ANALYSIS | Why is government not collecting statistics on smoking and Covid-19?

PHOTO: Getty Images
  • The government banned the sale of tobacco products, citing the relationship between smoking and Covid-19.
  • But the government is not collecting data on hospitalised Covid-19 patients who are smokers, or smokers who have died of Covid-19.
  • Collecting this data can help the government determine the validity of its decision.

The South African government instituted a ban on the sale of tobacco products, citing the problematic relationship between Covid-19 and smoking, but it has not been collecting data to this effect.

The government's decision on the prohibition of all tobacco sales took effect on 27 March when the lockdown started.

It has been reiterated several times that the overarching reasons for the decision to ban the sale of tobacco products are to protect human life and to reduce the potential strain on the healthcare system.

READ | 'There isn’t much merit from a scientific perspective in banning smoking' - top scientist

In the Fair Trade Independent Tobacco Association's (FITA) urgent application to overturn the government's ban on the sale of tobacco products, Cooperative Governance and Traditional Affairs Minister Nkosazana Dlamini-Zuma also cited international studies on the relationship between Covid-19 and smoking.

The evidence from the studies suggests that the use of tobacco products may increase the risk of transmission of Covid-19 and that smokers may also have an increased risk of developing a more severe form of the virus.

The Gauteng High Court in Pretoria found in favour of the government's arguments on imposing the ban and dismissed FITA's application with costs.

The government is facing a second legal challenge relating to the ban, by British American Tobacco South Africa (BATSA) and nine others. This case is expected to be heard in August.

In Dlamini-Zuma's answering affidavit to this challenge, where she also speaks on behalf of President Cyril Ramaphosa, the minister refers to the studies that speak to the increased risk of transmission of Covid-19 and the possibility of a more severe form of the virus for smokers.

In the affidavit, Dlamini-Zuma said:

This, in turn, will increase the strain on the health system by increasing the number of people who will need hospitalisation and access to resources, such as intensive care unit (ICU) beds and ventilators.

"As stated, the emerging research about the relationship between smoking tobacco products and Covid-19 shows that the severity of Covid-19 outcomes is greater in smokers than non-smokers.

READ | Illegal cigarette trade may reduce economic harm of tobacco ban - govt in court papers

"Smokers have higher ICU admission rates, a higher need for ventilators and a higher mortality rate than non-smokers. Smoking thus increases the strain on our limited healthcare resources, including our health workers."

The credibility and interpretation of the studies have been questioned by both BATSA and FITA, who presented other expert opinions with differing views on the available studies.

BATSA have also argued that Dlamini-Zuma has not provided evidence that smoking cessation for a limited period would reverse or reduce the risk of contracting a more severe form of Covid-19.

Without going into which argument should be accepted as credible or empirically correct, it is clear from the reading of the government's papers that the ban was imposed as there is a fear that smokers, if they get Covid-19, will place strain on the health system as they may be subjected to a more severe case of the virus.

EXPLAINER | What the WHO says about smoking during Covid-19

If this is the government's stance, then why isn't the same government collecting data in South Africa, which could only help them determine the validity of their decision as well as play a role in informing their decision going forward?

The Department of Health confirmed that data on smokers and Covid-19 is not being collected.

The department could not provide statistics on how many Covid-19 patients in ICU, as of 28 June, are smokers.

Department spokesperson Popo Maja said:

In the ICU context, we don't collect this data routinely – we do collect comorbidities for treatment purposes. ICU staff are primarily focused on saving lives and not collecting data.

The department further said that it does not collect data on how many of the Covid-19 deaths were smokers.

News24 reported on Monday that there were 657 patients in both public and private hospitals nationally, and that 258 Covid-19 patients were on ventilators.

Maja's assertion that ICU staff are primarily focused on saving lives and not collecting data cannot be disputed, but wouldn't the knowledge of a smoking history help with the planning of treatment purposes in the same manner that comorbidity data is collected?

If this data is not important for treatment purposes, it must surely still be important in the context of managing the pandemic. After all, it was the same sort of data collected that informed the government's position on the ban in the first place.

READ | Difficult to say when cigarette ban will be lifted - Ramaphosa

The collection of data on smokers hospitalised for Covid-19 can arguably help determine the level of strain that tobacco users have put on the health system, which in turn could also help determine when the ban should be lifted.

Without the actual statistics on smokers and their hospitalisation, the government's only way of dictating when the ban should be lifted will be determined by the overall number of Covid-19 cases in the country and the strain of these cases on the health system.

Therefore, the prohibition of tobacco products will most likely only be lifted once there is dramatic decrease in the number of daily infections and deaths being reported.

We know the government has dictated that the lockdown levels will be determined on an assessment of the infection rate and the capacity of the health system to care for those who are sick.

Without these smokers' statistics, it is also difficult to fathom how Ramaphosa, on 23 April, who did not cite reasons, announced that the ban would be lifted as the country moved into Level 4 of the lockdown.

Days later, the government made a U-turn when Dlamini-Zuma announced the ban would remain in place.

Dlamini-Zuma, at the time, noted concerns that some people shared cigarettes, which could spread the novel coronavirus, as well as around 2 000 submissions received that opposed the lifting of the ban.

The reasons for the initial proposal to lift the ban has never been made available.

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