Put these stats in your pipe and smoke them: NDZ

Despite the jury being out on whether smoking worsens Covid-19 symptoms, the government insists it is right to continue to ban the sale of tobacco products in lockdown.

On Wednesday, the government filed papers in the Pretoria High Court in response to an application by the Fair Trade Independent Tobacco Association (Fita) to have the ban overturned.

Fita approached the courts on May 4 after co-operative governance and traditional affairs (Cogta) minister Nkosazana Dlamini-Zuma announced that in lockdown level 4, tobacco product sales would remain banned.

Announcing his decision that SA would move from level 5 to level 4 in April, President Cyril Ramaphosa said the ban would be lifted. He later came out in support of Dlamini-Zuma.

In its response to Fita’s legal challenge, the government and Dlamini-Zuma filed a trove of documents, including 3,674 pages of government records outlining how it decided on the ban.

Fita chairperson Sinen Mnguni said the association was perusing the documents and would respond in court.

In her court documents, Dlamini-Zuma said the rationale for the ban was to “protect human life ... and to reduce the potential strain on the health-care system”. 

“The constitution imposes positive duties on the state to protect, promote and fulfil the rights in the Bill of Rights, including the right to life and the right to have access to health-care services.

“The state has a duty to take steps to prevent the spread of disease and to reduce the burden on the health system ... any decisions concerning lockdown measures must be taken with this duty in mind.” 

She said, like the rest of the world, South Africa faced an unprecedented crisis.

“Covid-19 poses a clear and present danger to human life and our country’s health-care system. Covid-19 is a new disease. As a result, scientific knowledge is still evolving. Studies about the potential lines between the use of tobacco products and Covid-19 are still being undertaken.

“However, from the studies that have been done so far the evidence is that the use of tobacco products increases not only the risk of transmission of Covid-19, but also the risk of contracting a more severe form of the disease.”

Dlamini-Zuma said this heightened strain on SA’s health-care system by increasing the number of people who required intensive care unit treatment and ventilators.

She argued that banning tobacco products reduced these risks.

“Empirical evidence shows that the health benefits after stopping smoking begin soon after quitting. A report by the Human Sciences Research Council indicates that 88% of smokers were unable to buy cigarettes under lockdown level 5, suggesting the temporary ban was effective in reducing access to cigarettes and usage.”

She said with infection numbers rising, government had to take a “cautious approach”.

Dlamini-Zuma said the health-care system and health workers had to be protected from being overburdened and overwhelmed.

“It is well known that tobacco use affects the lungs ... this is the case even without Covid-19. According to the World Health Organisation, the tobacco epidemic is one of the biggest public health threats the world has ever faced, killing more than eight million people a year

“[More than] seven million of these deaths are the result of direct tobacco use, while about 1.2 million are the result of non-smokers being exposed to second-hand smoke.”

She argued that the economic cost of tobacco use placed a substantial strain on health-care systems when it came to treating diseases caused by smoking.

Dlamini-Zuma said it was logical that with smoking known to lead to respiratory diseases, tobacco use “may lead to increased risks in relation to Covid-19".

She said when government considered the ban, it looked at various scientific studies which had examined links between the disease and tobacco products.

“Of course, as Covid-19 is a new disease, scientific studies to assess the links ... are still in progress. Conclusions are necessarily evolving as more research becomes available.

“However, it is possible to draw some conclusions from the data that has been generated so far.” 

She said data showed the severity of Covid-19 in patients who smoked was more severe than in non-smokers, with more smokers requiring ICU admissions and ventilators, and more smokers dying.

Dlamini-Zuma, without naming any studies, said a survey of 1,099 patients with Covid-19 found that, “among the patients with severe symptoms, 16.9% were current smokers and 5.2% were former smokers, in contrast to patients with non-severe symptoms, where 11.8% were current smokers and 1.3% were former smokers.

“In the group of patients that either needed ... ventilation, admission to an ICU or died, 25.5% were current smokers and 7.6% were former smokers.

“Another study found that, among the patients with severe symptoms, 16.9% were current smokers and 5.2% were former smokers. A systemic review concluded that smokers suffered more severely from Covid-19 ... .” 

Tobacco use, argued Dlamini-Zuma, was directly related to Covid-19 comorbidities such as diabetes and cardiovascular disease.

“People who have comorbidities experienced a higher mortality rate from Covid-19. This means that the use of tobacco products puts people at increased risk if they do contract Covid-19 ... meaning that they are more likely to occupy ICU beds and ventilators.” 

She said SA had roughly eight million smokers, “and if a conservative estimate of 1% of the eight million smokers were to contract Covid-19, 80,000 smokers will be infected countrywide.

“If an estimated 10% were to need ICU, this would translate into 8,000 people needing ICU hospital beds and ventilators in the whole country, which would greatly exceed the current availability of approximately 4,000 ventilators.”

She said smokers of dagga and tobacco products in poor communities were at greater risk of contracting Covid-19 because of sharing infected saliva.

“Cross-infection is concerning during this time of the pandemic.”