Saturday, 2 May 2020

Smoking and COVID - Now is the time to quit.....

This my the longest post so far, unless you don't smoke, in which case that's about it. You clearly slipped through the net of big tobacco and can literally breathe easy and do something else…..

However if you do smoke, or live with someone who smokes, or have a loved one who smokes, or are just interested in the whole crazy phenomenon of smoking, then please read on....If this helps you move toward quitting, or helping someone else quit, then I will be delighted. 

There are lots of resources out there to help quitting smoking, from your local primary health care team, to advice from the NHS website and a multitude of pamphlets and books; the best one I found to be Allen Carr’s :The Easy Way to stop Smoking. Better still is huge sense of relief for you, and the love and respect from family and friends that ending your smoking career will bring. 

Perhaps, early in the age of COVID19, now really is the time to stop. 

Smoking and COVID19


It looks like smokers are more likely to get COVID in the first place. This is true of other respiratory viruses. Smokers are twice as likely to get flu and did worse with MERS. Reversible damage to the lining of the airways and the constant hand mouth touching are more likely to help the virus find its way to the lungs.

What do we know about smokers who get COVID? A recent 
review from March 20 (which already seems an age ago) shines some early light on the relationship between smoking and COVID:

A small study suggested that smokers are 14 times more likely than non-smokers to have severe disease. Another that smokers were 2.4 times more likely to be admitted to ITU. I’m sure more data will emerge, but as COVID is mainly a respiratory virus, it will hit smokers, and those with other "western" illnesses caused by smoking, the hardest.

So, here is my personal missive, gleaned from years of being a smoker myself as well as a GP seeing the problems caused by smoking in every clinic. It may well be that I saved more lives and more suffering by helping people quit smoking that any other single intervention in my time.

While I penned this with MS in mind, it applies even more to the dilemma of smoking and COVID19. I’ll include it as some readers of this blog have MS, but also because it highlights just what a huge health boost non-smoking is.



COVID and Vaping


By smoking I also mean tobacco, cannabis and also the increasingly widespread half-way house of vaping, big Tobaccos latest adaptation to the market. Inhaling collections of inflammatory and carcinogenic chemicals deep into the lungs is going to hurt, no matter what the substance or the method . 

In particular, no-one vaping should be complacent. Flavoured tobacco has already been shown to cause "popcorn lung" which I can assure you is not as amusing as it sounds. This was due to one particular ingredient, subsequently removed. 

However, It might be interesting to hear the NHS advice on vaping:

"It may come as a surprise to many that we don't know exactly what is in e-cigarettes and the effect they have on health, especially given that there are more than 7,000 different "e-cigarette flavours" and the devices are used by millions"

Sounds to me like a recipe for disaster!

There are concerns across the pond too, where vaping is increasing common in the young, who comprise of 20% of COVID19 admissions. Astonishingly, vaping in US teenagers increased by 80% (yes, eighty per cent!!) between 2018-19 alone!  

Let's not take another half century to prove that inhaling tobacco vapour flavoured with umpteen unknown chemicals is likely to cause problems for health.  

Don't be distracted either by the theory that nicotine may have a role to play in treating COVID. Might nicotine on its own reduce the risk of infection? No one knows yet, but that smoking worsens your chances with COVID is pretty universally agreed.

How many people still smoke?


The latest UK figures from the National Statistics Office still makes grim reading.  15.8% of adults still smoke in the UK (18% of men and 14% of women). Rates in the UK might be dropping, and are thankfully dropping faster in the young, but it still means one in 6 people smoke. Worrying too is that nearly 3 million people in the UK are vaping.

Globally,  1,1 billion people smoke, 80% of whom live in low and middle income countries. 6 million people die annually, including 600,000 from passive smoking

Smoking is in fact, a bigger problem than ever. So why the hell are so many people smoking? Why do you smoke??  Here are my reflection on a lifetime of helping people to quit.

