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Year : 2021  |  Volume : 8  |  Issue : 4  |  Page : 459-460

Hookah smoking and COVID-19 in India: Fan the Flames

1 Department of Clinical Pharmacy, Poona College of Pharmacy, Bharati Vidyapeeth (Deemed to be University), Pune 411038, Maharashtra, India
2 River Route Creative Group LLP, Mumbai, Maharashtra 400013, India

Date of Submission23-Aug-2021
Date of Acceptance24-Nov-2021
Date of Web Publication22-Dec-2021

Correspondence Address:
Dr. Prasanna R Deshpande
Department of Clinical Pharmacy, Poona College of Pharmacy, Bharati Vidyapeeth (Deemed to be University), Pune 411038, Maharashtra.
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/mgmj.mgmj_63_21

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In recent years, hookah smoking has gained popularity in India, especially among youth. However, its abuse increases the risk of COVID-19. The present letter discusses the harmful effects of hookah smoking, international policies for the cessation of hookah smoking, and the pressing need to have policies to mitigate hookah use and curb the spread of COVID-19 in India.

Keywords: COVID-19, hookah, India, public health, SARS-CoV-2, smoking

How to cite this article:
Varghese R, Karsiya J, Deshpande PR. Hookah smoking and COVID-19 in India: Fan the Flames. MGM J Med Sci 2021;8:459-60

How to cite this URL:
Varghese R, Karsiya J, Deshpande PR. Hookah smoking and COVID-19 in India: Fan the Flames. MGM J Med Sci [serial online] 2021 [cited 2022 Aug 13];8:459-60. Available from: http://www.mgmjms.com/text.asp?2021/8/4/459/333324

  Introduction Top

Although the mortality rate is less, the COVID-19 pandemic has shown devastating results in India, to date. Recent studies have shown hookah (Waterpipe, Narghila, or Shisha) or vape pens to be one of the potential risk factors responsible for the spread of coronavirus.[1] They are used to smoking numerous flavored substances, including cannabis, tobacco, and opium. Its use is apparent in many other countries, including India.[2] Globally and in India, its high pervasiveness, particularly among young adults, is a matter of great solicitude.

Smoking (in general) doubles the risk of developing a severe coronavirus infection.[3] The smoke particles (by hookah or any other means) and coronavirus damage the lungs in an analogous way. They attack the inner lining of the lungs, damage the cells/alveoli, inflame the lungs, (consequently)reduce the capacity of the lungs to fight against infection, and cause difficulty in breathing.[4] Moreover, it makes it easier for the virus to invade and damage the lungs, especially if already impaired by hookah/tobacco smoking. Even a single session of hookah can inflame the lungs and damage the cells.[5] Hookahs are not only instilled with long and difficult-to-clean pipes but also harbor a cold water reservoir; both are deemed ideal for the transmission of SARS-CoV-2.[2],[6],[7] Furthermore, the Middle-Eastern Respiratory Syndrome (MERS) Coronavirus transmission is also attributed to water-pipe smoking, owing to its prevalence in the geography.[8]

Hookah is more dangerous than a cigarette. One hour of hookah smoking equals nearly 200 puffs (1 cigarette generally involves 20 puffs); whereas the amount of smoke inhaled in a hookah session is ~90,000 mL (500–600 mL in cigarette smoking).[9] Second-hand and third-hand hookah smoke are also perilous for non-smokers. Second-hand smoke contains smoke from tobacco and heat sources (such as charcoal).[10] The mouthpiece, the hose, and the water in hookah can shelter and transmit microorganisms to shared users. Since cleaning and washing parts of the water pipe are arduous and time-consuming, most hookah parlors avoid cleaning them.[11]

  Hookah cessation in india Top

The cessation of hookah in India can be achieved in multiple ways. The geographies such as Egypt, Abu Dhabi, Dubai, Canada, which witness extensive hookah use, have issued a public health warning to limit their usage, especially in workplaces, public, and enclosed spaces.[2] In India, governments are now adopting the same principles as Delhi, Uttar Pradesh, and Chandigarh to curtail COVID-19 transmission.[12],[13],[14] The following strategies may be followed for hookah cessation (as adopted from WHO FCTC guidelines) at the national level to control COVID-19 spread at the individual- and community-level[15]:

  1. Track the use of hookah and its safeguard policy;

  2. Impeding people from hookah usage;

  3. Striving help to stop hookah use;

  4. Admonishing about the hazards of hookah;

  5. Prohibiting hookah advertisements, promotion, and financing;

  6. Increasing the tax levied on hookah.

Furthermore, Hookah centers’ guidelines may also be implemented in India which involve the following points[16]: There should be a worker designated only for picking up, cleaning, and sanitizing hookahs. Hookahs should be quickly cleaned and disinfected after each use in a sink, specifically assigned to clean hookahs. Hookahs should not be used without cleaning/sanitizing. There should be separate and designated areas for used and sanitized hookahs. The equipment should be subsequently disassembled and minutely cleaned (including intricate cavities) after each use. After sanitization, the equipment should be air-dried and stored in a way, to avoid external contamination. Use disposable mouth tips without sharing hookahs. Patrons should not be allowed to bring their hookah pipes or any related equipment.

