Check the full report:

WHO-FCTC-Regulatory-Practices-on-water-pipes

Executive summary

This report, prepared by the WHO FCTC Secretariat’s Knowledge Hub on Waterpipe Tobacco Smoking (KH-WTS), summarizes the global regulatory practices for waterpipe use, identifies the gaps in evidence on such practices, and provides key observations for the development of future policies that are aimed at regulating and controlling waterpipe use.
Available reports, peer reviewed manuscripts, grey literature, and policy briefs were carefully reviewed to produce this document. Experiences gained from fighting the tobacco epidemic to date, which is mostly cigarette-focused, has taught researchers, policymakers and governments that fast action is also needed to curb the waterpipe epidemic. Sufficient scientific evidence has been generated about the toxicology and harmful health effects of waterpipe smoking to justify swift action. What remains lacking is strong implementation, monitoring and enforcement of laws, policies, interventions, and rigorous evaluation pertaining specifically to waterpipe control.

Global regulatory practices

Experiences from thirty-nine countries – all but one Parties to the WHO FCTC – were reviewed. They have been identified as having regulations on waterpipe tobacco products and/or on waterpipe use. Information is also available from some of the countries on the enforcement of various measures, including those regulating health warnings on waterpipe tobacco packages, waterpipe use bans and bans in advertising, promotion and sponsorship of waterpipe tobacco. Turkey was found to have the most advanced waterpipe-specific regulations.
The information on these global regulatory practices, however, is limited and scattered in various resources. The reviewed documents also showcase the gaps between the legislations and regulations, and their implementation. This reinforces the need for appropriate documentation of implementation and evaluation. Further, reporting on how these countries benefitted from each other’s experiences, the challenges faced by the law enforcement agencies, and the lessons learned from the process were absent in most reports.
More research will also be needed to explain the process for implementation of waterpipe regulations and experienced successes, and how challenges faced during implementation were addressed. Proper evaluation is also lacking in most cases, allowing only limited assumptions concerning the effectiveness, efficiency, sustainability, as well as short-term and long-term impact of these actions.

Check the full report:

WHO-FCTC-Regulatory-Practices-on-water-pipes

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Kindly check the below link for the EMRO TFI legislation database:

http://www.emro.who.int/tfi/ban-tobacco/index.html

Check the below link for the “call for papers” to the tobacco thematic edition of the EMHJ:

http://www.emro.who.int/emh-journal/authors/call-for-papers.html

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Waterpipe Tobacco Smoking Regulations & Challenges &

Illicit tobacco trade and taxation in the EMR

Beirut, Lebanon 06-09

 November/2018

The WHO FCTC Waterpipe Tobacco Smoking Knowledge Hub (WTS-KH), and the Framework Convention Alliance (FCA) with the technical support of WHO EMRO, conducted a two consecutive workshops on November 6-7 and on November 8-9, 2018 at the American University of Beirut, Lebanon.

Workshop #1 is on November 6-7: Waterpipe Tobacco Smoking (WTS) Regulations & Challenges; at the VML classroom, American University of Beirut.

The objectives of the workshop are:

1. To review the current global tobacco control laws and policies as they relate to regulating waterpipe tobacco smoking (WTS) and the extent of implementing by Parties of the Framework Convention on Tobacco Control (FCTC) articles for that purpose.
2. To identify challenges associated with the enactment and enforcement of WTS control legislation in the context of different countries;
3. To discuss how evidence to date can guide regulation of waterpipe smoking in public places and the implementation of regulations that take into consideration the unique design of the waterpipe and its accessories and their use;
4. To draw a set of recommendations for future actions tailored for the identified regulatory specificities and challenges of WTS.

Workshop #2 is on November 8, 9:  FCA EMRO FCTC Capacity Building Workshop; at the at the Diana Tamari Sabbagh Building, First Floor, TBL classroom, American University of Beirut.

