COVID-19 pandemic, considered as a major health challenge in the world, has  led  to deaths, business  closures,  loss  of  income  and livelihoods, a  rise  in  mental  distress and an inevitable impact  on  health behaviours.

As COVID-19 is a respiratory disease lot of speculations do arise in the minds of the smokers regarding their susceptibility to get the disease due to their smoking habits. Assessing  these changes is  essential  for low and  middle income  countries where  the  vast majority  of  tobacco  users  live  but  cessation  support  is  still  rudimentary.

In the light of this, a study done in Pakistan by Kamran Siddiqi,PhD et al, Affiliated to University of York, UK and The Initiative, Pakistan, has randomly recruited 2062 cigarette smokers and their change in patterns of smoking were observed throughout the pandemic period. The researchers found  bidirectional  changes  in  smoking  patterns, while majority of smokers reported either quitting or reduction of smoking, some reported an increase of smoking too.

Out of all the participants 14% smokers  reported  quitting and among  those  who  continued  smoking  68%  have reduced the smoking patterns. Apart from the potential  risks of smoking like high risk of infection,  hospitalization and mortality associated with COVID-19, lack of access,  affordability and opportunity  to  smoke during the lock down times have also affected the positive changes in their habits, especially among the smokers in low income category with a risk   to  lose  their jobs if they  continued  smoking during the pandemic times.

Out of those who continued smoking, 14% have maintained as per the pre-COVID era, 18% have increased  cigarette  use. Out of those who stopped smoking, 39% have  relapsed in  the  subsequent  months.  Mental  stress,  anxiety,  social  isolation during pandemic times and  lack  of  access  to  cessation  support were identified as the causative factors for the increased  consumption and relapses. The majority of them were financially  stable  than  the  rest  of  the  cohort.

More efficient smoking  cessation  treatments and interventions could  have  converted  these unusually  high  number  of  quit  attempts (including the later relapsed cases) observed  among  smokers  during  COVID-19  into  permanent  abstinence. Even  small  scale  changes  in  tobacco  use  consumed  by  over  a  billion people  worldwide,  could  lead  to  major  shifts  in  future  disease  burden.  More  importantly,  a  better understanding  of  the  magnitude  and  nature  of  such  behaviour  change  can  help  services  and policymakers  to  respond  in  an agile  and  effective  manner.

Offering  smoking  cessation  treatment by  implementing  Article  14  of  the  WHO  Framework  Convention  for  Tobacco  Control  should  become an  even  greater  priority  for  countries  like  Pakistan  where  millions  of  smokers  are  willing  to  quit  but have  little  access to  cessation  interventions.