It's the first study to look at e-cigarette use and COVID-19—and the results were surprising, even to researchers.

By Claire Gillespie
August 12, 2020
Advertisement

Since the early days of the pandemic, there have been questions around the relationship between vaping and COVID-19. The link made sense—COVID-19 is largely a respiratory disease, spread through infected droplets—but the US still lacked a scientific study on e-cigarette use and coronavirus, until now. 

A new study published Tuesday in the Journal of Adolescent Health established the long-suspected relationship between e-cigarette use and COVID-19 risk. Stanford University researchers recruited 4,351 participants, between the ages of 13 and 24, from all 50 states, the District of Columbia, and three territories. The participants answered a series of questions in a survey format, including whether they had ever used vaping devices or combustible cigarettes, whether they had vaped or smoked in the past 30 days, and whether they had experienced COVID-19 symptoms, received a test for COVID-19, or received a positive diagnosis of COVID-19 after being tested. 

Data collected from the survey showed that COVID-19 infections were associated with e-cigarette use, as well as use of both e-cigarettes and traditional cigarettes. Specifically, researchers found that teens and young adults who vaped were five times more likely to be diagnosed with COVID-19 than non-vapers. And if someone smoked both traditional cigarettes and e-cigarettes, they were seven times more likely to get a positive test result. The study also showed that testing for COVID-19 was more likely among those who vape—dual users in the past 30 days were nine times more likely to get tested for COVID-19 than non-users, while those who only used e-cigarettes were nearly three times more likely.

The study doesn’t speak to the reasons for these results, but the researchers have some hypotheses about their findings. 

“First, we know that vaping hurts the lungs and immune system, so it might be that youth using e-cigs who are exposed to the virus are more harmed by it,” lead author Bonnie Halpern-Felsher, PhD, a professor of pediatrics and director of research in the division of adolescent medicine at Stanford University, tells Health. “It might also be that youth vaping [and/or] smoking increases exposure to the virus as youth often share their e-cig devices, or the hand-to-mouth action, whereby you can touch the virus and then your hands. Also, the large plume of aerosol could carry virus in the aerosol and then be breathed in deep in the lungs.”

The new study is important because previous studies on tobacco use and COVID-19 have largely been on adults and smoking traditional cigarettes. “They have often used clinic-based samples, largely those already tested or diagnosed, which means they are biased,” Halpern-Felsher says. “Our study is the first population-based study using a large sample of youth and young adults across the country, and first to include e-cigs.”

While the study did try to account for known risk factors for COVID-19, such as obesity, it was unable to correct for other known risk factors, such as hypertension—which is more present in older individuals. “That being said, the increased risk of being diagnosed with COVID-19 in those who had used e-cigarettes or were dual users of e-cigarettes and traditional cigarettes should be translatable to older populations as well,” Robert Goldberg, MD, pulmonologist with Mission Hospital in Southern California, tells Health

Since the early stages of the pandemic, various health agencies have also warned about a connection between smoking and vaping, and COVID-19 risk, with possible serious complications if they contract the disease.

“People with underlying health issues, such as heart or lung problems, may have increased risk for serious complications from COVID-19,” Michael Felberbaum, a spokesman for the Food and Drug Administration told Bloomberg. “This includes people who smoke and/or vape tobacco or nicotine-containing products.” And in April, Nora Volkow, MD, director of the National Institute on Drug Abuse, published a blog post warning that the coronavirus “could be an especially serious threat to those who smoke tobacco or marijuana or who vape.” 

The COVID-19 risk is yet another health harm related to e-cigs. In January 2018, a review of more than 800 different studies was released by the National Academies of Science, Engineering and Medicine. It concluded that e-cigarettes both contain and emit a number of potentially toxic substances, and found “moderate evidence” that youth who use e-cigarettes are at a higher risk for cough and wheezing, plus a worsening of asthma symptoms. 

Halpern-Felsher’s study has prompted lawmakers to urge the FDA to temporarily withdraw e-cigarettes from the market until the COVID-19 crisis is over. In a letter sent to FDA commissioner Stephen Hahn, MD, on August 11, obtained by CNN, they highlight their concerns that vaping could threaten the health and safety of Americans of all ages “given that young people are increasingly driving the spread of COVID-19.” In the letter, the House Committee on Oversight and Reform's subcommittee on Economic and Consumer Policy asks Hahn to confirm by August 18 whether or not the FDA will temporarily clear the market of all e-cigarettes.

Overall, Halpern-Felsher wasn’t surprised by the findings of her study in general, but she didn’t expect to see such a dramatic increase in risk of being diagnosed with COVID-19. For her, there should be no doubt: “This is a call to all to stop vaping." 

“Before the coronavirus pandemic, there was already ample evidence of increased risk of lung damage in those who vape compared to those who use traditional cigarettes,” Dr. Goldberg adds. “My advice is to quit vaping or never start vaping in order to minimize this risk.”

The information in this story is accurate as of press time. However, as the situation surrounding COVID-19 continues to evolve, it's possible that some data have changed since publication. While Health is trying to keep our stories as up-to-date as possible, we also encourage readers to stay informed on news and recommendations for their own communities by using the CDCWHO, and their local public health department as resources.

To get our top stories delivered to your inbox, sign up for the Healthy Living newsletter