The objectives of the workshop are:

1. Global Strategy, which includes an ambitious objective on prevalence reduction and identifies Article 6 as key
2. Provide an opportunity to the government delegates and FCA members to study the ITTP and art 6 guidelines.
3. Provide examples of evidence-based strategies on the implementation of art 6 guideline and ITTP ratification.
4. Discuss changes in the existing national laws and regulations according to the adopte art 6 guideline and ITTP strategies on how to introduce those changes and accelerate the ITTP ratification.
5. Make Governments and NGOs sit to gather on the same table and discus the barriers and facilities for implementation of art 6 and ratification of ITTP.
6. Provide examples of evidence-based strategies on the implementation of those guidelines.
7. To build capacity of the NGOs on how to collaborate and build effective national and regional teamwork on tobacco control.

Members of relevant government and civil society organizations from the region will be invited to participate and share their experience and expertise.

These workshops are co-sponsored by the WHO EMRO & the Financial Conduct Authority (FCA).

Click to see the full agenda, the participants and the presentations

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AUB, TFI, and WHO Team up on World No Tobacco Day

 Shedding light on tobacco use and control in Lebanon

Beirut, June 1, 2019: Marking World No Tobacco Day, the American University of Beirut (AUB), the Knowledge Hub on Waterpipe Tobacco Smoking (KH-WTS) and the Tobacco Free Initiative of Lebanon (TFI) in collaboration with the World Health Organization (WHO), organized an event to discuss tobacco control measures effectiveness and implementation in Lebanon. The initiative shed light on the alarming situation in the country, voiced a strong objection to any attempt at amending tobacco control Law 174, and signaled an opportunity to increase awareness on tobacco use in Lebanon, highlighting the progress made to date.

The event which took place at the Multipurpose Conference Room – Halim and Aida Academic and Clinical Center (Daniel ACC), AUBMC, witnessed the participation of H.E. Minister of Public Health, Dr. Jamil Jabak, as a keynote speaker. A host of members of the Lebanese Parliament, distinguished guests, AUB and AUBMC leaders and supporters in addition to Dr. Nakkash who served as the Master of the Ceremony attended the event and extended their support to such an initiative.

In 2005, Lebanon signed the WHO Framework Convention on Tobacco Control (WHO FCTC) global treaty, leading to the enactment of Law 174; however, Lebanon has yet to fulfill its commitment to implementing the articles of the Convention.  Many challenges have still to be met in order to bring full implementation of the treaty and safeguard the interest of the people from the interests of the tobacco industry and vicious means to promote its lethal products.

In his word, keynote speaker, H.E. Dr. Jamil Jabak, Minister of Public Health, shared his valuable perspectives on tobacco control and reinforcement of Law 174. He gave an overview of the effects of smoking on the person’s health, the health risks associated with it, the benefits of quitting smoking, and the necessary precautions that need to be adopted to combat the impact of smoking in our society. He said, “It is necessary that more effort be exerted to activate previously issued laws pertaining to the use of tobacco. Monitoring and prosecution are of utmost priority in order to secure healthier societies.”

In turn, Dr. Alissar Rady representing Dr. Iman Shankiti, WHO Representative in Lebanon said, “Law 174 for tobacco control is an important breakthrough in public health in Lebanon; it is a landmark towards Universal Health Coverage and an important cornerstone in introducing the culture of prevention and protection in health.”

Dr. Ghazi Zaatari, Director of the WHO FCTC Global Knowledge Hub on Waterpipe Tobacco Smoking at AUBMC said,  “The current situation of tobacco use in the country is alarming. The failure to reinforce the implementation of the Tobacco Control Law 174 by the government has sustained the very high levels of smoking and use of tobacco products, particularly among the youth, leading to more diseases and deaths in Lebanon. He added, “Experience gained from fighting the tobacco epidemic to date, which is mostly cigarette-focused, has taught researchers, policymakers, and governments that fast action is needed to curb the waterpipe epidemic.”

“It is unacceptable to have a law to protect citizens which the State is unable to implement, because of a number of officials, including ministers and MPs, refuse to implement it, and even call for its amendment on the grounds that this law negatively affects the interests of restaurant and club owners,” said Dr. Charles Jazra, TFI President. “As TFI, this situation clearly shows that there is a problem at the legal and health levels,” he added.

The event also featured an exhibition of valuable artwork by school children on the subject of tobacco control and Law 174, and the winning projects received The Antoine and Minerva Kairouz Award.

