Smoking and COVID-19

Smoking Cessation Banner

Smoking is a major risk factor for heart disease and stroke as well as many other serious conditions including cancer, respiratory and reproductive diseases. These conditions can affect people of all ages and tragically one in two smokers will die of a tobacco related illness.

Therefore, all efforts to support a smoke FREE society must be supported and we welcome the ban on the sale of menthol cigarettes from May 20th 2020. The pleasant taste from these cigarettes masks the true taste of tobacco and makes it easier for people to start smoking and to stay smoking.

If you are a smoker, the single most important thing you can do for your health is to give up! If there was ever a time to quit, now is it.

How does smoking increase the risk of COVID 19?

The COVID-19 pandemic has made it more important than ever to quit. Smoking can weaken your immune system and increase your risk of developing COVID-19 and suffering complications if you do get infected. The most recent evidence from the World Health Organisation highlights that smokers are more likely to develop severe disease with COVID-19, compared to non-smokers.


Tobacco smoking affects the function of the heart and lungs making it harder to respond to an acute infection. This happens as the natural barriers in the lungs are weakened and may make it easier for coronavirus to attach itself to the lung surface and infect lung tissue.

People who smoke are more likely to get the flu and are more likely to have a worse infection than people who don’t smoke. And just like the flu, a coronavirus infection may be more severe in people who smoke and will take longer to recover from the illness.

Hand to mouth

The virus can be transferred by hands, objects such as a cigarettes/vapes or surfaces. This why people are advised to reduce the amount of times they touch their face. This risk is increased when you smoke, as you are more likely to touch your face. Bringing your hands to your mouth frequently when smoking, can transfer the virus into your body.

Smokers who share cigarettes or vaping devices are also increasing their exposure to the COVID-19 virus.

How can I reduce my risk?

Stopping smoking or vaping now will lower the risk of severe symptoms and improve your outcomes if you contract the COVID-19 virus.

When you stop smoking the benefits are immediate:

  • the natural hairs in your airways (cilia) begin to work again which helps build your natural resistance to all types of infections
  • within 20 minutes your blood pressure and heart rate lower
  • after 8 hours the oxygen levels in your blood improve
  • after 72 hours your breathing and energy levels increase
  • after 2-3 months your lung capacity can improve by as much as 20-30%. All of these benefits will help reduce your risk and put you in a good position to fight the virus.

Don’t share cigarettes or vapes as you are potentially transmitting and spreading the virus between people.

Avoid smoking around others, as second hand smoke affects the airways and weakens the body’s immune system. Second hand smoke is particularly dangerous to children as their breathing rate is faster than adults so their lungs are exposed to more smoke.

Advice for quitting

Your own willpower and determination are essential components for quitting and getting the right help can double your chances of success. There are various treatment options available to help you quit and these include:

  • Nicotine replacement therapy (NRT) – can help to reduce cravings and manage withdrawal symptoms. People who use NRT to help them quit smoking are twice as likely to succeed compared to those who don’t. NRT is available at all pharmacies, without prescription.
  • Medication on prescription – examples include: Champix (Varenicline HCL) and Zyban (Bupropion HCL SR). These medications can double or triple your chances of quitting successfully. Your GP will help you decide which medication is right for you. However be sure to speak to your GP well in advance of your quit date as these medications are often taken for a period of time prior to quitting.

If you are thinking about quitting smoking or would like further information about the different support methods available visit the HSE website or call the HSE quit line on 1800 201 203. Both services are still operational throughout COVID-19 pandemic.

Diabetes and COVID-19

Diabetes is a major risk factor for heart disease and consequently many people living with diabetes are also living with heart conditions. It is unclear if having diabetes puts you at greater risk of contracting COVID-19 than anyone else, however it does increase your risk for complications if you contract the virus. Recent data from the Department of Health has highlighted that 23% of all ICU admissions due to COVID-19 have underlying diabetes. Having diabetes causes the body to raise glucose levels during times of illness or stress which makes it more difficult to fight infection.

