Sayyed Awad, 50, was admitted to the intensive care in Mansoura, 130 kilometers away from Cairo, as he was close to having a comma and not able to breathe. After x-rays, he was diagnosed with acute pneumonia.
Awad was a two-pack-a-day smoker. Picking up the habit at a young age, his health condition has been worsening since long ago but just two weeks before ending up at the hospital, he showed signs of pneumonia symptoms. His coughs produced greenish phlegm, and he had a remarkable shortness of breath along with frequent fevers and headaches.
The big surprise in his case is yet to come. Awad was not responding well to the pneumonia treatment at the hospital, and he began to suffer from diarrhea and vomiting.
Doctors started to suspect that he had another disease and performed a nasopharyngeal swab test in which a thin cotton swab is inserted two inches into the nostril, aimed towards the throat. As a result, he also contracted H1N1 (swine) flu and was eventually referred to the isolation.
Awad was also smoking “shisha” (water pipe) close to three times every day with his friends who got together at coffee shops. To that end, the likelihood that the flu was transmitted to him through the water pipes was quite high. Doctors said that his immunity was getting weaker as a result of chain smoking.
According to his doctors, both pneumonia and H1N1 flus would have been preventable had he not been a nonsmoker or kicked the habit earlier on. “I tried to quit many times, but I could not. On top of that, my big urge to smoke and meet with friends whom I usually smoke with made me underestimate the high risk of smoking,” said Awad a few days before ending up in the hospital where his condition reached the point where he could not speak.
Statistics on smoking in Egypt compared to the global use
Awad is one of the steadily increasing number of victims of smoking in Egypt and worldwide. In Egypt, there are 34,000 tobacco-related deaths each year according to statistics by CDC's Morbidity and Mortality Weekly Reports. On the global scale, around 5.4 million deaths a year are caused by tobacco use. Smoking is set to kill 6.5 million people in 2015 and 8.3 million in 2030, with the largest increase in low and middle-income countries.
The global epidemic of lung disease kills 10 million people each year according to the World Lung Foundation.
According to statistics by the state-run Central Agency for Public Mobilization and Statistics, the number of smokers in Egypt reached 13 million people out of a population of 90 million. The number of smokers showed little change, even with 40% tax raises since July 2010 or graphic images which the ministry of health put on every pack of cigarettes as a warning from the terrible health consequences of smoking.
In Egypt, nearly 60 percent of men use tobacco in some form. Egyptians consume 80 billion cigarettes annually, equal to 4 billion packs of cigarettes. An estimated 1.3 billion people are smokers worldwide (WHO).
Egyptians spend 8 billion pounds annually on smoking, constituting 22% of the monthly income per individual. An Egyptian family spends only 5% of its annual income on health care.
Conference on Lung Health
Tobacco smoking as the main driver behind acute respiratory infections (ARIs) was one of the main issues discussed in the 41st Union World Conference on Lung Health, convened in Berlin in November 2010 by the International Union Against Tuberculosis and Lung Disease (The Union).
The union ranked Egypt as one of the top 15 priority countries in terms of tobacco use. The priority countries represent approximately two-thirds of the world’s tobacco users, including China, India, Indonesia, Russia, Bangladesh, Brazil, Mexico, Turkey, Pakistan, Ukraine, Philippines, Thailand, Vietnam, and Poland. Meanwhile, Egypt is also considered the leading Arab country in terms of tobacco-related deaths.
ARIs is a disease group that includes pneumonia, influenza, and respiratory syncytial virus (RSV) – a virus that causes respiratory tract infections – are responsible for 4.25 million deaths each year.
RSV is the most common source of severe respiratory illness in children, yet no vaccine is available and there is no established treatment despite all the medical progress achieved in the past century. Three million hospitalizations result from RSV, and mortality is seven times higher in the developing world according to the first-ever Acute Respiratory Infections Atlas published by the World Lung Foundation.
According to the Acute Respiratory Infections Atlas, the death rate from pneumonia is 215 times higher in low-income countries than in high-income countries. Every year, three to five million people globally contract severe flu infections and as many as 500,000 people die.
Although bacteria and viruses are the immediate causes of most acute respiratory infections, malnutrition, air pollution, smoking, and overcrowding are the underlying drivers of vulnerability. All these factors made Egypt, the most populous country in its region, a fertile soil for developing ARIs.
As for tobacco, the report called for raising tobacco prices, enforcing “no smoking” policies, providing education about the harms of smoking and
secondhand smoke, banning all forms of tobacco advertising and marketing, and expanding the use of health warnings on cigarettes.
According to the internationally acclaimed Neil W. Schluger, Chief Scientific Officer of the World Lung Foundation, over 4 million people worldwide die every year from ARIs, mostly from low-income countries. Twenty percent of all child deaths are due to ARIs, which also accounts for 1.6 million deaths annually among those over 60. Each year, approximately 156 million cases occur. Of these, 97% are in the developing world.
Yet, only 1.2% of total funding for global infectious disease research was spent on ARIs which represents 26% of total disease globally. This stands in sharp contrast to 42% of funding being devoted to HIV which is not as deadly as ARIs. "Only about 1.2 percent of the pharmaceutical industry is devoted to developing new antibiotics," said Schluger. "The number of new antibiotics is less than half of what it was 15 years ago."
These are not diseases with "attractive markets." Only patients with the ARIs buy the drug for a short while and do not use it for a lifetime, compared to sexual performance drugs like Viagra which are used by a far larger number of people worldwide, are marketed more successfully, sell better and offer greater financial incentives for their makers.
