Tobacco-caused diseases are a bane to the pandemic.

"A cigarette is a pinch of tobacco rolled in paper with fire at one end and a fool at the other" had said George Bernard Shaw.

Grappling with a pandemic that has impacted humanity is no mean task. Scientists, doctors, governments, civilians — the entire world — have adorned their respective uniforms and stand united in this war against the SARS-CoV-2 virus. Inevitably, the entire focus of all authorities, leaders and citizens has shifted to containing the spread of the coronavirus disease (COVID-19). All contemporary issues and concerns of the society, which continue to affect the behaviour and lifestyle of the community, seem to have been neglected and, in return, are allegedly becoming a factor in making the pandemic more severe.

Amidst this horror, evidence has emerged from several studies in the countries hardest hit by the virus. The World Health Organization (WHO), in one of its statements, supported the evidence and claimed that COVID-19 casualties are alarmingly higher among people with pre-existing conditions including non-communicable diseases (NCDs), such as cardiovascular and chronic respiratory conditions, cancers, and diabetes. The statement further mentioned that we cannot ignore the fact that tobacco use is indeed the main common risk factor linked to all of these diseases, and can hence be considered to have a major impact on the adverse outcomes of the pandemic. Worst is to realize that every disease caused by tobacco is preventable only if we choose life, not tobacco.

Laura Weeden, Associate Vice President at Population Reference Bureau (PRB) and Dr Tara Singh Bam, Deputy Regional Director (Asia Pacific), International Union Against Tuberculosis and Lung Disease (The Union), Singapore, more specifically highlighted the interdependence of tobacco consumption, NCDs and COVID-19. They were speaking at an online session hosted by CNS (Citizen News Service) and Indian Institute of Management (IIM) Indore. Sensitizing and informing the public about the existence of this relationship is important to prevent the deterioration of public health. The preferential treatment of COVID-19 while neglecting the pre-existing NCDs and tobacco-related health issues can have adverse effects.

Non-communicable diseases, tobacco and pandemic

While it is true that no one is exempt from the clutches of the corona virus, there is increasing evidence to show that some sections of society are more vulnerable than others. One such section comprises those individuals with non-communicable diseases (NCDs).

According to Laura Weeden, NCDs are an important indicator of the overall health of a country and they happen to be one of the leading causes of deaths worldwide. The extent of evil that NCDs are capable of has been further amplified by the arrival of the COVID-19 pandemic. “People with underlying chronic conditions such as cardiovascular diseases, cancer, diabetes, chronic respiratory diseases are particularly at risk of infection as the global community grapples with the COVID-19 pandemic,” Weeden says.

Weeden stresses the importance of a thorough understanding of the challenges that these NCDs present. An essential part of this is to be aware of and identify the various lifestyle habits, commonly referred to as the behavioural risk factors, that increase a person’s risk of developing an NCD. These behavioural risk factors range from tobacco use and excessive drinking to obesity and other similar unhealthy lifestyle habits that people – the youth in particular – are prone to fall prey to.

Dr. Tara Singh Bam also shares Weeden’s views on the effect of NCDs during the pandemic. He adds that despite the lockdown conditions imposed due to the pandemic, it is essential that patients with respiratory diseases, like tuberculosis (TB), receive essential lifesaving medication during this period. Dr Bam, further throws light on the effects of tobacco usage, stating that people who consume tobacco are significantly more susceptible to COVID 19 - a study done in China, found that smokers are fourteen times more likely to be affected. Dr Bam says that tobacco is a “major risk factor”, and that the current situation stands as an opportunity for the health sector to relook into the policies, strategies, legislation and programmes put forth to decrease the consumption of tobacco. “Clearly, there is a need for tobacco control and NCDs prevention, at all levels- local, sub-national, national, regional and global”, says Dr Bam, further adding that improvement of the situation needs coordinated contributions from the media, executive, the health sector and the community at large. He says that there needs to be an effective “system for health” at all levels.

Role of those in power and the Singapore story

Dr. Bam, further throws light specifically on the role of “members of parliament at national and subnational level”, stating that they must ensure the enactment and amendment of legislation, approving budgets and mobilizing resources for a rapid and effective response, that leads to ensuring nation-wide adoption of WHO best practices for tobacco control and fostering the participation of constituencies in international partnerships.

Dr. Bam also wants the Media to play a vigilant role in calling out to the above sector in case essential services are not provided -and these include tobacco affected patients’ medication and child care facilities.

Dr. Bam cites the example of Singapore for its successful and effective rapid response to the pandemic accompanied by strengthened checks and stringent restrictions that led to tracking the virus closely. Singapore is also an example of tobacco control and NCDs prevention.

After sharing his insights, Dr Bam, answered a few relevant questions on the topic:

Question: What is the role of municipal authorities, and how can civil society be of support to the government system?

Dr. Tara Singh Bam: Local municipalities have the advantage of knowing the citizens on a closer level - they have a deeper understanding of the local systems in place and the needs of the people, and hence will be the best candidates to improve upon the same. The former could carry out a micro-level analysis, along with “building public awareness during COVID 19”, through the media.

Question: What are your views on the use of pan masala (chewing tobacco) and electronic cigarettes during the pandemic?

Dr. Tara Singh Bam: Tobacco products should be limited, if not banned, during the pandemic (and beyond). Usage of these products only increases the vulnerability of the user to a host of diseases.

Question: What do you have to say regarding the treatment of TB patients, especially in areas where social distancing is difficult, during the COVID-19?

Dr. Tara Singh Bam: People suffering from diseases like TB are more prone to COVID-19 and hence effective measures must be taken to ensure that TB patients are able to receive proper medication, even during the lockdown. Uninterrupted medication for TB patients is an imperative if we want to walk the talk on ending TB. Furthermore, if possible, there must be regular testing of TB patients for COVID-19, to ensure minimal spread.