Commenting on this initiative, Pierre Kairouz, TFI Co-Founder said, “The Antoine and Minerva Kairouz Award is a symbol representing efforts to save our children and youth from smoking, which leads to deadly diseases. Our goal is to instill in them a sense of responsibility to work towards a healthy Lebanon.”

The three parties behind this initiative are keen on promoting tobacco control measures in Lebanon, while WTS KH long-term goal is to achieve implementation of effective fiscal and economic policies that reduce the burden of smoking, including WTS, and improve population health throughout the region. Implementing the law will build a better future and a healthier life for the upcoming generations. These goals can only be attained by collaborations with the Ministry of Public Health and by promoting capacity building to generate tobacco and WTS control policies.

– ENDS –

About AUBMC

Since 1902, AUBMC has been providing the highest standards of care to patients across Lebanon and the region. It is also the teaching hospital for the Faculty of Medicine at AUB (established in 1867), which has trained generations of medical students and physicians, and whose graduates can be found at leading institutions around the world. AUBMC is the only medical institution in the Middle East to have earned the five international accreditations of JCI, Magnet, CAP, ACGME-I, and JACIE attesting to its superior standards in patient-centered care, nursing, pathology/laboratory services and graduate medical education.

The Faculty of Medicine has graduated over 4,000 medical students and physicians; the Rafic Hariri School of Nursing provides excellent education for the nursing staff, and the Medical Center meets the healthcare needs of over 360,000 patient visits annually.

About KH-WTS

AUB is a tobacco-free campus and for years has been an advocate and supporter of tobacco control in Lebanon and the region. It houses the Knowledge Hub for Waterpipe Tobacco Smoking, an outcome of a memorandum of understanding with the Convention Secretariat of the WHO Framework Convention on Tobacco Control that was signed in 2016. The mandate of this knowledge hub is to promote public health and tobacco control of waterpipe and other forms through education, research, and the dissemination of information that contributes to the implementation of the convention.

About TFI

TFI is the only nonprofit organization in Lebanon, specializing in tobacco control, that has been conducting for the last two decades tobacco control campaigns and educational programs at schools in Lebanon, reaching more than 100,000 children across the country. It has been a strong advocate of tobacco control policies in the country, heavily contributing to the voting of law 174. TFI began in the year 2000 after the death of Lawyer, Antoine Kairouz from lung cancer. Every year, TFI offers the Antoine and Minerva Kairouz Award for the best works done by students on the theme of tobacco control.

For more information, please visit our website www.aubmc.org or contact:

The AUBMC Office of Communications at 00961 1 350000 ext. 4732 – Email: praubmc@aub.edu.lb

NKBCI at 00961 1 350000 Ext 7903- 5150 – Email: nkbci@aub.edu.lb

Memac Ogilvy Public Relations at 01-486065 ext.138

Carmen El Hajj/ Charbel Ghsoub – charbel.ghsoub@ogilvy.com

Waterpipe Tobacco Smoking ADD

President Khuri’s filmed message for the World No Tobacco Day 2019 Assembly.

Click on the link to check the pictures of the event 

https://www.facebook.com/pg/waterpipeKH/photos/?tab=album&album_id=888982488104922

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Date: Sep 18, 2019

Time: 3:00 P.M (GMT+3)

Topic: “Health Effects of Waterpipe Tobacco Use” 

Objectives:

1. Increase public awareness on the health harmful consequences of tobacco use.
2. To reduce the use and the intention to quit WTS among smokers-among young people and adults.

Facilitator:  Dr. Hassan Chami

Director of Respiratory Care Unit, Director of Pulmonary Rehabilitation Program, Associate Professor of Medicine (AUB)

Check the Webinar Presentation 0- Chami Waterpipe Smoking – Sept 15 2019

Check the Webinar Recording HERE

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Increased risk of COVID-19 infection amongst smokers and amongst waterpipe users

Background

1- Smoking and increased risk of bacterial and viral infections

Smoking increases the risk of both bacterial and viral infections.

It has been documented that smokers incur a 2- to 4-fold increased risk of invasive pneumococcal lung disease, a disease associated with high mortality. Influenza risk is twofold higher and more severe in smokers compared with nonsmokers.[i] In the case of tuberculosis smokers also have a twofold increased risk of contracting the infection and a 4-fold increased mortality.

