A preliminary investigation of 7,000 individuals with COVID-19 by the Centers for Disease Control and Prevention (CDC) shows that 78 percent of those admitted to intensive care and 94 percent of those who were hospitalized and died had at least one other significant health issue. For those who vape — or smoke — this report should set off alarm bells. “It would make sense that people who smoke have more serious complications [from coronavirus] because smoking is associated with virtually all the high-risk groups that have been identified for this infection in terms of hypertension, chronic lung disease, and cardiovascular disease,” says Enid Neptune, MD, an associate professor of medicine at Johns Hopkins Medicine in Baltimore. As far as vaping is concerned, Robert Jackler, MD, a professor of otorhinolaryngology (ear, nose, and throat surgery) at Stanford University School of Medicine in Palo Alto, California, stresses that it may take some time to see evidence linking vaping to an increased risk of serious illness and death from COVID-19, “even though there is good, sound reason to think it is a risk factor,” he adds. RELATED: How to Quit Vaping: A Practical Guide
One Unhealthy Habit Rises as Another Falls
Dr. Jackler suggests that it’s difficult to understand vaping as a risk factor for COVID-19 complications simply because, compared with smoking, it’s relatively new. E-cigarettes hit the market around 2003, as the Consumer Advocates for Smoke-Free Alternatives details. In just under two decades, they have climbed in popularity as tobacco smoking has waned. Among adults in the United States ages 25 to 44, e-cigarette use almost doubled from 2012 to 2013 through 2018, rising from 2.4 percent to 4.2 percent, according to the public health organization Truth Initiative. Meanwhile, cigarette smoking has declined. The CDC reports that the number of adults over 18 who smoke dropped from 20.9 percent (in 2005) to 15.5 percent (in 2016). Truth Initiative estimates that just over half of current adult e-cigarette users also smoke regular cigarettes. Even though e-cigarettes have a short history, researchers have conducted hundreds of studies on their health effects and found that they present many of the same hazards as smoking. A consensus study released in January 2018 by the National Academies of Science, Engineering, and Medicine reviewed more than 800 scientific investigations on the health consequences and concluded that e-cigarettes contain a number of toxic substances that may increase the risk of lung disease, heart disease, cancer, asthma, and other chronic illnesses. On top of this, some vaping liquids containing THC (tetrahydrocannabinol, the compound responsible for the marijuana high) have been discovered to be laced with vitamin E acetate, a chemical additive linked to a recent national outbreak of a lung ailment known as EVALI. As of February 18, this vaping-related illness had led to more than 2,800 hospitalizations and 68 deaths in the United States, according to the CDC. RELATED: CDC Finds a “Toxin of Concern” as Vaping-Related Lung Illnesses Continue to Climb
The Lungs May Be Critically Compromised
Scientific study on whether vaping and smoking raise the risk of COVID-19 complications is just beginning. One investigation of 78 people with COVID-19, published online on February 28 in the Chinese Medical Journal, found that those with a history of smoking were 14 times as likely to develop pneumonia. So far, investigations on vaping and the virus have been even more scarce. Still, Stanton Glantz, PhD, the director of the Center for Tobacco Control Research and Education at the University of California, San Francisco, writes that “reporting of respiratory symptoms by e-cigarette users suggests increased susceptibility to and/or delayed recovery from respiratory infections.” Len Horovitz, MD, a pulmonary specialist at Lenox Hill Hospital in New York City, adds, “It’s already been clear with vaping that there’s an inflammatory response of the lung, so adding coronavirus to vaping could be disastrous.” Dr. Horovitz explains that vaping and smoking impair or kill off cilia, hairlike projections on cells in the airway that help clear the body of particulate matter and infectious agents. Vapers and smokers can have diminished lung capacity, and if the virus strikes, that can prove to be deadly. “When you get COVID and it begins to cause interstitial pneumonia, it leads to a swelling between the air sacs and it diminishes the oxygen uptake efficiency by the lung,” says Jackler. “Now if you’re a person who has 100 percent normal lung function and it is cut down by half, you can probably handle it with supplemental oxygen. But if you are a long-term smoker or vaper and have only 60 percent vital capacity in the lungs, if you cut that in half, you’re in very serious trouble.” RELATED: E-Cigarettes Raise Risk of Chronic Lung Disease, Long-Term Study Finds
