Dlamini-Zuma’s smoking science is shaky, and she omits crucial facts

Cooperative Governance and Traditional Affairs Minister Nkosazana Dlamini-Zuma says research shows “the use of tobacco products not only increases the risk of transmission of Covid-19, but also the risk of contracting a more severe form of the disease”.

The research in question, however, is not quite so clear cut.

Earlier this month, the Fair Trade Independent Tobacco Association (Fita) launched an urgent application challenging government’s controversial ban on tobacco sales during the national lockdown. Fita asked for the minutes from the meetings at which the National Coronavirus Command Council decided on the lockdown regulations and, specifically, the tobacco sales ban.

The government refused to provide the minutes, but agreed to furnish Fita and the court with a record of decision.

The record, which was filed this week, included a cache of research and a 17-page affidavit signed by Dlamini-Zuma, explaining the “overarching rationale” behind the ban.

The minister said scientific studies assessing the links between tobacco use and Covid-19 were still in progress, but “it is possible to draw some conclusions from the data generated thus far”.

“First, the available research showed that the severity of Covid-19 outcomes is greater in smokers than non-smokers. Smokers have higher ICU [intensive care unit] admissions, higher need for ventilation and a higher mortality rate than non-smokers.”

To support this, the minister cited “a large study of 1,099 patients with Covid-19”, which she said found that “among the patients with severe symptoms, 16.9% were current smokers and 5.2% were former smokers, in contrast to patients with non-severe symptoms, where 11.8% were current smokers and 1.3% were former smokers”.

“In the group of patients that either needed mechanical ventilation, admission to an ICU or died, 25.5% were current smokers and 7.6% were former smokers,” she added.

What the minister did not say, however, was that while the study did include a total of 1,099 patients, it only included 173 patients with severe symptoms.

And an article discussing the study, which was included in the record, in fact stated that “no statistical analysis for evaluating the association between the severity of the disease outcome and smoking status was conducted”.

“Another study found that among those who were infected with Covid-19 and died, 9% were current smokers,” the minister went on in the papers.

In reference to that study, however, the same article compared this figure to the 4% of those who did not die and were smokers; and concluded there was “no statistically significant difference between the smoking rates of survivors and non-survivors”.

When she announced the ban would be extended to level 4 – and now level 3 – of the lockdown, Dlamini-Zuma last month said that 2,000 people had written to government to voice their opposition to lifting the ban. Again, however, what she did not say was that several people also wrote to the government to voice their support for such a move. Included in the record filed this week were thousands of the public comments made.

One read: “I have been complying with the lockdown regulations but I am a smoker. Finding cigarettes is the only reason I moved from place to place.”

Another read: “I realise that most choices in life have pros and cons but, to the extent that we keep our ‘bad habits’ to ourselves, I am asking that supermarkets open up to selling wine and cigarettes.”

Constitutional law expert Professor Pierre de Vos said yesterday that to prove the ban was rational, the minister would have to show it was likely to reduce either the spread of Covid-19 or the number of people who got severely sick or died from it.

“From her affidavit, it doesn’t look like she has managed to make that link.”

What the public told her

• “Can you please lift the lockdown for vaping. Vaping saved my life and and help me quit smoking cigarettes.”
• “The curfew is just a way of criminalising normal human behaviour and is unlikely to make any difference to the spread of the virus. Cigarettes and alcohol restrictions fall into the same category.”
• “All those banned cigarettes sold by supermarkets and any shop in the country are sold on the streets with higher prices. Skuif or passing of a cigarette by one another is rife because some can’t afford to buy it, being expensive. Lift it to reduce the risk of passing the diseases from one person to another.”
• “Please allow vape juice sales.”

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