The mechanism of increased susceptibility to infections in smokers is multifactorial and includes alteration of the structural and immunologic host defenses. 

• Structural changes: Tobacco smoke and many of its components produce structural changes in the respiratory airways. These changes include increased mucosal permeability, impairment of the mucociliary clearance, changes in pathogen adherence, disruption of the respiratory epithelium, and peribronchial inflammation and fibrosis.^.[ii]
• Immunologic Mechanisms: Smoking weakens the function of body defense immune cells and the production of antibodies in humans and animals.^{[iii],[iv],[v]}

Increased risk of Coronavirus infection amongst smokers

There is still no robust evidence to suggest an increased risk of infection amongst smokers; however, analysis of deaths from coronavirus in China^[vi] shows that men are more likely to die than women, something that may be related to the fact that many more Chinese men smoke than women.  Among Chinese patients diagnosed with COVID-19 associated pneumonia, the odds of disease progression (including to death) were 14 times higher among people with a history of smoking^[vii] compared to those who did not smoke. This was the strongest risk factor among those examined.

2-Use of Waterpipe and risk of infection transmission

Practice of waterpipe use

Waterpipe smoking is usually practiced in groups. The hose is passed from person to person, and the same mouthpiece is usually used by all the participants. Most smoking sessions last 45 to 60 minutes but may also continue for several hours.

Even if the pipe and mouthpiece is only used by one customer at a time, it should be noted that waterpipes and hoses are generally reused by other smoking customers at the same day It is therefore, not surprising, that waterpipe smokers are exposed to microorganisms that may be harmful to health.[viii],[ix][x]

How do the waterpipes get contaminated with infectious microorganisms?

The risk of transmission of infectious microbial agents through smoking waterpipes is high

• If mouth pieces are not used individually the microorganisms can easily pass from mouth to mouth.
• smokers often cough into hoses and moisture in tobacco smoke promotes the survival of microorganisms inside waterpipe hose.
• Furthermore, the use of cold water in the water chamber for a cold airflow may facilitate the survival of viruses and bacteria.
• The spread of infectious diseases could also result from the uncontrolled, manual preparation of narghile.

Evidence of Infectious Disease transmission though waterpipe

Waterpipes and mouthpieces have been implicated in an outbreak of pulmonary tuberculosis in Queensland, Australia.[xi]^,[xii] .El-Barrawy et al. [xiii] related infection with Helicobacter pylori to waterpipes smoking in Egypt. The risk of transmission of the hepatitis C virus through waterpipes smoking was also demonstrated by Habib et al. (2001).[xiv] Other viruses that can be transmitted are Epstein-Barr virus (EBV), herpes simplex virus and respiratory virus [xv]. Fungal infections have also been reported to be waterpipes transmitted diseases when a patient with acute myeloid leukemia showed invasive infection with Aspergillus sp.[xvi][xvii]

Measures were taken by some countries in view of the potential risk of COVID-19 infection though waterpipe use

Some countries in the Eastern Mediterranean Region such as Iran, Kuwait, Pakistan, Qatar and Saudi Arabia have banned the use of shisha in public places such as cafes, shisha bars or restaurants to avoid COVID-19 transmission.

3- Recommendations

• Inform the public about the high risk of infection of COVID-19 when using waterpipe.
• Complete ban of the use of waterpipes in all public establishments such as cafes, bars, restaurants, etc. with no exceptions even if the mouthpiece or hose is changed with each individual use. Avoid sharing waterpipe mouthpieces even in home settings.
• Ensure the enforcement of the ban with adequate fines and penalties.
• Inform the public about the increased risk of COVID 19 infection in smokers versus non-smokers.
• Encourage smokers to quit smoking.