For the on-line world, this is a long post, but quitting smoking can be a long problem. If you want to read on, and if you smoke, I hope you to, I will cover:


  • Smokings grim history
  • My crazy world of smoking
  • The smoking trap - why we start
  • Hooked - why we continue to smoke
  • Tips to help quitting

            Honest contemplation
            Overcoming fear
            Ending prevarication 
            Demolishing illusions
            Dealing with stress
            Craving and how to deal with it
            Planning to quit
            Making the decision 

  •  Embracing the future
  • The wonderful world of non-smokers


Smoking’s grim history. 


I remember a popular black and white film from many years ago where a handsome young man and a beautiful young woman slowly approach for their first kiss. There is a pause as he affectionately and gently blows his second hand tobacco smoke into her face - she stops, closes her eyes, breathes it in, showing her appreciation for the gift– they smile and kiss. This was mainstream post-war culture, not really all that long ago. 

It is a worry also that so many films on Netflix and elsewhere increasingly feature actors smoking prominently. There can be no doubt this is influenced by cash.

Industrial scale smoking goes all the way back to slavery and the financial bonanza of having free labour and a cash crop. Pretty much along the lines of sugar. (more on that elsewhere) Tobacco is relatively easy to grow, preserve and to transport. The ideal market commodity.  As a mild intoxicant it had been an intermittent symbolic ritual for north American Indians, which we picked up and changed into a daily and then even hourly habit. So it became our most hideous import from the Americas. Montezuma’s revenge indeed!

Along came industrialisation and mechanisation, oiled by the slippery wheels of war, after which the whole western world seemed to become addicted. In the black market, prisons and concentration camps it became the means of exchange, currency. After World War Two, the pall of smoke was present in just about every home, every public place, every working environment, and even hospital wards. 

Untold numbers of homes were to be burned down, fires in factories, farms and football stadiums ignited by cigarette accidents. People burned in their beds as they nodded off with the last smouldering and literally deadly cigarette unfinished. 


Ironically, the blatantly obvious adverse effects of smoking were first quantified in doctors, only because at that time they were one of the few groups in society containing enough non-smokers to be able to compare what was happening with smokers. The results changed the world; we started to wake up. 

In the 1960’s my mother was advised by her GP to start smoking as it would settle her wayward nerves. I think she even tried to follow his advice, but couldn’t stand those initial horrible effects, despite my father’s encouragement. I’m not sure how many people that GP had killed with this advice. My dad smoked pipes and died prematurely with poor lungs and a heart attack.

This has since been controlled by determined campaigners and snail-paced government action, belatedly encouraged by increasing health costs after decades of cosy relationships with the tobacco industry. The Western culture is now definitely anti-smoking. Even the pubs are free of smoke and smoke free zones are widespread; yet good people continue to get hooked.

My crazy world of smoking...


I gave up smoking many years ago aged about 45, a decade before my diagnosis with MS, but long after I had qualified in medicine. Despite witnessing tobaccos deadly effects many times a day in my work, I struggled to quit totally for too many years. I understand the pitfalls and barriers.

I therefore became my own expert in one of the most illogical and damaging things I could possibly have done to my health.

The only positive thing about my own smoking history is that it has given me some understanding as to why anyone would ever do such a seemingly crazy and irrational thing as to start smoking in the first place. This applies even more today as smoking, long since the habit of royalty and celebrity, is now taken up almost exclusively by the less well-off sections of society and in the less well of nations of the world.

For any smoker with MS, or worried about COVID, stopping as soon as possible will improve life and the prospects for health. For any ex-smokers, this is a reflection on how we used to self-harm. For non-smokers, the smoking phenomena is a lesson in how some damaging habits can become ingrained.

The smoking trap - why do we start smoking


I was born in the mid 1950’s London – post-war migrations, bomb sites, war comics and smoke. London, for obvious reasons, was known as "The Smoke!" Smog from coal burning in the winter and tobacco smoke inside almost every household and public building – smoke everywhere.

A passive smoker since birth, I started activly smoking around the age of 16, and stubbed the last one out aged about 40. For many of those years a light smoker maybe, but I will now forever be an ex-smoker. While I feel the damage done in many ways has been repaired, the diagnosis of MS reminds me of my prior folly, my addiction. My name is Colin and I had the capability to be an addict.

I feel for and understand all those youngsters who still get caught in this pernicious cultural trap who are paying good cash to plant landmines in the field of their life. Why should anyone do this? Why did I? 

