Urge Jokowi to ban smoking in COVID-19 ‘high-risk areas’

The National Commission on Tobacco Control (NCTC) has urged President Joko “Jokowi” Widodo to enhance COVID-19 mitigation efforts by banning tobacco cigarettes and electronic cigarettes, especially in “high-risk areas”. In a letter issued on Monday, the commission urged the President to ban cigarette sales, remove cigarette displays from stores and tighten the ban on cigarette advertisements.

The NCTC stated that it was encouraging stronger “enforcement of cigarette-free areas”, adding that private homes could be included among the high-risk areas to ensure safety and comfort indoors. “The government [should] call on people who smoke to stop or reduce smoking in order to prevent an increase in COVID-19 deaths,” the letter said.

Joint Ministerial Decree N0. 17/2011 bans the use, sales and advertisement of cigarette on public transportation and in public spaces, as well as at health facilities, schools, houses of worship and playgrounds. The regulation does not stipulate any sanctions for violators, however. Komnas PT's call to impose a smoking ban during the epidemic is also endorsed by 17 health associations and organizations, including the Indonesian Public Health Association (IAKMI), the Indonesian Society of Respirology (PDPI) and the Indonesian Heart Foundation (YJI). PDPI chairman Agus Dwi Susanto said that that certain substances in cigarettes, such as nicotine and tar, could improve the regulation of the angiotensin-converting-enzyme-2 (ACE-2) receptors in the human body.

Studies have shown that the SARS-CoV-2 virus that causes COVID-19 uses the enzyme to enter human cells for replication, according to STAT. Agus cited a study "published ahead of print" on Feb. 28, 2020 in the Chinese Medical Journal suggesting that smoking could increase the risk of pneumonia when contracting COVID-19. He also cited another study published on April 15 in the Journal of Medical Virology, "The impact of COPD and smoking history on the severity of COVID?19: A systemic review and meta?analysis", which suggests that heavy smokers are twice as more likely to experience severe outcomes of the disease.

He said that smoking could reduce the motility of the cilia in the respiratory system that prevented harmful substances from entering the lungs by 50 percent. Smoking was also a cause of other immune system disorders. “Passive smokers are also at risk because they also inhale the dangerous substances in cigarettes,” Agus said at a virtual press conference on Tuesday. “Cigarette smoking can also cause [COVID-19] transmission, as the smoke spreads respiratory droplets when exhaled.” Smoking was also linked to comorbidity in patients with COVID-19, contributing to underlying health conditions such as heart failure, hypertension and diabetes that could increase the risk of dying from the disease. YJI chairwoman Esti Nurjadin said during Tuesday's press conference that the government’s appeal to work and study from home had led to smokers smoking at home instead of at the office, which put their families at risk of inhaling secondhand smoke. “The home, which was supposed to function as a place safe from COVID-19, is no longer safe,” Esti said, urging smokers to stop smoking at home.

IAKMI chairman Ede Surya Darmawan said that despite the health risks of cigarette smoking, Indonesia still had 65.19 million smokers, more than the combined number of smokers in the Philippines, Thailand, Malaysia and Singapore. Ede cited a 2007 study published in Public Health Nutrition that said cigarette consumption contributed 22 percent of weekly expenses in poor households after rice. The tobacco industry has also been a major contributor to Indonesia’s economy, generating 95.8 percent of the country’s taxable income in 2018 and employing 5.98 million workers in 2019, according to the Industry Ministry.