References:

[i] https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/217624

[ii] Dye  JAAdler  KB Effects of cigarette smoke on epithelial cells of the respiratory tract.  Thorax 1994;49825- 834

[iii] Sopori  MLGoud  NSKaplan  AM Effect of tobacco smoke on the immune system. JH  DeanAE  LusterM  Kimereds. Immunotoxicology and Immunopharmacology New York, NY Raven Press1994;413- 432Google Scholar

[iv] Sopori  MLKozak  WSavage  SM  et al.  Effect of nicotine on the immune system: possible regulation of immune responses by central and peripheral mechanisms.  Psychoneuroendocrinology 1998;23189- 204

[v] Tollerud  DJClark  JWBrown  LM  et al.  The effects of cigarette smoking on T cell subsets: a population-based survey of healthy caucasians.  Am Rev Respir Dis 1989;1391446- 1451

[vi] https://www.telegraph.co.uk/global-health/science-and-disease/coronavirus-dangerous-smokers/

[vii] https://journals.lww.com/cmj/Abstract/publishahead/Analysis_of_factors_associated_with_disease.99363.aspx

[viii] Koul, P.A., Hajni, M.R., Sheikh, M.A., et al., 2011. Hookah smoking and lung cancer in the Kashmir valley of the Indian subcontinent. Asian Pac. J. Cancer Prev. 12, 519e24. [PubMed

[x] Daniels K.E., Roman N.V. A descriptive study of the perceptions and behaviors of waterpipe use by university students in the Western Cape, South Africa. Tob. Induc. Dis. 2013;11:4. [PMC free article] [PubMed] [Google Scholar] [Ref list]

[xi] Urkin, J., Ochaion, R., Peleg, A., 2006. Hubble bubble equals trouble: the hazards of water pipe smoking. Sci. World J. 6, 1990e7. [PMC free article] [PubMed] [Ref list]

[xii] Munckhof, W.J., Konstantinos, A., Wamsley, M., et al., 2003. A cluster of tuberculosis associated with use of a marijuana water pipe. Int. J. Tuberc. Lung Dis. 7, 860e5. [PubMed] [Ref list]

[xiii] El-Barrawy, M.A., Morad, M.I., Gaber, M., 1997. Role of Helicobacter pylori in the genesis of gastric ulcerations among smokers and nonsmokers. East Mediterr. Health J., 3: 316e21. [Ref list]

[xiv] Habib, M., Mohamed, M.K., Abdel-Aziz, F., et al., 2001. Hepatitis C virus infection in a community in the Nile Delta: risk factors for seropositivity. Hepatology 33, 248e53. [PubMed] [Ref list]

[xv] Knishkowy, B., Amitai, Y., 2005. Water pipe (narghile) smoking: an emerging health risk behavior. Pediatrics, 116, e113e9. [PubMed]

[xvii] Szyper-Kravitz, M., Lang, R., Manor, Y., et al., 2001. Early invasive pulmonary aspergillosis in a leukemia patient linked to aspergillus contaminated marijuana smoking. Leuk Lymphoma, 42, 1433e7. [PubMed]

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Questions and answers on tobacco use, including waterpipe use and COVID19 in the Eastern Mediterranean Regionⁱ

What are the possible relations between tobacco use and the COVID19 epidemic?

Any kind of tobacco smoking is harmful tothe bodily systems, includingthe cardiovascular and respiratory systems[1][2]. COVID-19 can also harm these systems. Information fromChina, where COVID-19 originated, shows that people who have cardiovascular and respiratory conditions caused by tobacco use, or otherwise,are at higher risk of developingsevere COVID-19 symptoms[3]. Research on 55,924 laboratory confirmed cases in China shows that the crude fatality ratiofor COVID-19 patients is much higher among those with cardiovascular disease, diabetes, hypertension, chronic respiratory disease or cancer than those with no pre-existing chronic medical conditions[4]. Thisdemonstratesthat these pre-existing conditions may contribute to increasingthe susceptibility of such individuals to Covid-19.

Tobacco has a huge impact on respiratory health. The link between tobacco use and lung cancer is well-established, with tobacco use beingthe most common cause of lung cancer[5]. It alsosubstantially increases the risk of tuberculosis infection[6]. Further, tobacco use is also the most important risk-factor for chronic obstructive pulmonary disease (COPD), causing the swelling and rupturing of the air sacs inthe lungs, which reduces the lung’s capacity to take in oxygen and expel carbon dioxide, and the build-up of mucus, which results in painful coughing and breathing difficulties[7][8][9]. This may have implications for smokers, given thatsmoking is considered to be a risk factor for any lower respiratory tract infection[10]and the virus that causes COVID-19 primarily affects the respiratory system,often causing mild to severe respiratory 2damage[4]. However, given that COVID-19 is a newly identified disease, thelink between tobacco smoking and the diseasehas yet to be established.

