Hookah and COVID-19: How Hookah puts you at risk

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The deadly COVID-19 outbreak has shaken the world. In these uncertain times everyone should focus on the short and long-term public health consequences of COVID-19.

From the data we have so far, we know that smoking doubles the risk of having severe COVID-19.1 Lung damage from COVID-19 resembles the damage of smoke from cigarettes and other tobacco products that introduce particulate matter from the environment into the lungs.

Damage to the lungs from hookah is similar to the damage caused by COVID-19. Both hookah smoke and the COVID-19 virus attack the inner lining of the lungs. Damage to lung cells and inflammation of the tissue weakens the lungs’ ability to fight off infection. If lungs are already damaged from hookah and other tobacco product use, it makes it easier for the virus to invade the lung tissue, cause more severe symptoms and increase the risk of death.

Lung inflammation and cell damage has been seen among hookah users after only a single session.2 Hookah use damages alveoli, the delicate air sacs that bring oxygen to the lungs. COVID-19 also targets the lining of the alveoli and leads to inflammation and difficulty breathing.

For too long, hookah was wrongly assumed to be less harmful than cigarettes. It is now well-known that hookah’s health risks are serious.3 One hour of hookah smoking is equal to 200 puffs.4 5

Those who are around hookah use are also exposed to pollutants in secondhand hookah smoke that are damaging to the lungs.6 7

Additionally, the mouthpiece, the hose and the water in the hookah can harbor and transmit bacteria from one user to another when shared.8 This is a serious indicator that the COVID-19 virus can also spread through hookah sharing in the same way.

Just like cigarette smokers, those who smoke hookah are at higher risk of severe symptoms of COVID-19 than non-smokers. This is an opportunity for hookah users and other smokers to quit these dangerous habits and use this unfortunate situation as a fresh start.

Written by

Wael Al-Delaimy MD PhD
Professor, Department of Family Medicine and Public Health, University of California, San Diego, Associate Director, Institute for Public Health

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References renameme

  1. Guan WJ, Ni ZY, Hu Y, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020.
  2. Wolfram RM, Chehne F, Oguogho A, Sinzinger H. Narghile (water pipe) smoking influences platelet function and (iso-)eicosanoids. Life Sci. 2003;74(1):47–53.
  3. Eissenberg T, Shihadeh A. Waterpipe tobacco and cigarette smoking: direct comparison of toxicant exposure. Am J Prev Med. 2009;37(6):518–23.
  4. American Lung Association. An Emerging Deadly Trend: Waterpipe Tobacco Use. Washington: American Lung Association;2007.
  5. American Lung Association. Hookah Smoking: A Growing Threat to Public Health Issue Brief. Smokefree Communities Project, 2011.
  6. American Lung Association. Hookah Smoking: A Growing Threat to Public Health Issue Brief. Smokefree Communities Project, 2011.
  7. Zhou S, Weitzman M, Vilcassim R, Wilson J, Legrand N, Saunders E, et al. Air quality in New York City hookah bars. Tob Control. 2015;24(e3):e193–8.
  8. Masadeh MM, Hussein EI, Alzoubi KH, Khabour O, Shakhatreh MA, Gharaibeh M. Identification, characterization and antibiotic resistance of bacterial isolates obtained from waterpipe device hoses. Int J Environ Res Public Health. 2015;12(5):5108–15.