In 2019, over 5 million youths in the U.S. used e-cigarettes, and as of January 2020, approximately 2600 individuals (adults and youths) were hospitalized with e-cigarette, or vaping product use associated lung injury (EVALI) (Centers for Disease Control and Prevention [CDC], 2020). Earlier this year we provided an update on the vaping epidemic
in the U.S. but no one would have guessed that within a few months, we would be grappling with an all-encompassing global pandemic. In the early stages, data suggested that SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), primarily impacted the elderly and individuals with underlying medical conditions. However, a new study conducted at Stanford University School of Medicine found a compounding factor that can put the younger population at even greater risk — the use of vaping products. The study conducted by Bonnie Halpern-Felsher, PhD, professor of pediatrics, concluded that young people who vaped and were tested for COVID-19 were at higher risk for infection than those who did not use electronic cigarettes (e-cigarettes) (Gaiha et al., 2020).
The study examined whether youth cigarette and e-cigarette use are associated with COVID-19 symptoms, testing, and diagnosis. Surveys were conducted online in May 2020 and completed by 4,351 participants ages 13 to 24 throughout the U.S. The participants were divided into two groups – those who had used e-cigarettes and those who had never used nicotine products. These groups included equal numbers of people in different age ranges (adolescent, young adult and adult), races and genders. Individuals were asked whether they had ever used vaping devices or combustible cigarettes and whether they had vaped or smoked in the past 30 days. They were also asked if they had experienced COVID-19 symptoms, received a test for COVID-19 or received a positive diagnosis for COVID-19. The results were adjusted for factors such as age, sex, LGBTQ status, race/ethnicity, mother’s level of education, body mass index, compliance with shelter-in-place orders, rate of COVID-19 diagnosis where the participants lived, and state and regional trends in e-cigarette use (Gaiha et al., 2020).
The study found (Gaiha et al., 2020):
- COVID-19 diagnosis was:
- Five times more likely among users of e-cigarettes only
- Seven times more likely among dual users (conventional cigarettes and e-cigarettes)
- 6.8 times more likely among past 30-day dual users
- Testing occurred:
- Nine times more likely among past 30-day dual users
- 2.6 times more likely among past 30-day e-cigarette only users
- Symptoms such as coughing, fever, tiredness and difficulty breathing were 4.7 times more likely among past 30-day dual users compared to those who never smoked or vaped.
- Researchers did not find a correlation between COVID-19 diagnosis and smoking conventional cigarettes alone. This may be due to the fact that most young people tend to use both vaping devices and traditional cigarettes; very few solely use cigarettes.
- Lower socioeconomic status and Hispanic or multiracial ethnicity were linked to higher risk of COVID-19 diagnosis.
The World Health Organization (WHO) states that smokers may be more vulnerable to contracting COVID-19 simply due to the fact that the habit of smoking involves contact of the fingers (and potentially contaminated cigarettes and devices) with the lips which increases the potential transmission of viruses from hand to mouth (WHO, 2020). Transmission can also occur between individuals that share mouth pieces and other smoking devices, which is common with e-cigarette users (Gaiha et al., 2020).
These findings are not surprising. We know that inhaling substances such as tobacco smoke and vape mist affects the ability of the lungs to function and interrupts the immune system causing chronic inflammation in the airways (Rizzo, 2020). McAlinden et al., (2020) state that e-cigarettes and other vaping products increase “oxidative stress, inflammation, infections and airway remodeling in the lungs” of individuals who use these devices. Thus, smoking makes it more difficult for the body to fight off coronaviruses and other respiratory diseases (WHO, 2020). Couple this with the fact that SARS-CoV-2 rapidly invades the cells in our lungs and attacks the epithelial cells lining the airways may result in an individual that is highly susceptible to severe pneumonia, acute respiratory distress syndrome, sepsis and long-term lung damage.
Gaiha et al., (2020) recommends the following:
- Health care providers screen all youth for a history of cigarette and e-cigarette use.
- Parents, schools and community-based organizations educate youths on the effects of e-cigarettes on the respiratory and immune systems.
- Food and Drug Administration (FDA) regulate e-cigarettes during the COVID-19 pandemic.
- Develop and distribute youth-targeted COVID-19 prevention materials that include e-cigarette and dual use information.
Education and prevention are critical to halt the spread and impact of these two colliding public health crises.