Vaping and Smoking Rituals May Open the Door to the Virus
Another reason that vaping and smoking have a risk of making people ill with COVID-19 has nothing to do with potentially harmful ingredients but simply the gestures involved. “Vaping and smoking behavior inherently has risks because your fingers are holding the device or cigarette, and your fingers are going back and forth to your mouth,” says Jackler. “We know that the more times your hand goes to your face, especially your mouth or nose, the more likely you are to transmit the virus.” Also, using cigarettes, of the e-variety or any sort, can be a social activity that involves individuals gathering together. The CDC has been urging people to keep a safe distance from one another — at least six feet apart. On top of this, smokers and e-cigarette users may cough more than others, and they can heavily breathe out smoke or vapor, which can disperse infectious respiratory droplets into the air. Originally, health experts have warned about transmitting the virus through coughing or sneezing, but the National Academy of Sciences recently suggested that COVID-19 may be dispersed into the air simply by breathing. “I am concerned about the way people exhale plumes from vaping devices as a potential risk,” says Jackler. He explains that someone might enter a room some time after an e-cigarette user has exited and still be exposed to infectious droplets in the air. A study published online on March 17 in The New England Journal of Medicine found that the virus may hang in the air up to three hours. Jackler suggests that vaping may be worse than smoking in this regard because the aerosol produces such a fine mist that it could enable the virus to float in the air for especially long periods. RELATED: My Juul Breakup: 8 Steps That Helped Me Finally Quit Vaping
Could Vaping Help Explain Why Some Young People With COVID-19 Get So Sick?
A preliminary report released March 18 by the CDC also suggested that while most Americans who develop serious complications from COVID-19 are age 45 and up, a significant proportion are young adults. About 38 percent of individuals hospitalized because of the virus are between 20 and 54 years old, according to the study. Why so many younger adults with COVID-19 end up in the hospital is still unclear. Some may have a preexisting condition that heightens their risk, but Dr. Neptune speculates that vaping might also be a contributing element. “In the young cohort that is developing more serious illness from COVID-19, maybe e-cigarette use is one of the predisposing factors,” she says. A 2018 Gallup poll found that 2 out of 10 Americans ages 18 to 29 said they vape. In addition, statistics show that individuals are taking up the vaping habit at a young age. Results from an extensive survey of more than 40,000 respondents, published in October 2019 in The New England Journal of Medicine, revealed that vaping among U.S. middle school, high school, and college students ticked upward between 2017 and 2018.
Worry About COVID May Spark More Vaping and Smoking
An unfortunate twist in the current pandemic is that anxiety may be driving people to vape and smoke even more. In fact, sales of tobacco products in the United Kingdom rose by 9 percent in the third week of March, according to the Financial Times. “People who vape or smoke tend to do so more during times of stress,” says Jackler. “With all of us confined to our homes and life disrupted, it would not surprise me that established smokers and vapers who have a nicotine addiction would be doing it more just at a time when it is not a good idea.” RELATED: 12 Questions Answered About How to Handle Anxiety in the Time of COVID-19 He urges people to use this period of self-isolation as a time to change habits and quit vaping and smoking altogether. “To protect themselves and others during the COVID-19 epidemic, vapers and smokers should quit now to reduce their risk of becoming infected and to boost their lung defenses,” he says. The American Cancer Society recommends alternative ways for satisfying nicotine addiction, including nicotine lozenges, gums, or patches. Horovitz encourages individuals to take advantage of staying at home by pursuing other healthier activities. “Exercise, meditate, do things that you can do indoors that give you pleasure, whether it’s sewing, playing an instrument, watching a funny movie, or reading a book,” he says. “There are plenty of things you can do other than vaping or smoking a cigarette.” RELATED: 10 Virtual Ways to Escape Reality During the Coronavirus Pandemic