My first job was on a farm just outside London. At tea breaks in between the graft of shovelling tonnes of chicken dung out of the hideous chicken batteries where our “farm fresh” eggs were sold, the issue of smoking loomed large; because I didn’t smoke. I soon felt the urge to be like the rest of my new found friends, my farm working buddies. There was an intense camaraderie created by hard graft, and sharing a smoke had become and expression of this togetherness during moments of relief from the toil.

Smoking seemed fashionable and positive. I wanted to belong. My friends helped me to overcome the unpleasant initial effect of smoking, the nausea, light-headedness - the general unpleasantness of it soon passed as my tolerance built up and I slipped so simply into the worldwide club of smokers united by our brown fingers and plentiful sputum. 

My packet of fags and lighters became my little friends, always there when I wanted a bit of company with myself or others. There were no health warnings, and virtually no pressure to stop, quite the opposite – I felt like I had grown up! They were cheap and available everywhere. You could even buy them one at a time. Everywhere I went, there was smoke – and I was part of it – I belonged.

I started smoking about 5 a day until, and this will sound odd to younger ears, I was admitted to hospital with a fractured femur caused by my lack of experience and dangerous haste on a motor bike. Lying on the male Orthopaedic ward of the North Middlesex Hospital on Christmas Eve aged 16, I was slowly coming to terms with the advice that I would be there for about three months - I had expected they would put me in plaster and send me home!

The ward was full of young men, casualties from the toll of motor bikes, fast roads and a cavalier culture. The ward was also full of ash trays, packets of fags, matches - and smoke. On a sunlit winter afternoon, slanting light would cut thorough the west facing windows like it would through a dusty cathedral. 

“Nurse!” we would cry in anguish from our beds - “Could you empty my ash tray please!” I kid you not – this was partially because the ward was so full of young men, but the hospital was the same all over – I’m not sure if there were any smoke free areas at all – that would come years, indeed decades and millions of tobacco deaths later. 

By the time I was discharged from hospital, I had graduated to twenty a day, and a fully paid up member of the serious smoking fraternity. My heaviest smoking came when driving lorries up and down the motorways when one fag would simply follow another for much of the day, twenty became forty and sixty, though thankfully that spell didn’t last long. 

The decision to start my long march to medical school motivated me to exert some control and I became a lighter, yet still confirmed smoker.

Hooked - why we continue?


Once hooked a curious thing happens. Every break from work, every relaxing or pleasant moment of the day becomes associated with a smoke. Time passes and then smoking becomes so tightly associated with relief and positivity, it becomes happiness itself. Brainwashing complete!

Conversely, the thought of stopping smoking suggests the loss of that conditioned happiness and so for many smokers the loss of smoking seems just too hard to imagine. I had patients who, after listening to my suggestion that stopping smoking would improve their lives responded; “I couldn’t do that - I wouldn’t be happy”. Totally hooked by that Pavlovian connection between doing and even thinking something pleasant and smoking a cigarette. The marketing boys did an incredible job there!!

With a cigarette in your hand and tobacco in your pocket, the world seems at ease, there is contentment. If you run out of tobacco, or try to quit, then you become a bad tempered irritable monster. It’s not the chemical effect of nicotine. Nicotine does not make you happy, or alert, or irritable or relaxed. It is a drug with such a weak effect that you can get from it whatever effect you think appropriate to the moment. Without it, you’re on your own.

We become trapped in the smoker’s world, a different place altogether to where the non-smoker lives. Small slaves to Big Tobacco. There are feedbacks that make stopping difficult, make smokers more entrenched in the habit. Smokers associate with each other, as do other addicts. We understand each other, encourage each other, and can even moan about hose boring risk-averse types who don’t smoke. 

From my early twenties onwards, I tried giving up many times. I struggled. I knew that I would never really be content, never really at peace while a smoker. Cutting down was a good thing for health, but left me still with the cravings - even one cigarette day is a long way from experiencing the mind of a non-smoker.

