COVID-19 and restrictions on tobacco use

To the Editor:

The pandemic caused by COVID-19 has been a point of no return in our lives, with consequences that are difficult to imagine in other scenarios; and although the vast majority have been negative consequences, we must not lose sight of the fact that this situation has brought about some changes that we could describe as positive.

With the pressure and sometimes austerity imposed on current health systems, no one could have imagined that in a few days most of the hospitals in our country would be able to double or triple their intensive care beds, nor would a degree of citizen commitment similar to that observed during the lockdown period have been expected. Other examples, similar to this one, highlight the importance of context in motivation and human behaviour and, therefore, in subsequent social customs, rules and conventions.

At this point, we would like to make a special mention of one of the measures that we consider positive and that would probably not be on the agenda if the current pandemic had not occurred. We refer to the prohibition of smoking in the open air if the distance of two metres is not complied with.

Much has been written about tobacco and bans.¹ It is worth drawing a parallel with two previous smoking bans in our country: the hotel industry and psychiatric units.² In both cases the bans were met with some resistance, often with allegations of individual responsibility and freedom being made against them.³ However, it would appear that when a ban is supported by evidence⁴ (we would even dare to say by common sense), its development and acceptance end up imposing themselves on the collective consciousness.

That is why we believe that, in the same way that some changes have come to stay and shape the so-called "new normality", now is the precise moment when all the parties involved (legislators, legal bodies, health managers) must take the necessary steps to ensure that, within this new scenario, tobacco consumption is excluded from public spaces (something which, in fact, already exists in some countries or in our own country with other substances such as alcohol).

In view of the foreseeable criticism of this proposal, it is essential to point out that tobacco smoking is likely to kill many more people this year and the years to come than COVID-19 (50,000 deaths per year in Spain⁵). Even without taking into account the associated morbidity: diverse and multiple pathologies, with the consequent absenteeism at work.

This is why we believe that the same reasons that led us to take such drastic measures as total lockdown should underlie the ban on smoking outdoors. Therefore, taking advantage of the pressing need to do what is important, we advocate the implementation and maintenance of measures that can improve the health of citizens, which are based on evidence and which are aligned with other public health alternatives widely supported by a large number of associations. Without forgetting the supervision, control, and compliance commitment, by everyone, of these measures that we wish had come to stay.