“ARIs are the third largest cause of mortality in the world and the top killer in low-and middle-income countries. The drivers of ARIs, such as malnutrition, air pollution, and tobacco use, can be largely addressed through poverty reduction strategies, evidence-based public policies, medical knowledge, and funding,” said Dr. Nils Billo, executive director of the union, during the press launch for the Acute Respiratory Infections Atlas held by the World Lung Foundation (WLF) at the conference.
“We expect that the number of deaths from HIV, TB and malaria will decline over the coming years, but tobacco-related deaths are on a rapid rise, so governments, especially in low-income countries, must provide strict legislation banning any form of promotion, including indirect commercials through movies, and should direct its censorship to this track,” said Dr. S. Bertel Squire, president of the union, during the inaugural sessions of the conference.
Dr. Squire underlined the importance of hiking up taxes on tobacco annually above the rate of the inflation, adding that governments must tighten its grip on people who smoke in public, “fine and punish either smokers or tobacco companies violating the law, and above all the culture of smoking in the mainstream public opinion must be changed.”
The German Fund
Asked about the German government’s role aimed at helping the low-income countries, including Egypt, in creating anti-smoking campaigns and combating subsequent diseases, Gudrun Kopp (Parliamentary State Secretary to the Federal Minister for Economic Cooperation and Development in Germany) said that the “German government is helping Egypt and the entire African continent through the Global Fund, and we allocated a budget of 20 million Euros for medical research and finding new drugs and vaccines.”
The Global Fund is specifically dedicated for fighting AIDS, tuberculosis and malaria. Moreover, it has committed US$21.7 billion in 150 countries to support large-scale prevention, treatment and care programs related to the three diseases.
Deadly effects of smoking compared to shisha
“Around 5.4 million deaths a year are caused by tobacco, and the number will increase to 8 million by 2030, with the biggest rise in low- and middle-income countries,” said Professor Bill Bellow, Technical Advisor on Tobacco Control with the union, who also serves as an honorary professor of public health at the University of Sydney.
Smokers usually tend not to think about the chemicals in cigarettes, but they are often attracted to the effects of nicotine, such as a “boost” in their mood, improved concentration, and a sense of well-being. Smokers often say cigarettes or water pipes help relieve the stress of daily life or calm them down when they are angry.
“I smoke socially, but I usually puff cigarettes when I am under stress, or when I am drinking with friends and I do care much about the warning or scary pictures on the packs of cigarettes. I am used to seeing those picture,” said Ibrahim Hassan who began smoking socially 6 months ago but had not yet turned into a chain smoker.
Yet, contrary to common belief, smoking has the opposite effect on the smoker. When the chemicals in cigarettes are inhaled, they put smokers’ bodies into a state of physical stress by sending literally thousands of poisons, toxic metals and carcinogens coursing through their bloodstream with every puff they take.
And those chemicals affect everything from blood pressure and pulse rate to the health of our organs and immune system. “Over 4000 different chemicals containing poisons, carcinogens and heavy toxic metals are in the tar, in addition to the nicotine which makes it difficult for most smokers to quit, simply because it is more addictive than heroin,” said Prof. Bellow during J2J lung health media training sessions in Berlin, a project of the Washington-based National Press Foundation, prior to the launch of the conference.
Around 60 of the chemicals, such as tar, in cigarettes are known to cause cancer and every 6.5 seconds, a smoker dies, according to the World Health Organization (WHO). In the 20th century, around 100 million people died from tobacco use.
As for water pipes, most people think they are less harmful than cigarettes as the tobacco smoke goes through the water at the bottom of the shisha container. The water is believed to be like a filter before inhaling the smoke. However, "one hour with a water pipe is equivalent to something between 100 and 200 cigarettes," said Dr. Fatima el-Awa from the World Health Organization's (WHO) regional office. In addition, water pipes recently became a high-risk source of infections and viruses transmissible via the breath and saliva as in Awad’s case.
Nicotine is the substance that hooks most smokers, but is there any way to get off? Yes, according to Dr Rachel Hanks, US addiction psychiatrist. She said that addiction is just a disease and curable: “Nicotine, like any addiction, is biopsycosocial illness. It is the disease of the brain, rather than the failure of the will. There is a reward system in the brain that is triggered when a person takes an addictive substance, so the brain has a very powerful drive to get rewarded.”
Surprisingly enough, one out of ten in the world is addicted some substance, but scientifically speaking, addictions are similar to many chronic disorders such diabetes or asthma, which requires unwavering commitment from the patient and full compliance to the treatment. This includes treating the mind, the body and the soul.
This in turn requires family work, medication, and “relieving all drivers leading to addiction, like the place you are used to smoking in and friends you smoke with. It is similar to kicking out habits that you used to do,” said Ibrahim Al-Feqy, trainer and expert in human development. Once you quit the nicotine addiction, it will be a big leap for the recovery.
Some think that stopping smoking gradually is better, but many others who succeeded in quitting said they just took a decision not to smoke any more, and they did it.
Although water pipes have less nicotine than cigarettes, they have more harmful chemicals such as tars and carbon monoxide. This may explain why European governments are banning such types of tobacco from entering their borders, and what is already used in Europe is smuggled. “This tobacco is like a pie in the sky in Germany, but I know a guy who travels frequently. He brings it [the tobacco] but in small quantities, which is why it is quite expensive here,” said Ahmad from Lebanon who runs a coffee shop serving water pipes in Berlin, Germany.
Around 100 million people died because of tobacco use in the 20th century, and tobacco use will kill 1 billion people in the 21st century if current smoking trends continue, according to the World Lung Foundation and the American Cancer Society.
So ready to die middle aged or live even longer and die old but with a cancer or fatal disease? Keep smoking, according to researchers in Norway who tracked more than 50,000 people for a quarter century.