In the first few months of 2020, COVID-19 became the hottest topic on social media around the world.
Some of us may not have been so deeply aware before about the importance of good health. During Chinese New Year, all greetings turned from “Kung Hei Fat Choy” (may you be wealthy and prosperous) to “may you be healthy and safe.” This is the one and only wish we have for our loved ones. Since COVID-19 made its appearance, the damage it has brought to our lives made many of us finally realize that nothing matters without good health.
Some of us may not have previously cherished every single breath like we do right now. We used to take it for granted. Realizing how difficult breathing could be with lung inflammation, we realize that healthy lungs are essential for us to get back to normal life.
Protect the lungs – this has become our raison d'être for what it means to be “healthy and safe.”
To protect the lungs of people in China, where 300 million people smoke cigarettes and 740 million people are exposed to second-hand smoke, the first thing we should do is to quit tobacco and protect others from being exposed to deadly second-hand smoke.
Tobacco is a major risk factor for respiratory diseases. It threatens the lung health of everyone exposed to it.
With just a single breath, the hundreds of toxins in tobacco smoke begin damaging your lungs. Its harmful effects on the lungs are almost immediate.
When tobacco smoke is inhaled, the structures that sweep mucus and dirt out of your airways are paralyzed, allowing the poisonous substances in tobacco smoke to make their way into your lungs more easily.
Tobacco smoke results in reduced lung function and causes breathlessness due to the inflammation of airways and the build-up of mucus in the lungs.
These immediate respiratory symptoms are just a part of the damage tobacco does to your lungs.
In addition, second-hand smoke which contains more than 250 toxins and at least 69 known carcinogens, is also doing serious harm to your lungs.
Tobacco smoking and exposure to second-hand smoke are major risk factors for chronic lung diseases, including lung cancer, chronic obstructive pulmonary disease (COPD), tuberculosis (TB) and asthma. These lead to difficulty in breathing, dysfunction in lungs, and even death. Once one has developed chronic lung disease, it is almost irreversible.
What we’ve learned from the COVID-19 outbreak in China is that people with pre-existing conditions like respiratory disease and cardiovascular disease, both of which can result from smoking, face a much greater risk of severe illness with COVID-19 and higher rates of mortality. [i]
Now more than ever, it is time to protect the lungs by quitting smoking. Because of COVID-19, and also to reduce the number of tobacco-related fatalities - 5,000 people die every day in China because of tobacco use and second-hand exposure.[ii]
Everyone has a role to play to win this fight for our lungs and our health - smokers, family members, doctors, community and government.
Proven effective cessation services include brief advice from health professionals as part of their routine consultation or interaction, toll-free quit lines for tobacco users to access brief and potentially intensive behavioural counselling, and mobile phone-based interventions (mCessation) which use text messages to deliver cessation intervention.
Experience from other countries show that smokers enrolled in the “mCessation” program reported a nearly 20% absolute quit rate. These behaviour interventions are even more effective if they are used in combination with nicotine replacement therapies (NRTs) or medications that do not contain nicotine. WHO does not recommend e-cigarettes as cessation aids due to insufficient evidence and unknown long-term health impact.
According to the 2018 China Adult Tobacco Survey Report, smoking prevalence among people aged 25-44 and 45-64 has decreased since 2010 and 20% of smokers made an attempt to quit in the previous 12 months.[iii] The smoking rates in Beijing and Shanghai have decreased significantly since the implementation of their comprehensive smoke-free laws, which shows that more people are choosing to quit and choosing a healthier life.
However, 90% of those who attempted to quit did not use any of the measures or support mentioned above. Most cessation services in China are provided through cessation clinics but due to low awareness and accessibility, visits to cessation clinics is rare. In addition, not all provinces in China are covered by a quit line.
WHO recommends that China should provide a set of comprehensive cessation interventions to ensure people who want to quit are supported, no matter where they live. That includes integrating brief advice into existing primary health care systems, providing 24h toll-free quit line to all provinces, mobile-based cessation intervention, and high-level insurance coverage for cessation services and medication.
The willingness to quit is the first step for quitting successfully. To build the willingness, more effort is needed to raise awareness of tobacco harm and implement other tobacco control measures for a supportive environment: China should raise tobacco taxes and retail package prices; ban smoking in all indoor public places; ban tobacco advertising, promotion and sponsorship; print large pictorial health warnings on cigarette packs; and roll out mass media campaigns on the harmful effects of tobacco use.
Raising tobacco taxes is the most effective tobacco control measures a country can take to reduce smoking prevalence. Raising tobacco taxes and retail prices would lower the affordability of tobacco products especially for youth, helps large numbers of smokers to quit, and generates revenue for government which can be used for public health and health system reform.
Additionally, adopting national smoke-free legislation to ban smoking in indoor public places supports those trying to quit by making smoking less convenient, reducing second-hand exposure and making smoking behaviour less popular in public places.
In 2019, China announced the fight for healthy lungs by launching the Healthy China Action Plan 2019-2030, which set a target to decrease smoking prevalence from 26.6% to 20% by 2030.
China’s response to COVID-19 shows that with commitment from the highest levels, the immediate and strong implementation of whole of government, and the support and compliance from society, we can win this fight against tobacco and protect our lungs.
China has passed the first peak in the fight against COVID-19, but the global situation reminds us that it is not yet time to relax. To continue this fight against COVID-19, and to ensure our long-term health, we all need to win the fight for our lungs first to ensure we are all in good condition for any battles ahead.
We wish you health and safety. Enjoy every single breath.
References:
[i] Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19)
[ii] Smoking prevalence and attributable disease burden in 195 countries and territories, 1990-2015: a systematic analysis from the Global Burden of Disease Study 2015. Lancet (London, England). 2017;389(10082):1885-906.
[iii] 2018 China Adult Tobacco Survey Report