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The End of Smoking?

The role of casinos in reducing the risks of Covid-19

The End of Smoking?

The Covid-19 pandemic has closed all 989 commercial and tribal casino properties in the U.S. This is an unprecedented opportunity to reevaluate the risks and benefits of making these facilities smoke-free.

We’re well aware of our need to minimize the risk of transmission of Covid-19. We know we must implement Centers for Disease Control and Prevention (CDC) recommendations regarding physical distancing and barriers, masks and hand-washing, and evaluate team members for evidence of infection.

We also know that older individuals and those with chronic disease are at substantially increased risk for more severe disease. Notably, 58 percent of casino players are aged 50 years or greater.

Additionally, there’s emerging evidence that smokers are also a group vulnerable to Covid-19. In addition to its role in the development of chronic diseases such as heart disease, stroke, chronic obstructive pulmonary disease and cancer, smoking cigarettes has been determined as a risk factor for severe complications and death from Covid-19 by both the CDC and the World Health Organization (WHO), as well as others in the medical profession. In addition, while young adults are at a lower risk, the effects of smoking on the respiratory system make it more likely that smokers may have increased susceptibility to the virus.

Smokers may be especially susceptible to transmission because they move cigarettes to and from their mouths (and associated mucous membranes) and then touch and contaminate surfaces—by necessity, without a mask in place to protect others nearby.

Recent studies reveal that chronic secondhand smoke exposure worsens pulmonary inflammation and compromises the host’s ability to combat chronic and acute respiratory infections. That increases the likelihood that smokers will contract Covid-19, and limits their defense against it, in addition to increasing the well-known risk of both heart disease and lung cancer by 20 percent to 30 percent.

The fact that secondhand smoke compromises the host’s ability to combat respiratory infections raises serious health and liability concerns about casinos that allow smoking in their facilities.

Finally, as revealed in two recent studies, growing evidence reveals that aerosolized coronavirus particles exist in the air. A recent New England Journal of Medicine article raised concerns regarding aerosol and fomite transmission of SARS-CoV-2, especially since it’s been shown that the virus can remain viable and infectious in aerosols for hours.

As asymptomatic or pre-symptomatic but infected individuals exhale smoke through an infected respiratory system which is then expelled into the surrounding air, there exists the potential risk of coronavirus-carrying secondhand smoke particles that actually rise into the air instead of falling to the ground due to the warmth of the smoke.

This would actually lengthen the duration of airborne coronavirus particles in the air with the potential for entering the ventilation systems for wide distribution. Another group of researchers noted, “Of paramount concern is transmission from asymptomatic but infected caregivers via secondhand aerosol from e-cigarettes and secondhand smoke.”

Unfortunately, we’re also aware that, as noted by the American Society of Heating, Refrigerating, and Air Conditioning Engineers (ASHRAE), that casino ventilation systems do not eliminate exposure to the gases, toxins, carcinogens and particulate matter contained in secondhand smoke and e-cigarette aerosol. In fact, ASHRAE states, “The only means of effectively eliminating health risks associated with indoor exposure is to ban smoking activity.” This position is strongly reinforced by both the CDC and WHO.

While Nevada gaming operators have maintained a longstanding opposition to suggestions that smoking be prohibited in casinos, many other states and cities have moved forward with very good results.

There are now more than 800 smoke-free gambling venues in the U.S. Over the past few years, operators in multiple states such as Maryland, Massachusetts, Ohio and New York have developed smoke-free casinos. These casinos have been shown to successfully compete with others, whether smoking or not, in their regional markets. Smoke-free indoor air is simply not a barrier to providing a successful casino business, especially since 87 percent of U.S. adults are nonsmokers, including most casino visitors.

With casinos now closed until the pandemic parameters improve, and considering that reopened casinos will likely require masks for visitors, now is the time to move forward on making our casinos smoke-free for their employees and guests and to mitigate their liability.

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James M. Galloway, MD, FACP, is a cardiovascular medical doctor, media commentator and speaker. Galloway was assistant U.S. surgeon general, a rear admiral in the United States Public Health Service and the regional health administrator for the U.S. Department of Health and Human Services under presidents Bush and Obama.

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