Spain announced it was banning smoking in the street without social distancing as it stepped up restrictions to stop the spread of coronavirus today.
Health Minister Salvador Illa unveiled a raft of new measures to be enforced nationwide, including closing restaurants and bars.
He attended an emergency meeting of regional health authorities as the country battles a surge in the disease, with nearly 2,935 new cases in 24 hours reported on Thursday.
It takes the country’s total cases to 337,334, while the country’s death toll to 28,605, prompting fears of a second wave of the pandemic in Spain
The nationwide smoking ban comes after Spain’s northwestern region of Galicia introduced a ban on smoking in outdoor public places yesterday.
The move is supported by research from Spain’s health ministry, who last month found that smoking can spread the virus because people project droplets when they exhale smoke.
In addition, the virus could be spread when a person removes their face mask to smoke a cigarette, and by touching their cigarette before bringing it to their mouth.
But experts have warned there is not yet enough evidence to say for certain that the disease could be spread through tobacco smoke.
Spain announced it was banning smoking in the street without social distancing as it stepped up restrictions to stop the spread of coronavirus today as the country’s 7-day average cases have spiralled up in recent days
The Spanish Society of Epidemiology in July called for smoking to be banned in outdoor spaces. Above, a man smokes a cigarette in a street of Valencia on August 13, 2020
The move comes despite a mountain of research suggesting smokers are less likely to catch coronavirus.
Experts across the world have discovered very few smokers are getting hospitalised by Covid-19, suggesting they are protected or aren’t getting infected as much.
It is mandatory in all of Spain, except in the Canary Islands, to wear a face mask in all outdoor and indoor public spaces.
The Spanish Society of Epidemiology in July called for smoking to be banned in outdoor spaces, arguing there is a risk that smokers infected with COVID-19 but who are asymptomatic ‘could release droplets’ containing the virus ‘which put at risk the rest of the population’.
Alberto Fernández Villar, head of the pneumology department at Vigo hospital, and a member of the Galician government’s clinical committee, said: ‘We know smokers with Covid-19 have a greater viral load and are potentially bigger spreaders.’
Viral load refers to the number of particles of the coronavirus – called SARS-CoV-2 – someone is first infected with.
No scientific studies have conclusively proven that smokers have a higher viral load, compared to coronavirus-infected non-smokers.
But evidence has shown smokers may have more ACE-2 receptors, which the virus latches on to to infect humans.
This means someone with more ACE-2 receptors may be more susceptible to a large viral load entering their bloodstream.
Spain’s highly decentralised system of government makes regions responsible for healthcare, leading to a patchwork of different measures to curb the virus across the country of 47million people.
The World Health Organization has said tobacco users are likely to be more vulnerable to being infected by the virus and could increase the possibility of transmission of the disease since it involves contact of fingers with the lips.
While the smoking ban was applauded by many medical experts, some questioned its effectiveness.
‘There is not yet enough solid scientific information to show that in open spaces, tobacco smoke can transmit the disease,’ Fernando Garcia, an epidemiologist at the Carlos III institute for health, said.
‘To take such an extreme measure when there is not enough evidence, I think is a bit disproportionate.’
The ban on smoking comes as the country grapples with the worst infection rate in western Europe. Spain now has 376,864 confirmed total cases, and 28,579 deaths.
Spain confirmed 44,400 new cases over the past 14 days alone, compared with just 4,700 new cases registered by Italy, with 60 million inhabitants, which was the first European country to be rocked by the virus.
Spain is still in good shape compared with many countries in the Americas, where the spread seems unchecked in the United States, Mexico and several South American countries.
But hospitalisations with Covid-19 have quintupled in Spain since early July, when cases were down to a trickle after a severe lockdown stopped a first wave of the virus that had pushed the health care system to breaking point.
DO SMOKERS REALLY HAVE A HIGHER VIRAL LOAD?
ACE-2 receptors are structures found on the surface of cells in the lungs and airways which work with an enyzme called ACE (angiotensin-converting enzyme) to regulate blood pressure.
Its exact function in the lungs is not well understood but studies suggest it is protective against lung damage and low levels of it can worsen the impact of viral infections.
Scientists say that the coronavirus which causes COVID-19 enters the body through the ACE-2 receptor, which the shape of it allows it to latch on to.
This means that someone with more ACE-2 receptors may be more susceptible to a large viral load – first infectious dose of a virus – entering their bloodstream.
ACE-2 receptors have a shape which matches the outside of the coronavirus, effectively providing it with a doorway into the bloodstream, scientists say
People who have higher than usual numbers of ACE-2 receptors may include those with diabetes or high blood pressure because they have genetic defects which make them produce more. Emerging evidence shows that smokers may also produce more.
High levels of ACE-2 receptors may also be protective, however.
They are thought to be able to protect the lungs during infection and a study on mice in 2008 found that mice which had ACE-2 blocked in their bodies suffered more damage when they were infected with SARS, which is almost identical to COVID-19.
Smoking has in the past been repeatedly linked to lower than normal levels of ACE-2 receptors, potentially increasing the risk of lung damage from COVID-19.