It was crystal clear that my body or brain had no need for the nicotine itself, yet I had convinced myself, by years of sub-conscious conditioning that I needed it, that it provided some sort of comfort. All addicts go to lengths to convince themselves, and anyone who will listen, that is makes some sort of sense – that smoking offers relaxation, release; a mini mediation in the middle of stressful times, a time out.

Of course, like all great lies, this contains an element of truth. 

As I said, the brainwashed smoker will search for and find spaces in the day for reflection and relaxation which in themselves can be quite a good habit to establish. In my new life as a non-smoker though, I noticed that the need for such moments decreased substantially and the health benefits of meditation and relaxation are now satisfied by actual mediation and relaxation rather that the hazy multiple mini-time-outs that came with the habit. All my previous illusions about smoking have vanished into clean air.

I eventually put my last fag out, after many years of indecisive dithering. I knew, as that point arrived I would never smoke again. Once I had made the decision to stop, properly, and for ever, giving up was actually surprisingly easy! With COVID19 lurking, might it have been sooner, and easier? I think so!

It was actually a joy itself to leave the habit behind. A liberation! Later, I had to reflect on why it had been so difficult to do this till then; it all seemed such a con! 

The answer was, of course, was in my mind. 

Now, after a couple of decades as a ex-smoker, I look back on the phenomena with curiosity and a sense of compassionate interest that I had ever allowed myself to smoke at all, and for so long! Clearly, the most important thing is why should I ever have started, but for what it’s worth, I did learn to quit. Here are some of my hints and tips. 


Tips for stopping smoking


Honest contemplation


There is of course, a contemplation phase before we do almost anything. It needs embracing. If you think it through, and keep thinking of the harsh reality of smoking, then a time will come when it will be surprisingly easy to stop, with or without nicotine replacement therapy or the lesser evil (but evil nonetheless) of vaping. 

The first thing to realise is that once you see smoking for what it is, brainwashing, a confidence trick of truly global proportions, enrichment of the few paid for by the misery of the many, then you are on the noble path to resetting the mind, stopping, and never starting again. 

It is justifiable to feel anger for people who have been trapped by the manufacture and marketing of tobacco. Think of the millions who die every year because of it. Hospitals are still full of smokers. MS clinics are expanding all over the world due in part to smoking and terrible food. 

Globally, smoking continues to wash the brains and line the lungs and arteries of more than a billion people, right now. 

Feel infuriated that private fortunes continue to be made from tobacco and public fortunes continue to be spent on trying to reverse some of the damage. It is hideous, evil madness. And every cigarette you buy contributes to it. It is useful to reflect on this when contemplating the next smoke. One of these will be your last.

Remember, the most important thing to realise when contemplating stopping is that smoking is more of a brainwashing that a chemical addiction. Don’t be convinced that smoking is the most severe addiction there is. I have even heard it said to be worse than heroin. This is clearly nonsense. The withdrawing heroin addict will go through some severe and painful symptoms when stopping a habit. 

Smokers go through withdrawal to some extent during every sleep.

So do worry about smoking – with MS and now COVID (and even without either), you certainly should! Your journey might be short, it might be long, but it’s a journey that almost all smokers take. The threat of COVD makes this urgent. 

Overcoming fear


Be warned, everywhere there are messages about how difficult it is to give up. Special clinics are set up to administer nicotine replacement even though they only marginally increased success. Replacements too also increase success, though hardly impressive. 6.75 % of smokers having nicotine replacement were abstinent, double that of placebo, but an increase of only about 3% in absolute terms. I’m not saying don't use it, for some its helpful, but getting your mind in the right place is critical. The threat of  COVID will help.

Ending prevarication


There are so many reasons we can invent in our mind to delay the decision. Smokers have to be careful to pick the right time to stop, and that time if often sometime in the future; once one of the various stresses in life or our own issues have settled down or some spurious milestone in life has been passed.

We erect barriers to stopping, and then have to climb over them.

Nevertheless most people get to the point of stopping and stop. Now it the time to join them.


Demolish illusions


I had already noticed how easy certain people found it to stop. Some would even just agree to stop after a chat about the health effects as if it just needed a nudge from a dispassionate professional hardened to seeing people suffering from smoking. Others would stop immediately when a serious illness had arrived without complaints or cravings, though with a mountain of regret as the loss of health and sometimes  life.

