Since water pipe (Hookah) smoking is typically an activity that takes place within groups in public settings and water pipe use increases the risk of transmission of diseases, it could also encourage the transmission of COVID-19 in social gatherings.
According to WHO, smokers are likely to be more vulnerable to COVID-19 as the act of smoking means that fingers (and possibly contaminated cigarettes) are in contact with lips which increases the possibility of transmission of virus from hand to mouth. Smokers may also already have lung disease or reduced lung capacity which would greatly increase risk of serious illness.
Smoking products such as water pipes often involve the sharing of mouth pieces and hoses, which could facilitate the transmission of COVID-19 in communal and social settings.
Conditions that increase oxygen needs or reduce the ability of the body to use it properly will put patients at higher risk of serious lung conditions such as pneumonia.
There is an abundance of evidence regarding the vulnerability of smokers and those with COPD to contract influenza, tuberculosis and other lung conditions
We found, as some others recently noted, that angiotensin-converting enzyme-2 receptor increases in the lungs of smokers and patients with COPD, a potential therapeutic target for COVID-19 and the importance of smoking cessation. We reported that ACE2 is upregulated in the lungs of smokers and patients with COPD. As per earlier reports, it was noted that ACE2 receptor is upregulated in small airway epithelium including brush borders, type-2 pneumocytes and alveolar macrophages.
The expression was more in patients with COPD compared to normal lung function smokers, and none or little in never smokers, which shows that smoking regulates ACE2 expression and having COPD further exaggerates it, hence more susceptibility for COVID-19 in this population.