Hookah: coronavirus, infections, environment

Is smoking a hookah safer than other forms of tobacco use?

There is a belief that a hookah is a sort of "purer" alternative to cigarette smoking. However, NIH-funded studies (National Institutes of Health, USA) have found that hookah smoke contains numerous harmful chemicals, the content of which is often higher than in cigarette smoke. For example, the concentration of carbon monoxide in hookah smoke is ten times higher than in cigarette smoke, and formaldehyde is 3–5 times higher. Hookah smoke contains three times more phenols, which promote mutational processes and, accordingly, the formation of new tumors. Hookah smoke also contains a significantly higher level of benzene, which has been linked with the development of leukemia.

Like cigarettes, smoking hookahs fosters nicotine dependence, increases the risk of cancer and cardiovascular diseases.

Why is a hookah so popular? Consumers are attracted by the ritual, the variety of flavors, and the mistaken belief that the water in the reservoir purifies the smoke of toxins. In reality, not only does it not purify, but it often enriches infections.

Hookah and SARS-CoV-2

The infectious risks of hookah use have been known for a while. Even though hookah mouthpieces are disposable, the pipes and bowls are typically not washed and disinfected.

Hookah smoking has been linked to cases of tuberculosis. It is also easy to contract Helicobacter infection through hookah.

In light of recent events related to the pandemic, questions about the possibility of the novel coronavirus spreading through hookahs practically leave no doubt. Especially given the fairly long persistence of the virus in the environment, particularly in the presence of moisture.

Representatives of the National Institutes of Health recently published a public letter in the Canadian Medical Association Journal to draw attention to this problem.

The authors point out that "hookah smoking poses a threat of disproportionate increases in the frequency of COVID-19 among young people."

The letter also mentions that hookah smoke contains dangerous chemicals that damage respiratory tissues and increase susceptibility to viral infections, tuberculosis, and other infectious diseases, including coronavirus.

Regarding smoking in general, WHO also reminds that current data show a link between smoking and an increased likelihood of disease and death among hospitalized COVID-19 patients.

Some sources note that hookah parties were associated with mass registration of active coronavirus infections.

In Germany this was carefully tracked – more than a few dozen people became infected in a hookah bar, and about three hundred more were placed in quarantine.

In connection with this, experts urge:

• Actively inform the public about the high risk of infection with the COVID-19 pathogen when smoking hookahs;
• Completely ban the use of hookahs in all public establishments such as cafes, bars, and restaurants without any exceptions, even when using individual mouthpieces and hoses;
• Reinforce the ban with appropriate penalties.

...And about the consequences of the tobacco regulation crisis

When the heroes of films no longer have reputationally unfavorable status smoking cigarettes in scenes even for big money, and everyone publicly talks about the health harms of tobacco smoke, the tobacco industry — which, in law, is a narcotics business — began to look for loopholes, offering alternative "innovative" or "culturally tinted" products that supposedly have a "less detrimental" health impact. The regulatory sphere of their activities is not as robust and constantly lags behind. As a result — today we practically have the same thing as before — tobacco, but in the form of hookahs, vapes, electronic cigarettes, consumption of which is often not regulated and is accessible to almost every student.

However, returning to hookahs, considering their substantial popularity, it is worth recalling their enormous impact on the environment and air quality in cities.

According to studies, the indoor air quality index in places where hookahs are smoked is over 300 units, corresponding to the highest degree of danger according to air pollution level classifications.

Polluted air from hookah bars vents outside, thereby impacting public health — British researchers concluded this. Notably, in these studies only a quarter of cafe staff with hookah menus suspected potential harm to their health — simply from being in their workplace.

While the automotive sector faces pressure and moves toward reducing emissions, inventing turbo engines and electric cars, cafe and restaurant owners place couches and tables in green or pedestrian zones and produce hundreds of thousands of cubic meters of smoke, contributing not less, and sometimes moreto city air pollution than road transport.

Summer terraces are often defaulted into smoking zones, with harmful consequences extending to passersby.

Beyond cafe terraces, the hookah business often encroaches on zones of healthy recreation — beaches, parks, poisoning the air of the public space.

Outdated legislation combined with a lack of political will, a deficit of social mission among local authorities, makes this problem long-lasting and practically unsolved. Only awareness and an active stance by society and the media can move this issue off the dead center — which is important for the health of each of us.

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