E-cigarette users face ‘big’ risk for COVID-19
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Adolescents and young adults who used both e-cigarettes and combustible cigarettes were seven times more likely to acquire COVID-19, data show.
Even if young people used e-cigarettes only, they still faced a fivefold risk for COVID-19, researchers added.
“We know that youth don’t start using tobacco through cigarettes, they start through e-cigarettes,” Bonnie Halpern-Felsher, PhD, FSAHM, professor of pediatrics at Stanford University, told Healio Primary Care. “That is why even though we show dual use, we are more focused on e-cigs since that is what youth start with and are predominately using.”
Researchers analyzed survey responses from 4,351 individuals in the United States aged 13 to 24 years — including 2,168 who never smoked — to assess the relationship between COVID-19 and dual use (both vaping and smoking), vaping only and combustible cigarette use only. The researchers also accounted for respondents’ sociodemographic factors, BMI and compliance with shelter-in-place orders.
Halpern-Felsher and colleagues found that dual users were seven times (95% CI, 1.98–24.55) more likely to be diagnosed with COVID-19, and young people who used e-cigarettes only were five times more likely to be diagnosed (95% CI, 1.82–13.96). Identifying as male, other/nonbinary gender, Hispanic or other/multiracial was commonly associated with a COVID-19 diagnosis, researchers said.
“This study tells us pretty clearly that youth who are using vapes or are dual-using are at elevated risk, and it’s not just a small increase in risk; it’s a big one,” Shivani Gaiha, PhD, a postdoctoral research fellow in adolescent medicine at Stanford University, said in a press release.
The findings prompted U.S. Rep. Raja Krishnamoorthi, D-Ill., chair of the Subcommittee on Economic and Consumer Policy, to send the FDA a letter requesting that all e-cigarettes be removed from the market during the “coronavirus crisis,” writing that "it is the only responsible path forward."
An FDA spokesperson told Healio Primary Care that the agency responded to Krishnamoorthi’s letter but deferred questions regarding its contents to Krishnamoorthi’s office. The Congressman did not return requests for comment prior to this story’s posting.
Reference:
- House Committee on Oversight and Reform. Letter from U.S. Representative Raja Krishnamoorthi to FDA Commissioner Scott Hahn. https://oversight.house.gov/sites/democrats.oversight.house.gov/files/documents/2020.08.11%20RK%20to%20FDA%20re%20Vaping%20and%20Coronavirus.pdf. Accessed Aug. 21, 2020.
Perspective
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Frank T. Leone, MD, MS
The first thing I want to point out about the Halpern-Felsher, et al, article is that associations do not necessarily mean causation. While the study, all by itself, cannot be seen as evidence of causation, it is another piece of a jigsaw puzzle that suggests that the e-cigarette aerosol is causing an inflammatory reaction, and it has a variety of consequences that all stem from inflammatory dysregulation.
However, there are some elements of other data that, when taken together, suggest a possible, causative link between smoking, vaping and risk for COVID-19. The first sign of this possible link came a couple of years ago, when a study involving a cohort of patients aged 18 to 40 years who underwent assessments at regular intervals for 3 years concluded that those who used e-cigarettes plus combustible cigarettes — dual users — were the highest risk group. Those who only used one of those devices were also at risk, but it was not as significant.
We have known for some time that the chemicals in combustible cigarettes cause those users to have lung inflammation at a higher rate than nonsmokers. It’s almost like a roller coaster that has lost its brakes. Fast-forward to the e-cigarette vaping-associated lung injury (EVALI) phenomenon that started last year. Researchers discovered that e-cigarette aerosol causes lung inflammation to run amok — even more than combustible cigarettes. Now enter SARS-CoV-2 and COVID-19. We believe the infection accesses the body through epithelial cells that line airways and blood vessels , and that inflammation runs amok. This could be why e-cigarette users and/or dual users are at greater risk for COVID-19 than users of combustible cigarettes and nonsmokers.
Reference: Van Zyl-Smit RN, et al. Lancet Respir Med. 2020;doi:10.1016/S2213-2600(20)30239-3.
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