Dealing with stress


Stress is a big problem in modern life. It is magnified for people struggling with poverty and material hardship in our society shot through with inequality and its grim consequences. Part of why the lives of the disadvantaged are so much shorter than others is the fact that as a group they smoke so heavily. Mental health problems also cloud judgement and this make it easier to start and harder to stop.  Even without the formal diagnosis of a mental illness many find smoking to be a stress reliever. Again, of course, it’s all in the mind. 

Indeed, in my experience, smokers experience more stress. Chicken or egg? Might this be in part at least because stress provides us with the excuse for a cigarette? Perhaps even, almost subconsciously, searching for stress in order to justify the next smoke. I have to admit that I did. I think lots of smokers do. 

Smoking of course, relieves the craving for smoking. Might it be that self-evident truth offers some sense of control over the otherwise seemingly unsurmountable difficulties of life over which it is increasingly difficult to exert any degree of control? It offers the smoker the illusion of being able to choose.

Then the smoker has to face the sometimes long road back to the state of mind which existed just before the first cigarette. Back to being a non-smoker, though with perhaps a bit more of an understanding of addiction and those addicted, our own weaknesses and how the world works. This is the next phase of the smoker’s experience: quitting for good.

Bear this in mind. Many people in terrible situations go through the most awful stresses imaginable without the need for tobacco - if they happened not to have started it would not have entered their mind. Smoking does not help with stress, it adds to it. Any thought that it helps is a confidence trick played out by very clever and well-resourced advertising budgets of Big Tobacco. During my smoking phase, I was their slave, I was chained by my own illusions. Cast off those chains and join the free world!

It will remain important to look at the stresses involved in life; to change what can be changed, to wait for what changes itself and to accept what cannot be changed. You can change being a smoker! Just remember this:  Smoking makes stress worse!

Craving and how to deal with it.


When stopping smoking the withdrawal symptoms are all psychological. There is no physical pain, no hot flushes, no irresistible insomnia, just simple powerful, psychological craving, the mind searching for that lost ‘smoking moment’. 

Indeed, that smoking moment is one of the main problems, and one of the main obstacles to overcome before stopping. That perceived dependence on tobacco for our psychological well-being. Getting in right frame of mind helps overcoming craving, they can be observed, seen for what they are; get on with something else to distract you, or just experience them - they fade and they go.

After stopping, it is really so wonderful not to not have to plan, to anticipate, for thoughts not to revolve around that next smoking moment. Not having to constantly check supplies; lighters, cigarette papers and all the rest of the practical paraphernalia of smoking. Just to enjoy moments of relaxation, excitement, reflection or whatever, for what they are, reality! 

Until then, the enlightened smoker, if there is such a thing, cannot really enjoy life or be happy. Not until after quitting. Till you quit, be discontent with this aspect of your life, you should be. See it for what it is. 

Keep in mind that after climbing over the barriers which we erect to stop us becoming our true selves, stress will be less. More time, more money, and one big issue less to be tackled or worried about.

It is hard enough having MS; hard enough to have or be worried about having COVID. No one wants to be a burden, but that is exactly what smoking creates.

Stopping smoking is the first and most important thing you will do for yourself and for those around you. Think it through, think it through again. Look at every cigarette, see it as the enemy, worse than an enemy, a killer pretending to be a friend. Talk to those around you, listen to the many who have stopped. 

Don’t let yourself off the hook, engage with the enemy within and then decide to stop. That is the hard part getting to the decision. Letting it go, for once and for ever.

The only dubious advantage of smoking is a heightened appreciation of how good life is without it once you have given it up. 

Whatever technique you use to stop - and just stopping is up there with the most successful - those moments of relaxation, of reflection, of happiness, will continue, just without the cigarette. They will be better!



A bit of planning


I helps to mark the day with the disposal of remaining tobacco, if you have a compost heap, that is ideal. Out go the ash trays, cigarette papers, lighters, and all the other paraphernalia littering the smokers life and home. Tell everyone, make sure they know that this time it is for real. Prepare for the love and the gratitude. Prepare too to be the leader for other family members and friends who continue to be hooked. Do make it awkward for them to smoke. 

