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Because smoking aggravates symptoms of the novel coronavirus,
reduces the efficacy of its vaccine, and more easily causes ongoingconditions, what would you think about more carefully monitoringsuch harmful products when they are sold without much regulation?

I would like to inform you that people using tobacco products are extremely vulnerable
to the new coronavirus. I think that people responsible for product liabilities should
publicize the information about hazards to smokers.
https://elaws.e-gov.go.jp/document?lawid=406AC0000000085_20200401_429AC0000000045

Prime Minister Fumio Kishida
For the attention of the Cabinet Secretariat
Minister of Finance Shunichi Suzuki
Minister of Health, Labor and Welfare Katsunobu Kato

28 November 2022

Manabu Sakuta, Chairperson, Japan Society for Tobacco Control, General incorporated

Novel coronavirus and smoking:
The novel coronavirus has afflicted the world during three long years, and the following
three points have become clear.
In brief, it has been shown that1 If you smoke, you are more likely to become seriously ill or die.
2 The efficacy of vaccines is lower than for non-smokers
3 Sequela (ongoing pathological conditions commonly called long COVID) tend to lastlonger
Point 1 was first identified by Michiyuki Matsuzaki, the director of this society, and wasformally analyzed by Guan et al.1) on 28 February 2020. I then reported this information,and the FCA (FCTC Alliance) acknowledged it too. It was later acknowledged by theWHO based on a paper by Liu et al.,2) and on 20 March 2020 the WHO director generalannounced the association in the opening remarks, establishing worldwide guidance for
tobacco control.

Recently, a paper from Yokohama City University 3) stated that smoking

was the worst among the risk factors for aggravated symptoms during the Delta andOmicron epidemics, associated with nearly four times the severity. This risk was greaterthan for those having underlying medical conditions like obesity.

Risk of aggravated symptoms

Smokers

Non-smokers

Having underlying
conditions

Regarding point 2, papers have been published in Europe, the United States and Japanshowing that smokers produce no more than about half of the level of neutralizing
antibodies that non-smokers can produce. Similar results have been published for thoseusing heated tobacco4,5).

Level of neutralizing antibodies
10035
Non-smokers

Smokers

55
Having underlying
conditions

As for point 3, since around May 2020, studies have identified sequela of the novel
coronavirus (ongoing pathological conditions commonly called long COVID) to include

fatigue, shortness of breath, impairment of taste and smell, adverse effects on thinking
and memory, hair loss and joint pain. For smokers, the risk of developing such sequela
is 4.1 times higher according to an Italian study6), 8.4 times higher according a Britishstudy7), and the risk of depression among coronavirus patients is 5.5 times higher for
smokers according to a Chinese paper8).
Furthermore, there are also Japanese data9) which show that smokers took longer torecover from the sequela of coronavirus.

Risk of developing sequela (non-smokers = 1)

ItalyUKChina

As the person responsible for product liabilities, you must inform all users of tobacco
products about these facts, urgently, and I kindly ask that you please take steps likepublicity campaigns in this matter.

References
1) Guan W, Ni Z, Hu Y, et al. Clinical Characteristics of Coronavirus Disease 2019 in
China. N Engl J Med , April 30, 2020; 382:1708-1720 doi: 10.1056/NEJMoa2002032.

/Viewed 1st Oct. 2022
2) Liu W, Tao ZW, Wang L, et al. Analysis of factors associated with disease outcomesin hospitalized patients with 2019 novel coronavirus disease. Chin Med J (Engl) 2020
May 5; 133(9): 1032-1038. doi: 10.1097/CM9.0000000000000775. /Viewed 1st Oct,2022
2)b Smoking history is the greatest aggravating factor for COVID-19 pneumonia
http://www.jstc.or.jp/modules/information/index.php?content_id=246
3) Smoking is the worst: risk of severe symptoms of novel coronavirus during the Delta
and Omicron epidemics
http://www.jstc.or.jp/uploads/uploads/files/essay/220120corona.pdf4) 1. Smokers lose immunity from the novel coronavirus vaccine faster 2. Efficacy ofinoculation for people who are infected with the novel coronavirus: smokers have about
40% fewer neutralizing antibodies than non-smokers
http://www.jstc.or.jp/uploads/uploads/files/information/221026corona.pdf
5) Even after receiving a vaccine, smokers can not develop sufficient immunity.
http://www.jstc.or.jp/modules/information/index.php?content_id=295
6) Buonsenso D, Gualano MR, Rossi MF, et al. Post-Acute COVID-19 Sequelae in aWorking Population at One Year Follow-Up: A Wide Range of Impacts from an ItalianSample. Int J Environ Res Public Health. 2022; 19(17): 11093. Published 2022 Sep 5.
doi:10.3390/ijerph191711093
7) Paul E, Fancourt D. Health behaviours the month prior to COVID-19 infection and thedevelopment of self-reported long COVID and specific long COVID symptoms: alongitudinal

analysisof1581

UKadults.

BMC

PublicHealth:

22:

1176

https://doi.org/10.1186/s12889-022-14123-7/ Viewed 1st Oct, 20228) Li Z, He J, Wang Y, et al. A cross-sectional study on the mental health of patients with
COVID-19 1 year after discharge in Huanggang, China [published online ahead of print,2022 Oct 3]. Eur Arch Psychiatry Clin Neurosci. 2022; 10.1007/s00406- 022-01484-8.
doi: 10.1007/s00406-022-01484-89) Smokers take longer to recover from long corona
http://www.jstc.or.jp/uploads/uploads/files/information/221123c.pdf