungs, such as asthma and COPD
  • Chronic kidney, heart, liver, or certain neurological diseases
  • Diseases that affect your immunity, such as cancer or HIV
  • Diabetes
  • Obesity
  • Pregnancy
  • Smoking
  • Use of immunosuppressive medications, having had a transplant, or cancer treatment

The severity of COVID-19 among smokers is elevated for those still active smokers who get infected with the coronavirus and those who used to smoke in the past. Past smokers also have an increased risk of severe symptoms due to the existing lung damage. It’s important to note that exposure to second-hand smoke may also increase the risk of severe COVID-19 symptoms. 

Apart from regular cigarettes, electronic cigarettes also affect the outcome of COVID-19 significantly, as smokers of any type of cigarette are more likely to experience severe complications compared to people that do not smoke. 3 4

Are smokers more heavily impacted by COVID-19?

Smokers impacted by COVID-19 may experience more severe symptoms and face a higher hospitalization risk than non-smokers. This is because smoking causes damage to the heart, blood vessels, and lungs, which is why it increases the risk of heart and lung disease in general. 5

Smoking and COVID-19 have been the subject of many studies, which suggested that smokers have a greater chance of requiring mechanical ventilation when they end up in the hospital due to an infection with the coronavirus. On top of that, they have significantly higher odds of passing away due to the consequences of the infection. Complications of the heart are also suggested to be more frequent amongst smokers, such as heart failure or stroke. 6

Smoking could also affect COVID-19 in another way, as tobacco compromises the function of the immune system. This system is the natural way your body defends itself against viruses, such as the coronavirus. If it’s not working correctly due to smoking habits, the coronavirus can replicate itself and spread quickly within the body. This causes the disease to evolve with severe symptoms, which may lead to death. 

What to do if you’re a smoker and you get COVID-19

The treatment of COVID-19 for smokers is comparable to treatment for other risk groups and can be different for everyone, depending on your situation. In most cases, infections with the coronavirus can be treated at home. If you notice any symptoms related to COVID-19, then it’s crucial to get tested as soon as possible. If a COVID-19 test confirms that you have been infected, you should contact your doctor as quickly as possible to get more information regarding treatment.

Your doctor will assess your risk profile and ask questions to determine if you are at risk of severe symptoms or hospitalization. If you are eligible for antiviral treatment, your doctor will prescribe you medication that you can take at home. For this medication to be effective, it needs to get started up as soon as possible, so you shouldn’t postpone contacting your doctor. This medication will help your immune system fight the virus by decreasing the amount of virus in your body. 7

If you aren’t eligible for this medication, then there are still other things that you can do to alleviate your symptoms. You can: 8

  • Opt for painkillers such as Paracetamol, Ibuprofen, or Naproxen
  • Rest as much as possible
  • Drink enough water
  • Reduce your cough by taking cough medicine and sitting upright instead of lying on your back 

If you are a smoker with COVID-19, keep track of your symptoms and evaluate how your symptoms are progressing. You should contact your doctor if: 9

  • You’re gradually feeling worse
  • You're having difficulty breathing
  • You feel very weak, and basic tasks feel too difficult
  • You’re shaking or shivering
  • You still feel unwell after a 2 weeks

Smoking and COVID-19: prevention guidelines

To reduce your chances of getting severely ill, we’ve listed some things you can do to reduce your risks of severe COVID-19 as a smoker. 10

The most crucial thing smokers can do to reduce the impact of COVID-19 is to quit smoking and stop using products containing tobacco. Quitting will immediately impact your health, and after a few weeks, your circulation and lung function will start to improve again. Apart from protecting yourself, you’ll also protect those around you by reducing their exposure to second-hand smoke. To help yourself quit, you can make use of nicotine replacement therapies or try an intervention program. 11

Other ways of preventing COVID-19 both apply to smokers and non-smokers. You can drastically decrease your chances of getting infected by adhering to the following prevention measures: 12

  • Wash your hands regularly and thoroughly with water and soap
  • Use a mask that fits well, covering both the nose and mouth. Masks can set a barrier for the particles you breathe, cough, or sneeze out. Respirators such as the N95 mask provide higher protection as they fit closely on the face and filter out particles, including the virus that causes COVID-19.
  • Get vaccinated and keep your vaccination up-to-date with the recommended booster shots
  • Keep a safe distance from others
  • Improve indoor spaces' ventilation by opening a window or moving indoor activities outdoors.
  • Avoid contact with people who are experiencing COVID-19 symptoms or who have tested positive. 
  • Get tested for COVID-19 if you think you might have been infected, and stay home if you suspect that you have COVID-19. 

Wrapping up

The evidence linking smoking to COVID-19 has been attributed to the negative impact that smoking has on lung health and the immune system, which may make smokers more vulnerable to respiratory infections such as COVID-19. It’s crucial that smokers take proactive measures to protect themselves. If you are experiencing symptoms of the coronavirus, then it’s important to monitor yourself to see how your situation is evolving.


Q: Is it bad to smoke when you have COVID-19? 
A: As smoking has a negative impact on lung function and blood circulation, it’s strongly advised not to smoke when you have COVID-19.

Q: Are e-cigarette users likely to have more severe symptoms if infected? 
A: The connection between e-cigarettes and poor COVID-19 outcomes is still being investigated, but studies suggest that the use of e-cigarettes would also affect the outcome of a COVID-19 infection in a negative way. 

Q: How does the coronavirus affect smokers?
A: The coronavirus is thought to affect smokers heavily as their lung function is compromised due to smoking. Smoking also causes a weakened immune system, which makes it harder for your body to fight the virus. 

Q: Can nicotine affect my chances in the context of COVID-19? 
A: Some studies suggest that nicotine may activate anti-inflammatory mechanisms in the body that could help avoid severe symptoms of COVID-19. However, the evidence for these studies is limited and does not take away the adverse effects that smoking has on the body.