One year ago today, my hospital system admitted its first patient with COVID-19. It’s hard to believe that it’s already been twelve months. It simultaneously feels immensely long ago and like it was only yesterday; that what I know of medicine has changed forever and that nothing has changed. This pandemic has certainly brought me new knowledge and new ways of practicing medicine. I have treated patients with profound hypoxia by avoiding intubation in those I would have previously intubated, proning them while awake and more. I worked in our system to roll out a hood oxygenation protocol for our ICUs, a device that has been used for a long time in Northern Italy, but never by me or many others in the U.S. I have learned and grown as a lung and ICU doctor this year, as have many of us in medicine. We have watched amazing science unfold in front of us at a dizzying speed. However, some of the new data has only reinforced what we have known for a very long time, emphasizing the importance of maintaining focus on sound public health and prevention strategies despite the chaos of the pandemic. Two that I focus on often are the toll of tobacco and air pollution. Both of these run afoul of my general medical advice: “Don’t light things on fire and breathe them into your lungs.” Sometimes in the stress of a pandemic, working to save the life of the person dying in front of us, we doctors forget to focus upstream, on the funnel that may be sending more patients our way. Tobacco and air pollution kill every day, but in addition to data suggesting we should not use hydroxychloroquine and should use dexamethasone, we need to pay attention to the studies telling us that COVID-19 and combustion are a bad combination. Over 500,000 people in the U.S. have lost their lives to COVID-19, which is surely a severe tragedy requiring urgent action from all of us. But nearly that many, around 480,000, lose their lives every year to tobacco. The acute respiratory distress syndrome (ARDS), the dreaded fulminant lung damage seen in COVID-19, is more common in people who smoke. The lungs of smokers seem to be more leaky and prone to flooding when confronted with severe illness. Sure enough, despite misleading early attempts by Big Tobacco to suggest that smoking was not a risk for COVID-19, studies have shown us that COVID-19 progresses more severely in patients who smoke. We know that there can be deadly interactions with air pollution and viral infections in a similar way. Combustion engines and power plants give off a whole range of particulate matter, which is toxic to human health, in particular very tiny particles a fraction of the size of a human hair called PM2.5. This damages blood vessels directly, and in a virus that itself causes blood vessel damage and clotting, it is unsurprising that a severe and lethal interaction with COVID-19 has also been found; around 17 percent of COVID-19 mortality in the U.S. is due to its interaction with PM2.5. With today’s death toll, that would be around 87,000 people, and likely more by the time you read this. Learning about new treatments for COVID-19 and the ICU is certainly exciting, and of course, I am following news on vaccine effectiveness, new therapies, and new mutations with hope, interest, and fear, along with the rest of my ICU colleagues. But as physicians and a community, we also need to keep our gaze upstream at preventing patients from needing us in the first place. Fighting COVID-19 and decreasing its toll does not just rely on wearing masks, washing hands, vaccinations, and giving each other space. It is also important to reach out to people addicted to tobacco and provide resources for them to break free of smoking by adequately funding cessation programs and develop sound tobacco policy. Anytime a patient calls in worried about COVID-19, getting a test or vaccine, etc., we should be screening for tobacco use and offering help to quit. Similarly, we should be pushing policymakers to address air pollution as a public health concern and continue to work to reduce levels in our local communities. Decreasing the burden of combustion material, whether from a cigarette, a power plant, or an engine, will not only pay off now in reducing COVID-19 but also in future pandemics and in reaping the health care benefits of decreasing the constant toll of tobacco and air pollution in our communities. As physicians and others in health care who want to do all we can to bring an end to this pandemic and build healthier futures for our patients and loved ones, we should make sure to reach out to our local city council, county, and other elected officials to take fuel away from COVID-19 by advocating for clean air. Source