To reduce your risk of contracting COVID-19 you need to be extra vigilant by following the advice of the HSE and taking the recommended precautionary measures. You should be aware of the signs and symptoms of the virus, and if do become unwell phone your doctor to arrange an assessment and testing.

Be prepared

Be extra attentive to your glucose control and monitor on a regular basis if you have a blood glucose monitor. Regular monitoring can help avoid complications caused by high or low blood glucose levels. Ensure to have a supply of quick acting carbohydrates if your blood glucose levels drop, these include non-diet sugary drinks, fruit juice, jelly babies and glucose tablets.
There is no disruption to the supply of medicines and therefore there is no need to order more medicines than you need. However, you should make sure you have a 2 week’s supply. Supplies should include ketone strips if you have type 1 diabetes and an insulin pen if you use an insulin pump in case of pump failure.
Ensure you have a sick day regime to follow. This is a plan that has been agreed between you and your health care provider, with information and advice about how you should manage your diabetes if you become unwell. If you don’t have one you should contact your GP for advice.

Diet and emotional eating

A healthy, balanced and varied diet is important for everyone, but especially so for people with diabetes. During these uncertain times, you may find it more difficult to maintain a healthy diet. With more time at home, increased stress and worry, and reduced activity, you may find that your normal food intake has changed and diabetes management has become much more challenging.

It’s important to keep to a structured meal pattern as much as possible. Here is where a little planning will go a long way. Try to jot down a general plan of meals and snacks for the week ahead, and base your shopping list off of this.

Generally, aim to have 3 main meals, spaced throughout the day with 1-2 healthy snacks if needed. However, if you find you have a reduced appetite you may be under-eating, it can be best to have a “little and often” approach such as 3 smaller meals with 3 more nutritious snacks that are higher in energy. Both approaches will not only help to stabilize blood sugars throughout the day, but will also help you keep your appetite, or physical hunger levels in check. This in turn will help to prevent under or over eating. See our list below for snack ideas.

Healthy low calorie snack ideas:
• A piece of fruit and low fat plain yoghurt
• Hummus and vegetables
• A small handful of nuts (30g)
• ¼ avocado on 2 rice cakes
• Hard- boiled egg
• Low fat cottage cheese with fruit

Higher calorie snack ideas:
• Full fat Greek yoghurt with nuts and seeds
• Peanut butter on wholegrain toast
• ½ avocado on 4 rice cakes
• A 200ml glass of full fat milk
• A matchbox of cheese on wholegrain crackers

For healthier sweet treats that have less impact on blood sugar levels:
• Home baking using zero calorie sweeteners such as Stevia or Canderal
• Sugar free jelly
• A couple of squares of dark chocolate
• Low fat Greek yoghurt with peanut butter and raspberries
• Sugar free soft drinks

It is important to stay hydrated and aim to drink about 2 Litres of water per day. For those trying to increase their appetite, it is best for now to avoid too much caffeine and artificial sweeteners as these can suppress appetite.


Continuing to exercise is beneficial for your physical and mental health and importantly it helps improve diabetes control through the lowering of blood glucose levels. If you previously went to the gym or swimming, consider cycling or walking but be sure to follow social distancing recommendations and stay within 5km of your home. You could also try one of our online exercise programmes.

If you take medications that put you at risk of a hypo (this is when your sugar levels become too low and you can feel unwell) make sure you carry a fast acting carbohydrate snack and monitor your blood sugar levels as you normally would.
Ensure you check your feet after exercise for red marks and blisters, this is because individuals living with diabetes often have reduced sensation in their feet and are at increased risk of foot infections and injury.

Routine appointments

Many appointments have been cancelled or postponed due to the COVID-19 outbreak, this is to reduce the risk of infection for both patients and staff members. If you were due to attend for retinal screening, chiropody or your annual diabetes review, your appointment will be rearranged once it is safe to do so. However, your GP is still available and you should phone if you have any concerns, questions about your medication, or if you notice or develop any of the following:
• Changes to eyesight
• Consistently high or low blood glucose readings.
• Red, bruised or broken areas to your feet
• Signs of infection or you become unwell


You should continue to take your diabetes medication as normal. If you have any concerns it is important that you link with your GP who will connect you with the Diabetes team where necessary.

