Governments across the MENA region, including Saudi Arabia, Kuwait, and the UAE, have shut down shisha cafes as they attempt to slow the spread of coronavirus. 

In Europe, where shisha bars are also closed due to government-mandated shutdowns, a number continued to operate illegally. Government officials in both Germany and the United Kingdom caught out illegal shisha cafe operators when health authorities identified the cafes as the source of new coronavirus outbreaks. 

Earlier this month in the town of Gottingen in Lower Saxony, 36 people contracted coronavirus after visiting an illegally operated shisha cafe. A further 310 entered quarantine as a result of contact with those infected.

Perfect for spreading the virus 

The communal nature of shisha, with the pipe being passed among groups, makes it a natural conduit for coronavirus. Health experts have suggested that the threat is heightened by the fact that only the mouthpiece is changed between use by one group of customers and the next. 

The pipe and base remain the same between customers, furthering the risk of the virus spreading via particles from a contaminated user. The details of the spread of coronavirus during shisha use remain slightly unclear and further research is needed to understand in precise detail how the device contributes to the spread of the virus. Doctors remain sure, however, that the device is susceptible to spreading the virus. 

Health experts have also suggested that the large exhalations of smoke clouds may also contain virus particles with the risk being particularly high when smoking in an enclosed space. The bouts of coughing that often accompany shisha smoking present a further risk. 

Established health concerns 

The case against reopening shisha bars is being expanded by some to include a discussion of the health impacts of smoking shisha.

Prior to COVID-19 concern was growing over the health impacts of shisha with studies showing that smoking shisha for one hour can be as harmful as smoking 100 cigarettes. The practice has also been linked to increased rates of diabetes and obesity. 

The World Health Organisation (WHO) has previously stated that smokers are more likely to suffer from severe forms of coronavirus if they fall ill. As a result of the impact of smoking on the lungs, smokers are unable to fight the virus as effectively as non-smokers. 

Despite the health concerns, the number of daily shisha smokers remained high prior to COVID-19.  Arab News estimates there are 100 million daily smokers with 15% of 13-15 year olds in Kuwait, Bahrain, Oman, and Yemen smoking shisha. 

The use of charcoal for heating shisha is a further cause for concern as it releases carbon monoxide. In enclosed bars and spaces this can lead to poisoning of staff and patrons. Last year, a shisha cafe in Tooting, in South London, was forced to close after the residents in the flats above, including young children, suffered carbon monoxide poisoning. 

Carbon monoxide poisoning occurs when the colorless and odorless gas enters the bloodstream. As a result of mixing with haemoglobin, the blood is no longer able to carry oxygen and this causes the body’s cells and tissues to die.

Fortunately, all those in Tooting recovered, but the incident further highlights the risks of shisha. As coronavirus restrictions begin to ease and cafes reopen, there is space for broader discussions about the future of shisha cafes.