Are people who vape more susceptible to coronavirus complications?

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Last summer, the US saw an alarming rise in vaping-related lung injury, which peaked in September and led to more than 2,800 hospitalizations or deaths as of February 18 of this year, mostly among young people, according to the Centers for Disease Control and Prevention. Indeed, the Pew Research Center reported that vaping had increased among youth in the years leading up to the outbreak. Now, youth vaping has been largely eclipsed by the novel coronavirus pandemic, which has made more than 399,500 people sick in at least 166 countries as of Tuesday afternoon, per the New York Times. But some suspect that these public health crises, both respiratory, may be connected. Is vaping linked to coronavirus?

According to the physicians Mic spoke with, there isn’t enough data yet to draw a direct link between vaping and the novel coronavirus disease, known as COVID-19. But based on what we know so far about the effects of the ingredients that can be found in e-cigarettes, vaping may increase the risk of serious complications from COVID-19, at least in theory.

Murmurings about a possible association between vaping and COVID-19 have grown louder in recent weeks. New York City Mayor Bill de Blasio pointed out in press briefing on March 9 that a 22-year-old man who tested positive was otherwise healthy, although he did vape, CBS News reports. “We don't know of any pre-existing conditions, but we do think the fact that he is a vaper is affecting this situation,” de Blasio said. Meanwhile, a UCSF Tobacco Center Faculty Blog post called for people to stop vaping to lower their risk of serious COVID-19-related lung disease, and a National Institute for Drug Abuse blog post noted that COVID-19, “could be an especially serious threat” to those who vape.

More data is needed, but a link is plausible

“It’s all speculative at this point,” says Michael Blaha, the director of clinical research at the Ciccarone Center for the Prevention of Cardiovascular Disease at Johns Hopkins Medicine. “We don’t have links between these two (vaping and COVID-19) specifically.” To establish them, we’d need to conduct epidemiological studies on large numbers of COVID-19 patients, with data on whether or not they vape, he explains. Observing that, say, 20% of people who had bad outcomes — that is, became seriously ill — also vaped, while only 10% of those with good outcomes vaped, may hint at a link.

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Likewise, it’s still too early to explain whether vaping explains the cases of serious illness among young COVID-19 patients, according to Russell Buhr, a pulmonary and critical care physician at UCLA Health. “We are seeing a lot more younger people getting sick than we expected to,” he says. “I don’t think we know why yet.”

That said, “it’s plausible that the airway inflammation that can be seen with e-cigarette use, combined with any other insult, such as a virus, could potentially predispose you to a worse outcome,” Blaha tells Mic. This possibility is further bolstered by the association between vaping and chronic lung diseases like asthma; as well as acute lung injury, especially when combined with certain toxins that may be present in e-cigs, like vitamin E acetate.

But Blaha doesn’t think vaping increases the risk of novel coronavirus infection. “Anyone can get this virus just by getting exposed,” he says. Regardless of whether they vape, it appears that the virus hangs around in the upper respiratory tract — “but only in certain people does it seem to get down in your lungs and cause pneumonia.” In other words, anyone can get infected, but it’s possible that people who vape have an increased risk of their infection expanding to their lower respiratory tract, as well the severe symptoms that can result from this spread.

Vaping can affect immunity in the lungs, which could allow a novel coronavirus infection to take hold

Buhr also agrees that a link between vaping and COVID-19 is possible. “We do know that vaping can affect immunity in the lungs,” or the ability of the lungs to respond to and fight off infection, he tells Mic. He explains that nicotine in general impairs immune function in the lungs, and we have more limited data that cannabis, an ingredient in some vapes, can alter it, although we don’t know exactly how just yet.

Besides nicotine and cannabis, some ingredients in vape cartridges can slow the body’s ability to recruit the cells needed to fight an infection, Buhr adds. They can also irritate the lining of the lungs, basically transforming it from an impenetrable wall into a slatted fence that allows pathogens, like the novel coronavirus, to enter the lung tissue. “That’s how infection can take hold.”

Other indirect evidence from data on COVID-19 so far also points to a possible link between the disease and vaping, specifically findings by the Chinese Center for Disease Control and Prevention that the death rate was higher in men than in women, the New York Times reports. A possible reason for the disparity: the much higher rates of smoking among men than among women in China. The study didn’t account for smoking, Buhr points out, so we can’t say for sure. But “we know smokers appear to do less well the virus, and a lot of what we think happens with smoking may happen to a lower degree, but is still present, in an e-cigarette user,” Blaha says.

Viewing COVID-19 as an opportunity to quit

Buhr says his patients are using the coronavirus pandemic as motivation to quit vaping. If you vape, he suggests considering quitting, too, if you feel like you can. Blaha agrees, especially because of the emerging evidence of health risks associated with vaping, pandemic aside. Unless you’re vaping to wean yourself from regular cigarettes, “there’s no benefit,” he says. And even if you don’t contract the novel coronavirus, vaping could increase your risk for worse outcomes from the flu or other respiratory condition.

If you’re struggling to quit, Buhr recommends calling a doctor, who can provide resources, such as medication, as well as remote cognitive-behavioral therapy that allows you to get the help you need from a safe distance. The potential health risks of vaping are troubling enough as it is. Exercising extra caution by quitting now is probably a good idea, especially given the very real possibility that coronavirus may only add to these risks.