Further information

Further information on COVID-19 and diabetes can be found here:

Croí supports IPPOSI statement on PPI during pandemic

Statement released: May 12, 2020 by The Irish Platform for Patient Organisations

As the COVID-19 pandemic continues to unfold, IPPOSI are keen to ensure that the patient perspective is understood alongside broader public health considerations. To this end, our network of members, which includes 100+ patient organisation members (as well as many other individual patients), stands ready to provide support to Ireland’s health system in any way we can during this difficult time.

We have over a decade of experience in facilitating multi-stakeholder dialogue in response to a range of health challenges (access to medicines, e-health, patient involvement, clinical research). We regularly convene around one table as patients, academics, scientists, clinical researchers, pharmaceutical representatives, and healthcare professionals to identify areas of consensus and to propose solution-oriented responses.

We offer the knowledge, experience and breadth of this network as we continue to advocate for patients to be:

  • involved in the preparation of new policy documents, new research proposals, new innovative tools and treatments.
  • recognised as key partners in the design, delivery and evaluation of digital health solutions from the earliest possible stage.
  • informed and updated around the supply chain for existing medicines; and reassured that the process of assessing and reimbursing new medicines continues.


Strengthening our mutual commitment to patient-centricity and patient involvement

We understand that many decisions now need to be taken within an extremely short timeframe, however we underline that expediency should not trump the quality and/or representativeness of these decisions. Patients need to be involved in the preparation of new policy documents, new research proposals, new innovative tools and treatments. Involvement (particularly early involvement) can ensure that all perspectives inform the direction of travel and that key decisions and initiatives are informed by people’s ‘lived experience’. It is likely that this involvement can build confidence in both the process and the decision. We acknowledge that there may be instances where it is not possible to directly involve patients, and on these occasions, decisions must be consistent with agreed, existing national policy or clinical guidance (documents which hopefully benefitted from patient involvement during development).

**Currently, the NIHR (UK) has demonstrated best practice in this field by renewing its commitment to patient involvement, participation and engagement during the COVID-19 pandemic and by publishing eight new commitments to inform its approach during this period on 16 April 2020.


Investing in our health future by developing patient-driven digital solutions

We recognise that health systems are currently working hard to put in place digital solutions to address health sector challenges during a period of prolonged social distancing. We believe that to maximise the opportunities which digital health affords us, and to minimise the risks, patients need to be recognised as key partners in the design, delivery and evaluation of digital health solutions from the earliest possible stage. Decisions around how data is collected, stored, managed, used and shared must be informed by patient perspectives. We welcome the invitation from the National Children’s Hospital to incorporate patients and families in the process of procuring Ireland’s first national electronic health record. We understand that there are many other e-health projects already under implementation or in pilot phases, and we ask that patients be extensively involved in their evaluation and/or their modification for future large-scale roll out.

**The Data Guardian (UK) is organising a series of ‘Public Dialogue’ workshops throughout 2020 to support and develop guidance for data controllers (including health and social care providers) around how to carry out public benefit assessments when deciding on whether data should be used for purposes beyond individual care. The project oversight group includes patients.


Guaranteeing our medicines supply and approving the use of new (non-COVID) medicines

We know that governments around the world are under pressure to secure the supply of existing medicines (especially those touted as potential COVID-19 treatments) and that national resources have been redirected to the fight against COVID-19. However, we ask that both these efforts are balanced against the needs of the chronic and/or rare disease communities who rely on existing medicines and new medicines to improve their short- or long-term health outcomes.

Firstly, patients need to be informed and updated around the supply chain for existing medicines. Working together, we believe government, industry and patient leaders can get ahead of the media curve and provide reliable patient-tailored information directly to affected individuals and families, thereby reducing undue stress and stockpiling. We welcome the important work already done by the HPRA[1], the government and industry in this space.

