Eating with secondhand smoke around you isn't great. But is there a COVID-19 risk?
You're sitting outdoors at a Miami Beach cafe, ready to wolf down your waffle. Then a cloud of cigarette smoke wafts over from the socially distant table next to you.
The plume goes right into your maskless nostrils.
What appears to be just an irritant at brunch that might flare up your asthma now poses a medical question:
Is secondhand smoke a COVID-19 risk?
While there aren't any official studies yet, health experts say it's possible.
At a time when we're outside more, and of course, eating without masks, it's a question that needs some exploration - and explanation.
Doctors have learned a lot about COVID-19. It primarily spreads through small droplets from the nose or mouth. The disease commonly affects the lungs.
When people exhale smoke from cigarettes and e-cigarettes, they release droplets into the air, just like when they cough, sneeze or speak. If the smoker has COVID-19, "exhaling cigarette smoke could potentially also spread COVID-19," the World Health Organization said in an email to the Miami Herald.
It's a hypothesis WHO's team in Geneva is looking into. The team is assessing evidence for an updated meta-analysis on the possible link between tobacco, e-cigarette use and COVID-19, including secondhand smoke, a spokeswoman said.
Droplets are also released into the air when people vape and smoke cigars and hookahs, which means that if you're close enough to smell the smoke, you're likely inhaling their droplets, too.
Can you catch COVID-19 from secondhand smoke?
While there isn't "any direct evidence" yet that secondhand smoke could transmit COVID-19, if you put all the data together of what is known about the virus and how smoking works, "you can make a pretty compelling argument" that a risk exists, said Dr. Mark Block of Memorial Healthcare System. He is the chief of thoracic surgery at Memorial Regional Hospital in Hollywood and a regional board member for the American Lung Association in Florida.
Health officials also believe that the longer you're exposed to the virus, the higher your chance of falling ill is. This means that your risk of catching COVID-19 from a symptomatic or asymptomatic smoker could depend on how long you're smelling their smoke, Block said.
"When you're outdoors and you're walking past somebody or somebody passes you, the amount of time you are exposed to the aerosol is so limited that it's probably not a significant risk factor in getting infected," Block said. "Now that we are eating outside sometimes you're sitting downwind from somebody who is smoking so you smell their cigarette smoke. I wouldn't want to be in that environment for an extended period of time."
Still, even with the risks, experts say it's safer to stay outside where you can socially distance (be at least six feet away from others) than be packed indoors with other people.
Miami-Dade County's "New Normal" guidelines have two rules relating to smoking and vaping during the pandemic. One is that you can take your mask off to smoke and vape. The second is that people can't share cigarettes, vape pens, hookah instruments or any other smoking device used for vaporizing and smoking at restaurants.
The county's guidelines do not clarify if people are banned from smoking while dining outdoors. Since July, restaurant customers have only been able to eat outside in Miami-Dade and will continue to do so until indoor dining is allowed again on Aug. 31.
So, has secondhand smoke been a problem for diners?
Some restaurant owners say they've found guests are happy just to be able to sit down at a restaurant, even if it's outside, to not make secondhand smoke an issue.
"People might be giving each other a bad look, but the customers have been giving us a pass," said Sergio's Cuban restaurant owner Carlos Gazitua.
Other owners say they aren't taking any chances of blow-ups between diners.
Matt Kusher, who owns four Miami-area restaurants, limits smoking, even outdoors. When there is a disagreement between customers, he always sides with the non-smokers - a lesson he said he learned as a young restaurateur to choose families over single smokers.
"We always err on the side of a smoke-free environment," Kuscher said. "We typically ask them to stop smoking. We allow people to smoke only if they're the only ones on the patio."
Smoking and secondhand smoke has always been deadly and can cause serious health problems in the long term like lung cancer.
COVID-19 is just an extra risk that can affect your health much quicker, with symptoms usually appearing 2 to 14 days after exposure to the virus, health officials say. Most people recover from COVID-19, but some fall seriously ill and need to be hospitalized. Others die from COVID-19 related complications.
Are smokers, vapers at higher risk of falling ill with COVID-19?
"Sometimes smokers don't feel like they need to quit. ... Now they have an additional reason to quit smoking. With COVID, not only are you putting yourself at greater risk but you are putting the people around you at greater risk," Block said.
Current and former smokers may also be at higher risk of falling seriously ill with COVID-19 because smoking impairs the lungs, making it harder for the body to fight off coronaviruses and other diseases, according to WHO and the Centers for Disease Control and Prevention. Vapers may also have an increased risk of falling ill, said WHO.
Smokers and vapers also can't wear a mask while enjoying their cigarettes and are constantly touching their mouth, a big problem during the pandemic, Block said. Masks that cover your mouth and nose are meant to protect others from falling ill with the novel coronavirus.
"This is actually a great opportunity to quit smoking because the best way to quit smoking is to be motivated and go cold turkey and this is certainly a motivation to go cold turkey and quit," Block said, "not only to minimize your own risk of getting the illness and getting sick from it but to protect those around you."
How to help someone stop smoking or vaping
1. Talk with them about quitting and let them know you understand how difficult it is to quit smoking.
2. Help them create a plan. This includes setting a "quit date" and cleaning their home (drapes, sofa, clothes, rug, etc) so it stops smelling like smoke.
3. Throw out all their cigarettes and e-cigs and place candy and chewing gum around their home, Block said. Whenever they get the urge to smoke, they can chew on the gum or candy instead.
4. Show support.
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