Vulnerable population

COVID-19 presents a unique risk to smokers

“For some patients who smoke, this was the first time I’ve seen some fear in their eyes about the risks of continued smoking,” says Aaron George, DO.


Editor’s note: The AOA has partnered with the CDC’s Tips From Former Smokers® (Tips®) campaign to help raise awareness of the free quit-smoking resources the agency offers health care professionals in order to help people quit for good. Resources for physicians can be found here.

COVID-19 poses a unique threat to patients who smoke. Due to the impact smoking has on lung tissue and the immune system, COVID-19 has disproportionately harmed this population.

Recent evidence indicates that smoking also increases the presence of an enzyme that allows the virus to enter cells, which may further explain why smokers with COVID-19 are at particularly high risk of developing severe illness.

This risk underscores the importance of smoking cessation conversations between physicians and their patients. As physicians work quickly to respond to the crisis, some see an opportunity to support their patients in quitting smoking.

Throughout the pandemic, Aaron George, DO, a family physician in Hagerstown, Maryland, with expertise in community and population health, has continued to meet with many of his patients virtually. In this edited Q&A, he describes how COVID-19 has transformed his practice and how he’s working with patients on smoking cessation during the crisis. Dr. George partnered with the AOA in 2019 to support the CDC’s Tips® campaign to promote smoking cessation.

How do you feel patients who smoke are being impacted differently by this crisis?

For some patients who smoke, this was the first time I’ve seen some fear in their eyes about the risks of continued smoking. Many were eager to understand options to quit. Those who smoke will likely have a harder time combating the virus, and they understand this impacts them directly and in the near-term.

Has the pandemic prompted you to have different conversations with your patients surrounding smoking?

In the weeks leading up to the crisis, I was able to have some very frank conversations with patients who smoke about their risks if they continued and contracted the virus. I’ve used this as an opportunity to heartily advise my patients to quit.

I have warned my patients who do smoke that their likelihood of hospitalization is much higher. And while I do not seek to leverage or take advantage of a crisis, I can say that my patients responded well to this.

 Are you still seeing patients as you would normally, or are most “sick” visits or check-ins being done virtually?

At the state level, our governor has mandated that no more “nonessential” visits should occur. In my own practice, I have shifted to almost entirely “e-visits,” though I do still see some patients face-to-face as needed. Either myself, or my nurse, will call every single patient to determine if the visit could be postponed or performed virtually.

Has shifting to predominantly telemedicine visits created opportunities to counsel your patients who smoke?

Paradoxically, I am finding myself and my primary care colleagues have more time in these circumstances than we did previously. Patients are seeking to stay home and the volume of “e-visits” has not matched what we would have seen had patients sought direct or face-to-face care.

Therefore, I’m finding that the time with each patient is actually a bit longer, and I am able to spend more time with each patient. This actually allows more time for discussion about smoking cessation with patients. However, as the COVID crisis increases in my community, I anticipate that I will have less time for routine patient visits in the coming weeks.

Have you encountered any COVID-19 symptomatic patients and provided counseling to them?

Yes, COVID-19 symptomatic patients who smoke have been adamantly advised to use this as a reason to quit smoking. It’s an important conversation to have right now, and one that I take seriously.

Free CDC resources for physicians

Physician practices can post resources on their website, including linking to Tips® resources, syndicating content from the CDC’s site, and listing the free 1-800-QUIT-NOW (1-800-784-8669) quit line for English speakers and 1-855-DÉJELO-YA (1-855-335-3569) for Spanish speakers.

Free resources for health care professionals and their teams are also available from CDC’s Tips® campaign.

Physicians interested in partnering with the AOA on the 2020 Tips® campaign can learn more here.

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