Secondly, patients need to be reassured that the process of assessing and reimbursing new medicines continues. Accepting that we may be living with COVID-19 for some time, we must, at all costs, avoid the perception of a hierarchy of health needs. Patients need to be able to manage their existing conditions, and new medicines offering potentially life-saving or life-improving outcomes need to be reviewed for their clinical (and cost) effectiveness and made available for use. This is especially pertinent for immunosuppressed patients as new treatments may offer the potential to reduce their risk of complications as a result of underlying condition(s) were they to contract COVID-19. In line with our Patient Charter published in February 2019, we believe that strengthening patient involvement across the medicines assessment and reimbursement process will help bring these important issues to light.

**NICE (UK) has dedicated a section to keep the public updated on the progress of its assessment of new medicines. It shares a list of treatments which have been prioritised for assessment, including all new cancer medicines.

**IMPORTANT TO NOTE: All examples shared above have been taken from the UK. Unquestionably many of our European Member States are also working hard to involve patients in different aspects of the health sector during this difficult time, however the details of these efforts many not yet have been shared widely for English-speaking audiences.


This position is supported by IPPOSI patient, science and industry representatives. It has been reviewed and endorsed by:

The IPPOSI Board: representatives from patient, science and industry elected to provide strategic advice and governance

  • Ava Battles (Chair)MS Ireland
  • Neil Johnson, CROI
  • David McMahon, Irish Skin Foundation
  • Sarah O’Connor, Asthma Society Ireland
  • Anne-Marie O’Dowd, Cystinosis Ireland
  • Grainne O’Leary, Arthritis Ireland
  • Julie Power, Vasculitis Ireland Awareness
  • Kevin Whelan, Fighting Blindness
  • Orla Hardiman, Trinity College Dublin
  • Anne-Marie Healy, Trinity College Dublin
  • Louise Hopper, Dublin City University
  • Jason Last, University College Dublin
  • Jean Saunders, University of Limerick and CSCS consulting
  • Gaye Stephens, Trinity College Dublin
  • Nuala Carey Abbvie
  • Eleanor Hannon, Biomarin
  • Conchuir MacGlionn, Roche
  • Susanne O’Reilly, Novartis
  • Brid Seoighe, Janssen

The IPPOSI Policy Advisory Committee: representatives from patient, science and industry selected for their expertise in health policy.

  • Tomás Carroll, Alpha-1 Foundation
  • John Dowling, Men Against Cancer
  • Aoife Kirwan, MS Ireland
  • Rachel Morrogh, Irish Cancer Society
  • John McCormack, Policy Advisory Committee member
  • Julie Power, Vasculitis Ireland Awareness
  • Gaye Stephens, Trinity College Dublin
  • Gianpiero Cavalleri, RCSI
  • Jon Salsberg, University of Limerick
  • Clare Harney, IMSTA
  • Carmel Mulroy, Bayer
  • Fred Doherty, Sanofi
  • Paula Guerin, independent consultant (industry representative)

Croí Responds to COVID-19 in the West of Ireland

New Service Launched for Heart & Stroke Patients & Carers

Local Heart & Stroke Charity Croí is responding to the increased needs of those living with heart disease and stroke, as a consequence of COVID-19. Since the beginning of the coronavirus crisis, Croí has been experiencing an ever-increasing demand for information, support and advice from heart and stroke patients and their carers.

“Our health team of community nurses, dietitians, physios and exercise specialists are receiving phone calls, emails and significantly increased web and social media correspondence from all over Ireland – with the greatest demand being from the west of Ireland” says Croí CEO Neil Johnson, who outlined the reasons for this as:

  • Increased fear, anxiety and worry among heart patients and their families due to their increased vulnerability to COVID-19.
  • Increased need for reliable information and reassurance from a healthcare professional.
  • Increased isolation and loneliness.
  • Reduced access (perceived and real) to GP’s, or community health services.
  • Reduced access to services (e.g. cardiac rehabilitation, heart failure nurse specialists etc.) due to redeployment of HSE staff or postponement of services.
  • Cancelled or postponed clinic appointments or hospital procedures.
  • Reduced quality time with doctors or nurses – quicker discharge from hospital; shorter appointments (e.g.: virtual clinics).

