© Reuters / Nacho Doce
A region in Spain has introduced a ban on smoking in outdoor public places when social distancing cannot be guaranteed.

The ban came into effect Thursday in Spain's northwestern region of Galicia, with other areas mulling similar restrictions to curb the spread of the coronavirus.

Under a law approved by the regional government of Galicia late on Wednesday which came into force at midnight, removing a face mask to smoke in public is not allowed if it is not possible to maintain a distance of two meters (6.7 feet) between people.

The move is supported by research from Spain's health ministry, who last month found that smoking can spread the virus because people project droplets when they exhale smoke.

In addition, the virus could be spread when a person removes their face mask to smoke a cigarette, and by touching their cigarette before bringing it to their mouth.

But experts have warned there is not yet enough evidence to say for certain that the disease could be spread through tobacco smoke.

The move comes despite a mountain of research suggesting smokers are less likely to catch coronavirus. Experts across the world have discovered very few smokers are getting hospitalised by Covid-19, suggesting they are protected or aren't getting infected as much.

It is mandatory in all of Spain, except in the Canary Islands, to wear a face mask in all outdoor and indoor public spaces.

The Spanish Society of Epidemiology in July called for smoking to be banned in outdoor spaces, arguing there is a risk that smokers infected with COVID-19 but who are asymptomatic 'could release droplets' containing the virus 'which put at risk the rest of the population'.

The smoking ban is the first of its kind in Spain and is part of a series of new measures imposed by Galicia, best-known as the destination for pilgrims hiking along the Camino de Santiago, to curb the spread of COVID-19.

It has already ordered the closure of bars and nightclubs and restricted the number of people who can enter shops at the same time.

Officials in other regions such as Madrid and the southern region of Andalusia, along with those in the central regions of Castilla y Leon and Castilla La Mancha, said they were considering similar smoking restrictions.

Alberto Fernández Villar, head of the pneumology department at Vigo hospital, and a member of the Galician government's clinical committee, said: 'We know smokers with Covid-19 have a greater viral load and are potentially bigger spreaders.'

Viral load refers to the number of particles of the coronavirus - called SARS-CoV-2 - someone is first infected with. No scientific studies have conclusively proven that smokers have a higher viral load, compared to coronavirus-infected non-smokers.

But evidence has shown smokers may have more ACE-2 receptors, which the virus latches on to to infect humans.

This means someone with more ACE-2 receptors may be more susceptible to a large viral load entering their bloodstream.

Spain's highly decentralised system of government makes regions responsible for healthcare, leading to a patchwork of different measures to curb the virus across the country of 47million people.

The World Health Organization has said tobacco users are likely to be more vulnerable to being infected by the virus and could increase the possibility of transmission of the disease since it involves contact of fingers with the lips.

While the smoking ban was applauded by many medical experts, some questioned its effectiveness.

'There is not yet enough solid scientific information to show that in open spaces, tobacco smoke can transmit the disease,' Fernando Garcia, an epidemiologist at the Carlos III institute for health, told AFP.

'To take such an extreme measure when there is not enough evidence, I think is a bit disproportionate.'

With 30 cases per 100,000 inhabitants, Galicia has one of the lowest prevalence rates of the virus in Spain, which has nearly 330,000 infections, the highest number in Western Europe.

The ban on smoking comes as the country grapples with the worst infection rate in western Europe. Spain now has 376,864 confirmed total cases, and 28,579 deaths.

Spain confirmed 44,400 new cases over the past 14 days alone, compared with just 4,700 new cases registered by Italy, with 60 million inhabitants, which was the first European country to be rocked by the virus.

Spain is still in good shape compared with many countries in the Americas, where the spread seems unchecked in the United States, Mexico and several South American countries.

But hospitalizations with COVID-19 have quintupled in Spain since early July, when cases were down to a trickle after a severe lockdown stopped a first wave of the virus that had pushed the health care system to breaking point.

On Tuesday, Spain's ministry reported 805 people nationwide hospitalized over the past seven days. Half of the 64 people who died over the previous week were from Aragon, the region surrounding Zaragoza.