  Conclusion Top

Hookah smoking cannot be ignored as a health hazard for COVID-19 in India. Strategies such as creating awareness of the hazards, implementing strategies for cessation of hookah smoking, and framing guidelines for Hookah centers may be useful.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Arya S, Gupta R. COVID-19 outbreak: Challenges for addiction services in India. Asian J Psychiatr 2020;51:102086.  Back to cited text no. 1
Shekhar S, Hannah-Shmouni F. Hookah smoking and COVID-19: Call for action. CMAJ 2020;192:E462.  Back to cited text no. 2
Salah HM, Sharma T, Mehta J. Smoking doubles the mortality risk in COVID-19: A meta-analysis of recent reports and potential mechanisms. Cureus 2020;12:e10837.  Back to cited text no. 3
Al-Delaimy W. Hookah and COVID-19: How Hookah puts you at risk. Published 2020. Available from: https://tobaccofreeca.com/health/hookah-and-covid-19-how-hookah-puts-you-at-risk/ [last accessed February 3, 2021].  Back to cited text no. 4
Wolfram RM, Chehne F, Oguogho A, Sinzinger H. Narghile (water pipe) smoking influences platelet function and (iso-)eicosanoids. Life Sci 2003;74:47-53.  Back to cited text no. 5
Liu W, Tao ZW, Wang L, Yuan ML, Liu K, Zhou L, et al. Analysis of factors associated with disease outcomes in hospitalized patients with 2019 novel coronavirus disease. Chin Med J 2020;133:1032.  Back to cited text no. 6
Akisin YA, Ozis SE, Poyraz MB, Kurt H. Hookah use and COVID-19. Turkish J Biochem 2020;45:911.  Back to cited text no. 7
Alagaili AN, Briese T, Amor NMS, Mohammed OB, Lipkin WI. Waterpipe smoking as a public health risk: Potential risk for transmission of MERS-CoV. Saudi J Biol Sci 2019;26:938-41.  Back to cited text no. 8
Jacob P III, Benowitz NL, Destaillats H, Gundel L, Hang B, Martins-Green M, et al. Thirdhand smoke: New evidence, challenges, and future directions. Chem Res Toxicol 2017;30:270-94.  Back to cited text no. 9
Cobb C, Ward KD, Maziak W, Shihadeh AL, Eissenberg T. Waterpipe tobacco smoking: An emerging health crisis in the United States. Am J Health Behav 2010;34:275-85.  Back to cited text no. 10
Koul PA, Kaul SK, Sheikh MM, Tasleem RA, Shah A. Lung cancer in the Kashmir valley. Lung India 2010;27:131-7.  Back to cited text no. 11
[PUBMED]  [Full text]  
India TV News Desk. Use of Hookah in public banned to contain coronavirus spread in Delhi. Use of Hookah in public banned to contain coronavirus spread in Delhi. August 4, 2020; Available from: https://www.indiatvnews.com/news/india/use-of-hookah-in-public-banned-to-contain-coronavirus-spread-in-delhi-639358 [last accessed February 3, 2021].  Back to cited text no. 12
Allahabad HC orders a ban on hookah bars in UP. National Herald. National; 2020. Available from: https://www.nationalheraldindia.com/national/allahabad-hc-orders-ban-on-hookah-bars-in-up [last accessed February 3, 2021].  Back to cited text no. 13
NDTV News India. Chandigarh Bans Hookah Bars To Contain Coronavirus. December 14, 2020. Available from: https://www.ndtv.com/india-news/chandigarh-bans-hookah-bars-to-contain-coronavirus-2338510 [last accessed February 3, 2021].  Back to cited text no. 14
WHO Regional Office for the Eastern Mediterrnean. Tobacco Free Initiative | Know the truth | Tobacco and waterpipe use increases the risk of COVID-19. Cairo, Egypt: WHO-EMRO; 2008. Available from: http://www.emro.who.int/tfi/know-the-truth/tobacco-and-waterpipe-users-are-at-increased-risk-of-covid-19-infection.html [last accessed September 23, 2021].  Back to cited text no. 15
Government of Alberta. Guidance for restaurants, cafes, pubs, and bars. 2020. Available from: https://open.alberta.ca/dataset/5d8d3adb-8fe4-417e-9545b1e49b0a720a/resource/8f82a5ad-25bb-45be-8f4b-4b5ba6bc360b/download/covid-19-relaunch-guidance-restaurants-cafes-pubs-and-bars-2020-0820.pdf. [last accessed February 3, 2021].  Back to cited text no. 16


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