“Many people are afraid to visit their doctor or hospital, despite having symptoms that warrant attention and this will lead to adverse or worse outcomes,” said Johnson.

With funding support from local and national healthcare companies, Croí has launched a new community support service across the West of Ireland – Heartlink West – with endorsement from the cardiology services of the Saolta Group.

Announcing details of this new initiative, Croí CEO Neil Johnson said that: “Heartlink West will provide FREE support from our community based, multi-disciplinary health team, led by three highly-experienced cardiac nurse specialists. Concerned individuals can connect with us through a telephone helpline and daily ‘virtual health chats’. Those who call the helpline can speak with Nurses, Dietitians, Physios and Exercise Specialists. For the duration of the current crisis, we aim to provide this FREE service, Monday to Friday from 09:30 -17:30.”

Heartlink West has been made possible thanks to the support of several generous donations from regional and national companies. To learn more about this initiative or for ways to support us please visit

HeartLink West is available Monday – Friday from 9:00am – 5:30pm. Call 091-544310 or email

Controlling Your Portion Sizes

Portion tips from Croí's Dietitian

Portions Banner

Controlling your portions doesn’t mean you need to eat tiny amounts or measure out precisely the number of peas on your plate! However, we know that having a better understanding of healthy portion sizes helps prevent over-eating and weight gain. As we are now working from home a lot more, many people that would normally be eating in canteens and cafes are now preparing all meals from scratch at home. The portions served in canteens and cafes can be far greater than we need and we can get into a habit of viewing these larger portions as normal. Now might be as good time as any to retrain your brain to become satisfied on slightly less.

Use the Croí portion plate as a portion guide at mealtimes

Aim to fill your plate as follows:

  • Half plate of vegetables/salad
  • Quarter plate of wholegrain carbohydrates
  • Quarter plate of protein


Here are some tips to try:

  • Use a smaller plate: A standard-sized serving will look small on a large plate, making you feel dissatisfied. Use a smaller plate to prevent overloading. A general rule of thumb for a dinner plate size is 9 inches (23 cm) in diameter.
  • Use measuring cups for your carbs: If you are finding it difficult to gauge the right amount of pasta or rice to eat, try using measuring cups. A 200ml size mug is equivalent to 1 serving of cooked rice or pasta. (See the serving size guide for other food groups below).
  • Check the label: Make sure you know what portion the nutritional information on the pack relates to. It might be different to the amount you would normally serve yourself. Many products are packaged for sharing but will state a recommended serving quantity per person.
  • Smart Snacking: Be mindful of falling into a grazing/snacking habit at home. If you do choose a snack, aim for 150kcal (calories) per snack. This could be a low-fat yogurt and a piece of fruit, 2 rice crackers and 1 tablespoon of peanut butter/hummus, or 1 matchbox size of cheese and a small handful of grapes.
  • Leave the leftovers: Portion leftovers into a container and store in the fridge or freezer straight away so you’re not tempted to have seconds.
  • The 20 minute rule: Think you haven’t had enough? Wait for about 20 minutes before reaching for a second helping. It can take a little while for you to feel full after you have eaten. So avoid the temptation to keep eating and see if you get that feeling.
  • Slow down: Many of us can eat very quickly or eat while distracted at our desks or while watching TV. Our brain doesn’t get the chance to register this eating occasion. If we eat too quickly, we have usually over-eaten by the time our brain and tummy start to register this and we can feel uncomfortably full or suffer from indigestion. Slowing down the rate of eating actually helps us to enjoy our food and feel more satisfied on less.
  • Keep meal-times regular: Delaying eating for longer than 4-5 hours can have a knock on effect of eating larger portions sizes or less healthy food choices grab a ‘quick fix’ when hunger suddenly takes hold. Developing a structure on your day at home and scheduling time to prepare and eat your meals will help control your appetite and prevent over-eating or excess snacking.
Source: Department of Health / HSE 2016 Healthy Eating Guidelines.

This serving guide from the Department of Health / HSE 2016 Healthy Eating Guidelines, provides a handy visual for what servings of each food group should look like. For more information on the number of recommended daily servings per food group, based on your age, gender and activity level, click here.

