Most smokers are well aware of the numerous and severe health risks of smoking. The dangers of cancer, strokes, heart attacks and all forms of cardiopulmonary diseases are well documented. So no one should be surprised that smoking significantly worsens COVID-19, a pulmonary infection, and leads to disease progression.

“Tobacco smokers are more susceptible to COVID-19, more likely to be hospitalized and intubated, and twice as likely to die on a ventilator,” said Claudia S. Miller, MD, MS, professor emeritus in the Department of Family and Community Medicine in the Long School of Medicine.

“But while most smokers know their addiction is jeopardizing their chances of surviving this pandemic, how many of them stop to consider that their habit is jeopardizing the lives of older individuals, children with asthma or our health care workers?” she added.

Nonsmokers exposed to secondhand smoke, Dr. Miller explained, are vulnerable to the coronavirus as well.

Dr. Miller, along with other UT Health San Antonio physicians, is leading an effort to inform the San Antonio City Council on the dangers of secondhand smoke and to ban smoking in multifamily housing.

“We’re at a crisis stage as a community when it comes to COVID,” said Dr. Miller. “There are no vaccines. So what do you do when you don’t have drugs? There are public health actions. There’s social distancing, wearing masks and quarantines. Those are not medical treatments, they’re public health interventions. And there is another important ‘no cost’ public health intervention that has the potential to reduce COVID-19 infections, hospitalizations, intubations and deaths immediately: Stopping all smoking.”

Secondhand tobacco smoke, Dr. Miller said, paralyzes the cilia that keep particles — including viruses — from entering our lungs. And there’s no escape for people, the elderly and frail, for example, who live in the same building and share their indoor air with smokers.

“COVID-19 can hitchhike on aerosol particles contained in exhaled breath of symptomatic or asymptomatic smokers,” Dr. Miller said. “Tobacco smoke particles seep through all wall penetrations like electrical outlets, infiltrate the spaces between walls, and travel from floor to floor via the piston-like action of elevators. The only smoke-free buildings are those in which no one smokes.”

Even if you don’t live in the same building with a smoker, you should still be wary of secondhand smoke.

“Whenever someone smokes or vapes, they’re breathing out respiratory droplets,” Dr. Miller said. “So if you’re near someone who is smoking and you can smell the smoke, and that person is sick with COVID-19, you’re at risk of getting sick yourself. Not to mention, long-term secondhand smoke exposure can damage the lungs and make you more susceptible to coronavirus complications.”

Carlos Roberto Jaén, MD, PhD, professor and chair of family and community medicine, said the pandemic “provides us with an incentive to treat tobacco use disorder” in general. He added that “policy changes must be coupled with help for smokers to stop smoking,” pointing out that UT Health San Antonio offers effective treatment through its QUITXT program.

The COVID-19 pandemic should be a call-to-action for policy makers, said Dr. Miller, who has taught respiratory protection for almost 40 years.

“San Antonio maps show the highest rates of pulmonary disease in the lowest income areas of our community,” she said. “A ‘no smoking’ requirement for buildings with ‘shared air’ has enormous potential to reduce medical and personal costs to our families in the long term, and immediately reduce COVID-19’s impact on our community’s health and our city’s economy.”

Mandie Svatek, MD, associate professor of pediatrics at UT Health San Antonio, said a ban on smoking in multifamily buildings would not only impact the pandemic but would also address some of the environmental disparities in the city.

“Secondhand smoke is one of the top contributors [to COVID-19] and for affecting individuals with long-term detrimental health effects,” she said. “The time is now to create a smoke-free environment in multifamily housing that will impact these problems head on.”