There isan increased risk of more serious symptoms and death among COVID-19 patients that have underlying cardiovascular diseases (CVDs)[11][12]. According to the available evidence the virus that causesCOVID-19 (SARS-CoV-2) is from the same family as MERS-CoV and SARS-CoV, both of whichhave been associated with cardiovascular damage (either acute or chronic) [13][14]. Research has shown COVID-19 patients in China with CVDs are at greater riskof more severe symptoms[15]In addition, there is evidence that COVID-19 patients that have more severe symptoms often have heart related complications[16].This relation between COVID-19 and cardiovascular health is important because tobacco use and exposure to second-hand smoke are major causes of CVDs globally[17]. The effect of COVID-19 on the cardiovascular system could thus make pre-existing cardiovascular conditions worse. In addition, a weaker cardiovascular system among COVID-19 patients witha history of tobacco use could make such patientssusceptible tosevere symptoms,therebyincreasingthe chance of death[18].

How can use of waterpipe contribute to the spread of COVID19?

Waterpipes aretobacco products [19]and their use has both acute and long-term harmful effects on the respiratory and cardiovascular systems [20], likely increasing the risk of diseases including coronary artery disease and chronic obstructive pulmonary disease[21].

The communal nature of waterpipe smoking means that a single mouthpiece and hose areoftenshared between people, especially in social and communal settings[22]. In addition, the waterpipe apparatus (including the hose and chamber) itself may contribute to this risk by providing an environment that promotes the survival of microorganisms outside the body. Most cafés tend not to clean the waterpipes after each smoking session because washing and cleaning waterpipe parts is labour intensive and time consuming[23][24].These factorsincrease the potential for the transmission of infectious diseases between users[20].Consistent with this, evidence has shown that waterpipe use is associated with an increased risk of transmission of infectious agents such as respiratory viruses, hepatitis C virus, Epstein Barrvirus, Herpes Simplex virus, tuberculosis, Heliobacter pylori, and Aspergillus[25][26][27][28][29][30]. Social gatherings provide ample opportunityfor the virus that causes COVID-19 to spread [31].

Since waterpipe smoking is typically an activity that takes place within groups in public settings[22]andwaterpipe use increasesthe risk oftransmission of diseases, it could also encourage the transmission of COVID-19 insocial gatherings. When this smoking takes place in indoor areas, as it does in many places, the risk could be higher.

Will strengthened tobacco control measures help in this context?

In 2008, WHO introduced theMPOWER technical package,which is based on key tobacco demand reduction articles of the WHO Framework Convention on Tobacco Control (WHO FCTC),as follows:

• Monitor tobacco use and prevention policies
• Protect people from tobacco use
• Offer help to quit tobacco use
• Warn about the dangers of tobacco
• Enforce bans on tobacco advertising, promotion and sponsorship
• Raise taxes on tobacco.

Strengthened tobacco control measures including tobacco free public places and protection of people from second hand smoke as per the WHO FCTC Article 8 and its Guidelines will reducethe risk of suffering from severesymptoms. Lower tobacco use will reduce rates of many respiratory and cardiovascular conditions that are strongly associated with more serious COVID-19 symptoms and mortality.

Reducing the demand for tobacco products, including waterpipe, could also indirectly discourage the social gatherings that contribute to the spread of the virus.ú

Good respiratory and cardiovascular health is important for a COVID-19 patient topositivelyrespond and successfully recover from the disease.

Specifically regarding waterpipe usage, since it is often overlookedin tobacco control efforts, there is a significant opportunity for positive health outcomes at this time, both with respect to COVID-19 and generally, if immediate comprehensive tobacco control measures are takenthat include the control of waterpipe.

Countries can use the WHO’s highly effective MPOWER policy package to support their formulation and implementation of tobacco control measures.

