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SARS-Cov-2, Smoking, and Nicotine Consumption: Investigating the Intended and Unintended Consequences of Responses to COVID-19 around the World

The COVID-19 pandemic brought isolation, social distancing, and economic downturn. The pandemic, and government’s response, also appears to have affected the use of tobacco and nicotine products. Stress and anxiety, both well understood drivers of nicotine use, coupled with a reduction in time spent in areas where smoking is banned, may have driven increased consumption. But the pandemic also disrupted social interactions that may promote smoking; reduction in environmental triggers and disposable income coupled with heightened focus on pulmonary health may have promoted cessation. Additionally, two further features of the pandemic require investigation: Misinformation surrounding the unfounded theory that smoking might have a protective effect COVID-19 (resulting from an incomplete scientific understanding of the viral pathology) could have changed perceptions of risk. Regulatory responses to the crisis also likely affected the availability and accessibility of products. The pressure on governments to respond to the pandemic left little time for regulators to consider possible unintended consequences of unprecedented interventions. Tobacco bans in South Africa and Botswana may have inadvertently increased illicit trade in tobacco products (ITTP). And in other locations, the differential lockdown policies for vape-shops and tobacco retailers may have nudged consumers of safer nicotine products towards combustible tobacco. This paper explores how tobacco and nicotine users altered their consumption in response to the pandemic, and investigates which features of the pandemic, and the world’s response, drove those changes. A review of English-language, peer-reviewed and pre-print research articles published in the PubMed database, is supplemented with a brief analysis of industry data for combustible tobacco and SNPs to explore how the pandemic affected demand for and behaviors around tobacco and nicotine.