It is time to get serious about the tobacco epidemic

Several studies to date show that COVID-19 and tobacco can be a killer combo.

Dr. Hala Kahi Mouawad, Family Medicine Specialist, Tobacco Treatment Specialist and Tobacco Free Initiative board member, writes a special blog for Berytech on the occasion of World No-Tobacco Day 2020.

Dr. Kahi explains how since the beginning of the COVID-19 pandemic, the World Health Organization has identified smoking as one of the risk factors for COVID-19 and recognized smokers as a potential vulnerable group, urging them to quit smoking in order to minimize their risk as well as that of those exposed to second-hand smoke.

Several studies to date show that COVID-19 and tobacco can be a killer combo. Here is why:

  1. Smoking weakens the immune system and may double the risk of developing any respiratory infection like COVID-19 infection. Moreover, the frequent touching of fingers to the mouth and sharing of mouthpiece or hose from waterpipes significantly increase the risk of viral transmission.
  2. Smoking has detrimental effects on the cardiovascular and respiratory health, which puts smokers at risk of developing severe complications if they become infected by COVID-19.
  3. Second-hand smoke inhaled by non-smokers can affect their lung health and lead to illnesses making them more susceptible to COVID-19 disease.


Public health measures implemented in Lebanon have been effective in flattening the curve of the COVID-19 epidemic. Fortunately, the death toll has not exceeded 26 as of May 31, 2020. Nevertheless, on the other side of the health spectrum, Lebanon has one of the highest rates of smoking in the region leading to a tobacco epidemic that kills 4800 people every year (400 deaths/month = 92 deaths/week= 13 deaths/day).

Worldwide, tobacco has been and remains the biggest public health threat and the leading preventable cause of death and diseases. It is the only consumer product that can kill up to half of its users. Every year 8 million people die around the globe due to tobacco related diseases, among which 1.2 million are non-smokers exposed to secondhand smoke. Besides killing millions, tobacco costs billions of dollars to societies through direct healthcare expenditures and indirect productivity losses associated with morbidity and mortality. In Lebanon, the total cost estimate is US$327.1 million per year.

Due to the current COVID-19 pandemic, tobacco’s adverse impacts on health and on the economy may be significantly magnified. This is why it is a crucial time for the government to implement tobacco control policies, make smoking cessation services available and enforce Law 174, particularly the complete ban of smoking in indoor public spaces. Smoke free environment will not only protect non-smokers from the health consequences of involuntary exposure to tobacco smoke but also motivate smokers to quit, reduce the number of people initiating smoking and help build a society where tobacco use is denormalized and no smoking is the norm.

About the author

Dr. Hala Kahi Mouawad is a Family Medicine Specialist and a Certified Tobacco Treatment Specialist. She also obtained a post graduate diploma in Medical Education and is an Arab Board-certified Family Physician. Dr. Kahi has more than twelve years of practice experience in the clinical field. She is a lecturer in Nicotine Addiction at USJ’s Faculty of Medicine and an active advocate in Tobacco Control.

She established to date several Specialized Smoking Cessation Programs. She is a member of the board of Tobacco Free Initiative (TFI) – a non-governmental organization specialized in fighting against tobacco smoking, as well as a member of ATTUD – Association for the Treatment of Tobacco Use and Dependence.

Recently, she conducted a research project about the integration of tobacco intervention training into medical curriculum. Her other practice areas include Occupational Health, University Health and School health.

Tobacco Free Initiative (TFI) is the only Lebanese Non-Governmental Organization dedicated to tobacco control. It was established in 2000 by the family of Lawyer Antoine Kayrouz who passed away due to lung cancer.

Through dedication and hard work, TFI has built a solid expertise in tobacco control, leading it to win the 1st prize award from the World Health Organization in the Middle East in 2008 for the exceptional work achieved in this field, and was also chosen in 2009 by the Ministry of Health to be the only NGO (beside the Consumer Protection Association) to be member in the National Commission on Tobacco Control and in the regional commission for the Middle East.

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