How can regional tobacco control legislation support the limitation of the virus spreading?

The same considerations thatapply to tobacco control globally as per the WHO FCTC and the MPOWER policy packagealso apply to tobacco control within the Eastern MediterraneanRegion (EMR). Countries should seek to limit the use of waterpipe and other tobacco use in order to reduce its well documented health impactand improve people’s respiratory and cardiovascular health.

Controlling tobaccouse and reducing waterpipe usemay be important for reducing the risk of the transmission of the virus that causes COVID-19.It is important that the control of waterpipe use is taken especially seriously at this timeand within a comprehensive approach to control all tobaccouse in light of WHO FCTC obligations and MPOWER policy recommendations.

In general, WHO recommends that countries fully implementthe WHO FCTC and the MPOWER policy package.This includes a comprehensive ban onall forms of tobacco use,includingwaterpipe, in all public places (incl. cafes and restaurants).Such a ban may help prevent anyincreased risk of transmission of the virus that causes COVID-19 that may be related to tobacco use. Countries should ensure that this ban is fully enforced.

Why is this a good time to try and quit tobacco use?

Tobacco use dramatically increases the risk of many serious health problems, including both respiratory problems (like lung cancer, TB and COPD) and cardiovascular diseases. While this means that it is always a good idea to quit tobacco use, quitting tobacco use may be especially important at this time to reduce the harm caused by COVID-19.Tobacco users areprobably less likely to become infected if they quit because the absence of smoking helps reduce the touching of fingers to the mouth. Also, it is possible that they would better manage the comorbid conditionsifthey become infectedbecause quitting tobacco use has an almost immediate positive impact on lung and cardiovascular function and these improvements only increase as time goes on[10]. Such improvement may increase the ability of COVID-19 patients to respond to the 5infection and reduce the risk of death. Faster recovery and milder symptoms also reduce the risk of the transmission of the disease to other people.

What are the key lessons learnt from previous experiences?

From previous experience in responding to MERS-Cov and SARS-CoV, general precautions should be taken,especially in social gatherings[31].

Waterpipes may bea catalyst for social gatherings in environments thatcould increase disease transmission.

Previous evidence showsthatsmoking has adverse effects on the survival of individuals with infectious diseases[32]and evidence from otheroutbreaks caused by viruses from the same family as COVID-19 suggeststhat tobacco smoking could, directly or indirectly, contribute to an increased risk ofinfection,poor prognosis and/or mortality for infectious respiratory diseases[33][34].

What is next??

This document is based on the most updated available evidence.

Evidence is still evolving and the document will be subject to updates in light of any new emerging evidence. Regularlywe will look into the new available evidence and update the document.

In the context of COVID19 countries are encouraged to take the needed action to protect the public from the devastating health consequences of tobacco use in light of their international commitments under the WHO FCTC and WHO recommendations.

References

[1] World Health Organization, World Heart Federation, Cardiovascular harms from tobacco use and secondhand smoke: Global gaps in awareness and implications for action, Waterloo, Ontario, Geneva, 2012.

[2] World Health Organization, World No Tobacco Day 2018: Tobacco breaks hearts -choose health. not tobacco, Geneva, 2018.

[3] W.-j. Guan, Z.-y. Ni, Y. Hu, W.-h. Liang, C.-q. Ou, J.-x. He, L. Liu, H. Shan, C.-l. Lei, D. S. Hui, B. Du, L.-j. Li, G. Zeng, K.-Y. Yuen, R.-c. Chen, C.-l. Tang, T. Wang, P.-y. Chen, J. Xiang, S.-y. Li, J.-l. Wang, Z.-j. Liang, Y.-x. Peng, L. Wei, Y. Liu, Y.-h. Hu, P. Peng, J.-m. Wang, J.-y. Liu, Z. Chen, G. Li, Z.-j. Zheng, S.-q. Qiu, J. Luo, C.-j. Ye, S.-y. Zhu and N.-s. Zhong, “Clinical Characteristics of Coronavirus Disease 2019 in China,” New England Journal of Medicine, 2020.

[4] World Health Organization, Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19), 14-20 Februray 2020., 2020.

