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VERIFY: Are post COVID-19 lungs worse than long-time smokers' lungs?

Our Verify team spoke with two pulmonologists to find out how lung damage of recovering COVID-19 patients compares to lung damage from habitual smoking


Are post-COVID-19 lungs worse than long-time smokers' lungs?


It depends on the severity of the COVID-19 case. However, our experts say that it's generally true. 


  • Dr. Panagis Galiatstatos- Pulmonary and critical care medicine physician, assistant professor in the Division of Pulmonary and Critical Medicine at the Johns Hopkins School of Medicine, director of the Tobacco Treatment Clinic
  • Dr. Michael Matthay- Professor of Medicine at the University of California, San Francisco


Lots of people on social media are talking about the long-term effects of COVID-19.

One tweet from a woman who says she's a trauma surgeon and ICU doctor, got a lot of buzz online.

"I don't know who needs to hear this, but 'post-Covid' lungs look worse than any type of terrible smoker's lungs we've seen," she wrote. "And they collapse. And they clot off. And the shortness of breath lingers on... & on... & on."

Lots of people began comparing the two online. So we're Verifying:

Do people who recover from COVID have worse lung damage than long-time smokers?

Our Verify researchers spoke with two pulmonologists, doctors who specialize in the respiratory system: Dr. Panagis Galiatsatos at Johns Hopkins School of Medicine and Dr. Michael Matthay, a professor of Medicine at the University of California, San Francisco.

They both agree the tweet is pretty accurate, but it’s a bit too broad -- not all recovering COVID-19 patients have worse lungs than all smokers.

"The challenge we have is it's going to be grey," Galiatsatos said. "Severe COVID-lung would be worse than a patient who smokes's lungs. Mild cases, likely no."

"Mild COVID would be like I smoked for one decade," Galiatsatos later added.

Our Verify researchers asked Dr. Matthay if he thought that someone who is sick with COVID inherently has worse lungs than someone who's been smoking for a decade.

"Yes, yes they do," Matthay said. "They definitely do, because the patients who have COVID-19 lung injury and pneumonia, particularly in both lungs, yes, they definitely have worse lungs radiographically and functionally than the patient has just been cigarette smoking for 10 or 20 years."

Dr. Galiatsatos shared x-ray images of patients with the Verify team to show the differences between normal lungs, lungs belonging to a COVID-19 patient and lungs from a long-time smoker:

Credit: Panagis Galiatsatos
  • Healthy lungs (left) are uniform with a little bit of gray to this, showing the gas exchange transpiring.  
  • Lungs of a COVID-19 patient (middle) are more opaque and white, which shows inflammation and an active infection.
  • Smokers' lungs (right) may have a portion that's dark black which can indicate emphysema.

Both Galiatsatos and Matthay noted that the rate at which your a patients' lungs become damaged by COVID is much faster than by smoking.

"To me, this is kind of like comparing what's worse...a category five hurricane or an earthquake in a large metropolitan area?" Galiatsatos said. "They're both bad. They're just different types of that."

RELATED: VERIFY: Law giving children consent over parents in vaccinations was in DC, not national

The difference is the rate at which they ravage your organ and induce symptoms like shortness of breath and coughing: one occurs gradually, the other rapidly.

"The severe COVID-19 patient gets to be expedited to that symptom level in a very short period of time," Galiatsatos said. "So both lung imaging are bad, they are horrible, and they'll give you those same symptoms just one much faster than the other one. So to me, I would say someone with severe COVID-19 from SARS-CoV-2 you're experiencing what a person whose smoked extensively for years, they're experiencing those symptoms in an immediate sense, versus having to wait decades."

But Dr. Matthay says there’s a silver lining.

"Many if not most of the COVID-19 patients with severe lung injury will have a good prognosis for recovering most of their lung function, and that that's exactly the difference with smoking-induced lung injury, the potential for recovery is minimal," Matthay said. 

He said that data from the past year suggests that those with COVID-19 related lung injuries, should gradually recover.

It’s also worth noting a couple of weeks after that tweet went viral the original poster tweeted, "a reminder-this is my personal experience, not a trial or nationwide data.”

So we can Verify, according to our experts, yes, in general people recovering from severe COVID-19 have worse lung damage than habitual smokers. 

Remember patient recovery is a whole spectrum.

Do you have something you want our Verify team to look into? Email the whole team, verify@wusa9.com

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