Smokers particularly at risk of coronavirus complications

Our readers have their say on smokers, Italy, and clapping in the evening
A woman wearing a face mask smokes a cigarette in Vilanova i la Geltru near Barcelona on March 24, 2020 amid a national lockdown to stop the spread of the COVID-19 coronavirus. Spain is Europe's second-hardest hit country by the coronavirus outbreak, with over 33,000 confirmed cases of the disease and 2,182 deaths. / AFP / LLUIS GENE

I write to you in reference to your recent coverage of the coronavirus pandemic. Cigarette smoking is rarely, if ever, mentioned in the context of the current pandemic. Smoking, active and passive, reduces the immune systems significantly and is associated with at least twice the risk of viral or bacterial infections. If a smoker is infected he is more likely to get a pulmonary complication and die than a non smoker. A smoker is more likely to need a ventilator if infected. A small study from China suggests that a smoker who is on a ventilator is much more likely to die than a non smoker.
Much of the modelling for the current pandemic is based on data from China. However, about fifty five per cent of Chinese men smoke. If this smoking prevalence was fed into the modelling of covid-19 it is likely to alter the sensitivity of the input data, thus providing a less extreme model. Smoking rates in Italy and Spain are twice those of the UK. It has been said that all models are wrong but some are useful, the usefulness depends on the amount of common sense applied.
At the very least, the UK authorities should be informing people about both active and passive smoking risks and strongly encouraging people to stop. For some this is not the best time to try to stop smoking but they should be made aware of the risks and isolate themselves even more stringently. Hopefully, this will reduce the number of ventilator episodes and thus some of the pressures on intensive care units. However large or small the effect of advice on smoking, the impact for the individual and the NHS as a whole may be very important.
We must try to get it right.
Dr C K A Foote, Amersham

Italy's tragedy must not be repeated

I write to you in reference to Nicky Harley's article Italy records world's highest coronavirus daily death rate as figures reach almost 1,000 (March 28). It is heartbreaking to hear about the deadly impact the virus has had on Italy. I hope other countries will take stock of the Italian tragedy and act quickly.

K Ragavan, Bengaluru

Evening applause is great but there are those who need sleep 

I write to you in reference to Katy Gillett's article Watch: Rounds of applause 'for unsung heroes' echo around Dubai and Abu Dhabi on Wednesday night (March 25). I understand some people wish to show their support to medical staff. But my elderly father works tirelessly in the morning and is in bed by 9 pm. I cannot stop him from working but the least I can do is ensure that he gets a good night's sleep, which has been quite difficult for the past week due to the loud noises.

I welcomed this initiative the first time around thinking it would be a one-off, but it has become a daily ritual. In this time of covid-19, we need to think about our elderly.

Sidra Parveen, UAE