Making the decision


Deciding to really quit is the hard part because before that moment arrives, we have really decided not to stop. I have myself, and seen so many others discover the fact that it is actually quite easy to give up when you get to the point when you REALLY decide to do so. 

“Trying” to stop, “giving it a go”, “seeing how you get on”, are all metaphors for 100% certain failure. Trying to stop means nothing more than seeing how long you can go before you crack, succumb to the craving, to become ‘happy’ again – if the mind continues to believe the tobacco myth of contentment, then failure is inevitable. Trying to stop like this is like a form of torture, and leaves you feeling a failure when inevitably lighting up again.

When you really think honestly about smoking, over and over, look up the information, listen to smokers, smell smokers, look at you finances, think about yourself, MS, COVID, your family, your surroundings, your prospects and the hard scientific reality of smoking, slowly but surely you can move to an understanding of your weaknesses and the path becomes more clear.  The decision crystallises. It’s a wonderful moment.

Then perhaps realisation comes that that it is actually completely normal for us not to smoke, and that is where we belong. We are all inherent non-smokers. 

Embrace the future


Stopping smoking is the best investment for the future you can make. Reflecting on this also helps developing the right frame of mind. The reduced risk of dying from a heart attack, or stroke, or getting cancer, lung disease and now CODIV is really pretty amazing. As well the simpler fitter life of a non-smoker. 

At the same time, don't give too much power to the addiction. I remember in younger years contrasting my addiction to that of occasional smokers. People who might smoke one or two a week when out drinking with others or at parties, and who would have no problem at all with craving or the need to smoke at other times. They give up all the time. Truly addictive drugs do not behave like this. I felt encouraged that the problems with smoking are all in the mind. 

This is not to minimise the difficulty of quitting, it is to correctly identify it. After all, we can, literally 'change our mind'.  Smokers, like other addicts, have created thinking which is different from non- smokers. This means that we have to change our mind-set to become a true non-smoker. We have to reverse the brainwashing. We have to cleanse our minds of the love of nicotine before we can cleanse our lungs, arteries, brains and genes.

The wonderful world of non-smoking


When I really decided to stop, and did, the benefits seemed totally clear on a day to day basis. Perhaps when quitting half-heartedly, the mind damps down how much physically better it feels to be a non-smoker. There is also the immediate release from the mental energy expended every day in smoking related thoughts and actions. That was the most noticeable benefit for me – freedom from the effort involved in trying not to smoke. Suddenly, it is all behind me, for ever. 

Free at last!

So for me, stopping smoking was and remains to this day a joy. On the first day as an ex-smoker my lungs started to clear and the cough started to settle. 

After the first week I became less breathless on exertion. 

Month after month the benefits built up. and then for my life since it has been simply fantastic not to be a smoker. 

Year after year, the pernicious risks of smoking are moving back to my normal, non-smoking levels.

Twenty years after stopping smoking I remain so grateful I stopped. I have no idea how I would be if I had continued, but I can state with near certainty that the MS would have come on earlier and have been worse. I may not even be alive. It is like a near miss – I survived smoking. Phew!

Writing this again makes me glad for being able to breathe normally, and for having an better chance if I get COVID.

The worst health decision of my and your life was to start smoking and the best is to stop. It’s as simple as that.  I feel a deep sense of compassion for smokers who sense their predicament and feel trapped. We all make mistakes; we do silly things, we are influenced by bad information, we are vulnerable to marketing, culture and mythology. 

I hope this post helps people stop smoking, but ultimately it is a part of our own individual journey, a paths full of wrong turns and empty cul-de-sac’s. Hopefully we will get there in the end. COVID makes the case all the more compelling, more urgent.

I now know that there will never be a circumstance of stress, hardship or even tragedy that would be helped by the damaging distraction of smoking. That is because tobacco doesn’t improve things, it makes them worse. It is a phase of life that washes into the past, a sign that life has moved on, that we learn, and that things can improve. 

For all you smokers out there who have given up, well done. Thank you.

For those who still smoke, the relief is yet to come. Go for it!

Not smoking is just fantastic! 

Don’t wait too long!



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