CDC Prioritizes Smokers for COVID-19 Vaccine

Patients who smoke are more likely to be hospitalized and more likely to die than nonsmokers.

February 08, 2021

ALEXANDRIA, Va.—Most Americans are anxiously waiting the opportunity to get the COVID-19 vaccine, and the U.S. Centers for Disease Control (CDC) has added smokers to the list of priority groups for the shots, reports USA Today.

“I could see why people would feel as if that would be unfair, but people who are smokers are in general at higher risk for getting sicker when they develop COVID-19,” said Dr. Samuel Kim, a thoracic surgeon at Northwestern Medicine in Chicago.

A study published Jan. 25 in JAMA Internal Medicine, found that people who smoke or who have smoked in the past are more likely to be hospitalized or die from COVID-19 than people who haven’t smoked. In addition, smokers are also more likely to have other diseases such as high blood pressure, coronary artery disease and chronic obstructive pulmonary disease or COPD.

The Cleveland Clinic study found that COVID-19 patients who had smoked more than 30 packs of cigarettes were 2.25 times more likely to be hospitalized and 1.89 times more likely to die compared with people who had never smoked. Researchers at the University of California, Los Angeles, discovered how smoking worsens COVID-19 infections in a smoker's airways, in a study published in Cell Stem Cell. The group infected cultures exposed to cigarette smoke and identical cultures that weren't exposed and saw between two and three times more infected cells in the smoker cultures.

Dr. Kim from Northwestern Medicine said some studies have found smoking also can impact the immune system, so a smoker’s body can’t clear infection as well as the body of a nonsmoker. If the COVID-19 infection progresses to severe disease and lung damage, some patients could require lung transplants. 

“When you take a look at those lungs,” he said of the extreme COVID-19 cases, “those are worse than any other lung disease I’ve ever seen.”

Carmel Shachar, executive director of the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School, said in an interview with Harvard Law Today that smoking should be considered among the pre-existing conditions that qualify people for priority access to COVID-19 vaccines under CDC guidelines.

“I think there needs to be an acknowledgement that there are different social pressures and factors that go into people’s choices to smoke,” Shachar told Harvard Law Today. “For example, we know that rates are different between different socioeconomic groups and different ethnic groups. So, if we penalize smokers by saying, ‘You are at heightened risk of having a really bad outcome if you get COVID, but we think you did this to yourself,’ we’re disproportionately burdening the health of communities of color and lower socioeconomic communities.” She adds that “anytime a person gets vaccinated, it’s good for the community.”

The CDC has published a toolkit to help essential employers inform their workers about vaccines to protect against COVID-19, raise awareness of the vaccines and address common questions and concerns.

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