• Posted August 11, 2020

COVID-19 Risk Up to 7 Times Higher for Young Vapers

Young people who use electronic cigarettes face an increased risk of COVID-19 infection, according to a new study.

Teens and young adults who vaped were five times more likely to be diagnosed with COVID-19. And young folks who vape and also smoke regular cigarettes have a sevenfold higher risk of getting COVID-19, researchers found.

The finding -- published Aug. 11 in the Journal of Adolescent Health -- prompted lawmakers in the United States to ask the U.S. Food and Drug Administration (FDA) to clear the market of all e-cigarettes until the coronavirus crisis is over.

"These are really, really high numbers. I really want people to realize that e-cigarettes aren't safe. It's not just harmless, flavored water. There are real, significant, serious harms associated with these products," said the study's senior author, Bonnie Halpern-Felsher, a professor of pediatrics at Stanford University in California.

The study wasn't designed to tease out whether there's a direct cause-and-effect relationship, but Halpern-Felsher said there are a number of plausible biological reasons a vaper or smoker might be more susceptible to a COVID-19 infection.

Halpern-Felsher said it's known that e-cigarettes can affect the lungs and the immune system. Plus, there's a pathway that SARS-CoV-2, the virus that causes COVID-19, relies on to get into cells, and e-cigarettes may make this pathway more available.

The more likely possibility is that teens may share e-cigarettes, she noted. If one teen is infected, the next who uses the device could inhale virus particles deep into their lungs. The exhaled vapor may also contain the virus, and could potentially infect people nearby.

That's why the chairman of the U.S. House Committee on Oversight and Reform's Subcommittee on Economic and Consumer Policy called on the FDA to remove vaping products from the U.S. market.

Rep. Raja Krishnamoorthi (D-Ill.) asked FDA Commissioner Dr. Stephen Hahn to confirm by Aug. 18 whether FDA will do so.

The new research followed a Chinese study that found smokers in that country had more serious infections and were hospitalized more often. While teens and young adults appear to be less affected by the new coronavirus, researchers wondered if e-cigarettes -- which are popular among U.S. teens -- might boost COVID-19 infection rates.

To learn more, researchers conducted an online survey. More than 4,300 U.S. teens and young adults (aged 13 to 24) completed the survey in early May. Half said they had used e-cigarettes.

Those who vaped and smoked were five times more likely to have COVID-19 symptoms, including coughs, fever, fatigue and trouble breathing, than those who never smoked or vaped. Young people using both e-cigarettes and tobacco cigarettes were nine times more likely to be tested for COVID-19 than their non-using peers. Those who just vaped were nearly three times more likely to get tested for COVID-19, the study found.

"Here's another study showing that e-cigarettes are linked to another serious outcome. There's no reason for e-cigarettes to be on the market," Halpern-Flesher said.

Patricia Folan, director of the Center for Tobacco Control at Northwell Health, in Great Neck, N.Y., said the findings highlight the importance of strongly encouraging young people to stop vaping and/or cigarette smoking.

For young people who are already hooked, it isn't always easy to find help quitting, she said. But Folan added that some state quit-lines and online sites, such as the Truth Initiative, may have programs tailored to younger people.

Dr. Michael Grosso, chief medical officer and chair of pediatrics at Huntington Hospital in Huntington, N.Y., called the findings "provocative." He suspects they will alert primary care doctors that certain patients may have an elevated risk.

But he also pointed out that the study can't show that e-cigarettes directly boost COVID-19 risk.

"Though it's plausible that tobacco products might increase the infection rate by damaging the respiratory epithelium [the lining of the lungs], it is equally likely that use of e-cigarettes is a marker for risk-taking" behavior, Grosso said.

More research is needed to learn if e-cigarettes and traditional cigarettes cause the increased risk or not, he said.

"In the meantime, it seems that for whatever reason, adolescent and early adult users of e-cigarettes are at serious risk for COVID-19 infection and its complications," Grosso said.

More information

Learn more about the risks of vaping from the U.S. Surgeon General.

SOURCES: Bonnie Halpern-Felsher, PhD, professor, pediatrics, and founder/executive director, Tobacco Prevention Toolkit, Stanford University, Calif.; Patricia Folan, DNP, director, Center for Tobacco Control, Northwell Health, Great Neck, N.Y.; Michael Grosso, MD, chief medical officer and chairman, pediatrics, Huntington Hospital, N.Y.; Journal of Adolescent Health, Aug. 11, 2020