Mexican Bean Soup

This hearty soup is so simple to make and a great way to incorporate more legumes such as beans in your diet. It is low in calories and high in fibre, making it an excellent, heart-healthy choice!

Serves: 8
Prep time: 5 mins
Cook time: 25 mins
Nutrition information per serving (not incl. bread) : 104 calories; 12g carbs; 4.7g protein; 3.4g fat; 4.2g fibre

Dietitian’s tip: Many combinations of beans work just as well: mixed beans, chickpeas, kidney beans, butter beans, borlotti beans, black eyed beans etc.


Mexican Bean Soup Recipe


  • 1 large or 2 small red onions
  • 5 tbsp olive oil
  • 1 vegetable stock cube, made up to 750ml stock
  • 3 cloves of garlic
  • ½ tsp chilli powder or cayenne pepper
  • ½ tsp ground cumin
  • ½ tsp ground coriander
  • 3 tins chopped tomato
  • 1 tin red kidney beans or mixed beans
  • 1 tin chickpeas or cannellini beans
  • 1 tbsp chopped coriander or parsley


  1. Heat the oil in a large saucepan over a low to medium heat.
  2. Finely dice the red onion and add it to the saucepan. Sweat the onion for 6-8 mins until it begins to soften.
  3. Crush or finely dice the garlic. Add it to the onions along with the ground cumin, coriander and chilli pepper or cayenne pepper.
  4. Continue to cook for 1-2 mins longer, stirring continuously.
  5. Add the tinned tomatoes and the stock. Stir well and bring it up to the boil.
  6. Once boiling, reduce to a simmer. Drain and rinse the beans before adding them in.
  7. Place the lid mostly over the saucepan, with some room for the steam to escape. Allow to simmer for 15 minutes.
  8. Allow to cool before blending. If you prefer a chunkier soup, only blend ¾ of the batch.
  9. Sprinkle the fresh herbs on top before serving with some crusty wholegrain rolls.
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Brown Bread Recipe

Recipe from Croí Friend and Mayo Man, Michael!

A fresh loaf of homemade brown bread coming out of the oven is hard to beat! It gives a sense of accomplishment far out of proportion to the ease with which it is made.

Makes: 1 loaf / approx. 16 slices
Prep time: 30 – 50 mins
Cook time: 50 mins

Approx. nutritional information per slice: 106 calories; 18g carbs; 3.4g protein; 2.1g fat; 3g fibre

Dietitian’s tip: You may use one type of seed or a combination, just ensure the total weight required remains the same. A very coarse stone-ground flour is essential and it not too difficult to find.



  • Sunflower oil, for greasing the tin
  • 2 tbsp treacle
  • 30g fresh yeast or 7g dried yeast
  • 350 – 425ml warm water
  • 420g extra coarse stone-ground wholemeal flour
  • 40g sunflower seeds
  • 10g flaxseeds or linseeds
  • ¾ tsp reduced sodium salt



  • Grease a 900g loaf tin very lightly with the sunflower oil
  • Pre-heat fan oven to 180°C
  • Mix the treacle with about 300ml warm water, then crumble in the fresh yeast (if using) or sprinkle in the dried yeast. Stir and leave to sit for 5mins for the yeast to activate.
  • Place the flour, seeds and salt into a large mixing bowl and mix together.
  • Stir the treacle, water and yeast together and pour it all at once into the flour.
  • Using your hand, mix through the liquid, adding extra water as you go until you have a wet, almost sloppy dough. If the dough is too dry it won’t rise well.
  • Next, scoop the dough into the loaf tin and spread evenly. It should come just half way up the tin. Leave in a warm place to rise for 20 – 40mins until it has risen right to the top of the tin.
  • Place in the pre-heated oven for about 45mins. The run a knife around the outside edges of the loaf, tap the tin upside-down on the counter to pop it out. Return the bread to the oven, upside-down for a further 5 mins.
  • Cool on a wire rack before slicing and serving. It is best eaten day of but will hold for a couple of days!