In another about-turn, government says the tobacco ban will remain in place.
Alcohol will also remain off the shelves. Government has defended the alcohol ban saying it was meant to curb unnecessary socializing and physical contact.

It is well known that both substances weaken the immune system. In addition, lung damage, and a higher cancer risk are all effects of alcohol or tobacco use.

However, experts say it is a complex issue, warning that forced abstinence during this stressful period poses a risk to regular drinkers and smokers.

About 6% South African women and 30% of men over 15 years old smoke tobacco daily according to the Department of Health’s 2016 Demographic and Health Survey. According to the World Health Organization, South Africans alcohol consumption is also significantly higher than the world average, with 65% regularly engaging in binge drinking.

Health effects

Dr Keith Scott from the South African Drug Policy Initiative (SADPI), says, “Alcohol is probably the most harmful drug of all the recreational drugs”.

It weakens the cardiovascular system by hardening the arteries, increasing the risk of heart attacks and strokes. It  also causes several types of cancer, including those of the breast, liver, and stomach. Cigarette smoking also increases your risk of cancer and heart attacks, and causes significant long-term lung damage.

Dr Lize Weich from the Department of Psychiatry at University of Cape Town says alcohol consumption poses a risk to mental health. Welch says alcohol  “can cause changes in mood, behaviour, coordination, and judgement.”

Immune system impact

If used regularly, both substances tend to negatively affect the immune system, which is crucial in how the body reacts to the coronavirus. Pulmonologist at the University of Cape Town Lung Institute, Dr Richard van Zyl-Smit, explains that “physically there are changes to the lung itself that increases your risk of infection” in smokers, and that the immune cells both in the lungs and the blood become efficient.

Weich warns that chronic and acute alcohol use is linked to the progression of some viral infections and making people more vulnerable to lung infections.

However there is not enough data or research on COVID-19 to know whether regular smokers are directly at a higher risk of the disease, but it is likely that it may increase the severity of symptoms.

Van Zyl-Smit points out that people who already suffer from lung damage, for example, chronic obstructive pulmonary disease (COPD), are at a higher risk of infections in general.

While the effect on a COVID-19 patient isn’t proven yet, he says it is clear that “if you have COPD and you get COVID, you are in very big trouble” because your ability to survive, including on a ventilator, will be compromised.

Lockdown withdrawal

Despite these risks, experts are divided on whether stopping drinking and smoking cold turkey is a good idea. Scott calls the idea that a short-term withdrawal will significantly reduce the disease risk “absolute rubbish”.

“If they haven’t got those drugs, they’re going to be stressed, so their immune system will be suppressed.” He says anecdotally that the number of distressed smokers that have reached out to SADPI during the lockdown has strongly outstripped the alcohol drinkers who have complained of withdrawal.

Van Zyl Smit says “it’s an excellent time (to quit) because the stakes have never been higher.” He says that while longer term lung damage won’t be reversed, some of the benefits, such as a lower blood pressure and higher oxygen levels, happen within hours.

But he does acknowledge that the anxiety and boredom caused by the lockdown make it harder to stop now.

Comparing the effects of the two substances, tobacco seems to be the bigger risk contributor, while alcohol does increase sociability and therefore may compromise people’s likelihood to physically distance.

Van Zyl-Smit, says that “smoking is a much bigger risk than alcohol in terms of the substance,” because alcohol would have to consumed at large quantities to affect respiratory immunity. Scott agrees that longer term tobacco effects are more detrimental, while a heavy drinking binge could be worse in the short term.

Weich advises those who cut down alcohol consumption to consult their doctor if they experience withdrawal symptoms.- Health-e News

[Updated: 9:15pm 29 April 2020. The update was made to reflect government’s decision to reverse the lifting of the selling of cigarettes after level  five of lockdown]