Has coronavirus killed off shisha cafes forever?

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Caline Malek
June 12, 2020

Compared with non-smokers, studies show smokers overall are more likely to develop severe COVID-19 symptoms

WHO warning says shisha smoking could facilitate coronavirus transmission in social settings

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DUBAI: The age-old, convivial practice of sharing the shisha, or the waterpipe, during an evening of conversation and laughter has long been an integral part of many cultures, including in the Middle East. But now it is facing its biggest test of survival in living memory.

The World Health Organization (WHO) says using shisha involves the sharing of mouth pieces and hoses, which could facilitate the transmission of the coronavirus in social settings. The Middle East, with its thousands of shisha cafes, is particularly vulnerable.

As the pandemic gripped the world, many countries in the region — including Saudi Arabia, the UAE and Kuwait — imposed bans on shisha use. But this practice was drawing flak even before the COVID-19 era, with health experts warning that it was even more harmful than cigarette smoking.

According to the WHO advisory on shisha, “one hour of shisha use is equal to smoking approximately 100 cigarettes. It can be less or more, depending on the many factors.”

A review of studies by public-health experts convened by WHO on April 29 found that compared with non-smokers, smokers overall are more likely to develop severe COVID-19 symptoms. It also found that smoking impairs lung function, making it harder for the body to fight off coronaviruses and other respiratory diseases.


A man smokes a waterpipe (shisha or hookah) at the premises of the first traditional Turkish bath (Hammam) opening in the occupied Palestinian West Bank city of Hebron on March 11, 2019. (AFP/File Photo)

Dr. Assem Youssef, specialist pulmonologist at Medcare Hospital in Dubai, says shisha smoke contains high levels of tar, carbon monoxide, heavy metals and cancer-causing chemicals.

It increases the risk of lung and oral cancers, heart diseases and other circulatory diseases. “Shisha use by pregnant women can result in low birth-weight babies,” Dr. Youssef told Arab News. “Shisha pipes, if not cleaned properly, may lead to serious infectious diseases.”

Shisha and COVID-19

Smokers overall are more likely to develop severe COVID-19 symptoms, compared to non-smokers (WHO).

“In shishas, only the nozzle is replaced after every use,” said Dr. Rami Sukhon, a specialist in family medicine at Dubai’s Al Zahra Hospital. “When smoking the shisha, there is a risk of the particles of saliva travelling through the nozzle down to the shisha base, which is not sterilized after a smoker is done with it,” he said.

“Further, shisha cafes are usually closed spaces, especially in summer, where several people exhale large volumes of smoke through their mouths and nose into the same air – this also poses the risk of spreading the virus through droplets released into the air.”
However, more research is required to assess the exact level of risk, Dr. Sukhon said.

On the matter of e-shishas, electronic water pens which operate in the same manner as an e-cigarette, experts say these are just as harmful.

The WHO has strongly recommended their ban in public places. However, the spread of the virus through the e-shisha has a different context.

“In e-shishas, if the shisha pen is not shared between people and is not smoked within a closed room with other people, the risk of spreading the virus can be considered as being lower,” Dr. Sukhon told Arab News. “Also, the volume of smoke from a shisha pen is less than from an actual shisha.”


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