[5] F. Bray, J. Ferlay, I. Soerjomataram, R. L. Siegel, L. A.Torre and A. Jemal, “Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries,” CA: A Cancer Journal for Clinicians, vol. 68, no. 6, pp. 394-424, 2018.

[6] K. Lönnroth and M. Raviglione, “Global Epidemiology of Tuberculosis: Prospects for Control,” Seminars in Respiratory and Critical Care Medicine, vol. 29, no. 5, pp. 481-491, 2008.

[7] N. Terzikhan, K. M. C. Verhamme, A. Hofman, B. H. Stricker, G. G. Brusselle and L. Lahousse, “Prevalence and incidence of COPD in smokers and non-smokers: the Rotterdam Study,” European Journal of Epidemiology, vol. 31, no. 8, pp. 785-792, 2016.

[8] Institute for Health Metrics and Evaluation, “GBD Compare | IHME Viz Hub,” [Online]. Available: http://vizhub.healthdata.org/gbd-compare. [Accessed 12 03 2020].

[9] C. Janson, G. Marks, S. Buist, L. Gnatiuc, T. Gislason, M. A. McBurnie, R. Nielsen, M. Studnicka, B. Toelle, B. Benediktsdottir and P. Burney, “The impact of COPD on health status: findings from the BOLD study,” European Respiratory Journal, vol. 42, no. 6, pp. 1472-1483, 2013.

[10] U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, The health consequences of smoking: 50 years of progress -A report by the Surgeon General, Atlanta, 2014.

[11] C. Huang, Y. Wang, X. Li, L. Ren, J. Zhao, Y. Hu, L. Zhang, G. Fan, J. Xu, X. Gu, Z. Cheng, T. Yu, J. Xia, Y. Wei, W. Wu, X. Xie, W. Yin, H. Li, M. Liu, Y. Xiao, H. Gao, L. Guo, J. Xie, G. Wang, R. Jiang, Z. Gao, Q. Jin, J. Wang and B. Cao, “Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China,” The Lancet, vol. 395, no. 10223, pp. 497-506, 2020.

[12] Y.-Y. Zheng, Y.-T. Ma, J.-Y. Zhang and X. Xie, “COVID-19 and the cardiovascular system,” Nature Reviews Cardiology, 2020.

[13] T. Alhogbani, “Acute myocarditis associated with novel Middle East respiratory syndrome coronavirus,” Annals of Saudi Medicine, vol. 36, no. 1, pp. 78-80, 2016.

[14] Q. Wu, L. Zhou, X. Sun, Z. Yan, C. Hu, J. Wu, L. Xu, X. Li, H. Liu, P. Yin, K. Li, J. Zhao, Y. Li, X. Wang, Y. Li, Q. Zhang, G. Xu and H. Chen, “Altered Lipid Metabolism in Recovered SARS Patients Twelve Years after Infection,” Scientific Reports, vol. 7, no. 1, 2017.

[15] Q. Ruan, K. Yang, W. Wang, L. Jiang and J. Song, “Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China,” Intensive Care Medicine.

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ⁱNote: Many countries in the Eastern Mediterranean Region have reported cases of COVID-19. The WHO is actively involved in supporting Member States prepare and respond to the outbreak. Further regularly updated information about COVID-19 and the WHO’s work can be found here: http://www.emro.who.int/health-topics/corona-virus/index.html

For information on countries that took action to strengthen tobacco control in light of COVID19 please contactTobacco Free Initiate WHO EMRO emrgotfi@who.int

(please Check the link below)

March tobacco use and COVID 19 updated

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We’re proud to announce that Dr Ghazi Zaatari, Interim Dean, Faculty of Medicine, American University of Beirut, Professor and Chair; The Waterpipe Tobacco Smoking Knowledge Hub Director based at AUBMC – American University of Beirut Medical Center American University of Beirut (AUB) has been awarded the prestigious World No Tobacco Day 2020 award – one of the Eastern Mediterranean Region awardees winners.

Every year, WHO recognizes individuals or organizations in each of the six WHO Regions for their accomplishments in the area of tobacco control. This recognition takes the form of WHO Director-General Special Recognition Award and World No Tobacco Day Awards.

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