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Editor's Note: John Maa, MD, is a past president of the San Francisco Marin Medical Society. The opinions expressed in this comment are the author's own.
(CNN) - A college friend who is now a doctor first introduced me to an e-cigarette in 2008. He bought his cigarette online in China in hopes that it could go from smoking to vaping, but he ended up using both. A few years later, he shared a pleasant surprise: He had managed to quit smoking and vape.
The breakthrough came one winter while recovering from a cold. When he reached for the electronic cigarette, he realized the danger of exposing his recovering lungs to a cloud of smoke. He gave away his electronic cigarette and never smoked or vaped again. Her success story highlights the power of a second event to end nicotine addiction. The current covid-19 pandemic can serve as a similar warning call for smokers to quickly stop.
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In the past 10 months, three serious waves of severe acute respiratory illness have forced the US emergency care system from 1) the electronic cigarette or the lung injury associated with the use of vaping products (EVALI), 2 ) influenza season and 3) covid-19. Around June 2019, U.S. hospitals They first noticed an increase in respiratory illnesses related to e-cigarettes. The US Centers for Disease Control and Prevention (CDC) They tracked this Evali outbreak to early 2020, eventually counting 2,807 hospitalized patients in all 50 US states, with 68 deaths through February. Overlapped with the Evali crisis has been the flu season, which runs from October to May. So far, the CDC estimates that there have been at least 39 million cases of influenza in the U.S., leading to 400,000 hospitalizations and 24,000 deaths. The third stress has been the worldwide pandemic of covid-19, totalizing, at the time of publishing this note in 347,003 cases only in the USA. And 10,335 deaths.
Smoking has many negative effects on respiratory health, and the possibility of a relationship between smoking (both traditional cigarettes and marijuana) or vaping with covid-19 emerged in the first observations in China. A report, which looked at 1,099 laboratory-confirmed cases in China, revealed that 12.4% of smokers died, required ICU admission, or required intubation, compared to 4.7% of those who never smoked. Another study found that among Chinese patients diagnosed with covid-19 pneumonia, the odds of disease progression (including death) were an order of magnitude higher among smokers compared to nonsmokers. The World Health Organization has observed that cigarette smokers can have a more serious illness if they become infected with Covid-19.
The United States Food and Drug Administration (FDA) has reported that cigarette smoking and vaping can leave users with underlying health problems and increase the risk of coronavirus pneumonia and increase its severity. More research should be done to determine the scope. The US Surgeon General Smoking has been reported to be strongly related to asthma, chronic obstructive pulmonary disease (COPD), pneumonia, and coronary artery disease, all of which impair the immune response and ability to fight covid-19.
Active research is underway to assess the long-term health risks of marijuana use and vaping, including pediatric chronic bronchitis. New York City Mayor Bill de Blasio highlighted a possible connection between the coronavirus and vaping after noting that a healthy 22-year-old man in New York, whose only risk factor appeared to be a history of vaping, was hospitalized for covid-19. The CDC has reported that up to 20% of patients hospitalized for covid-19 in the U.S. They are between 20 and 44 years old, and California Governor Gavin Newsom noted that half of California's covid-19 cases are younger adults, ages 18 to 49. Michigan Governor Gretchen Whitmer speculated that the popularity of vaping could explain the increased incidence of covid-19 among youth and young adults, and the National Institute on Drug Abuse has included e-cigarette smokers on the list of groups that could be more affected by covid-19.
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A related question is whether previous vaping-related lung injuries may predispose to an increased risk of contracting covid-19. Surviving Evali patients may develop long-term respiratory problems. If they were to contract covid-19, they could also be at increased risk for respiratory failure, prolonged intubation, and mortality.
As they recover from coronaviruses, smokers must do everything possible to stop protecting their lung health. Repeated inhalation of an electronic cigarette (possibly covered in viruses or bacteria) violates the principle of minimizing contact with the mouth and face to reduce the risk of contracting covid-19. Sharing an e-cigarette with others only further increases that risk. While the butt is discarded after each use, electronic cigarette devices are used repeatedly. Perhaps e-cigarettes should be designed to be disposable and minimize the risk of infection transmission. Another area for further study is whether the aerosol plume generated by the vaporizer could deposit virus particles on the surfaces of the environment.
The majority of the Evali outbreak cases were associated with vaping marijuana / THC contaminated with vitamin E acetate. But the CDC did not exclude that there could be other causes, as 14% of Evali patients “exclusively used products containing nicotine".
Perhaps some of the mysterious Evali cases from winter 2019 should now be re-analyzed, to determine if the coronavirus may have played a role. Bronchoscopy biopsies and lung samples stored in pathology labs across the United States could be evaluated for coronavirus RNA. Similarly, re-analyzing end-of-the-year influenza cases can reveal whether the current cases of infection we are witnessing are actually a second wave.
Covid-19's initial impact on the electronic cigarette industry was a disruption to the supply chain. About 90% of the world's electronic cigarette hardware is produced in China, and many factories in Shenzhen were closed during the coronavirus outbreak there. More recently, many electronic cigarette stores across the US have closed, having been defined as non-essential services. This probably made it more difficult for young people to purchase vaping devices from peers or older siblings, or at school. Another unintended benefit of mandatory school closings has been the opportunity for parents to supervise and hold conversations with their children while they are at home to curb youth vaping.
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Given the adverse effect on respiratory health, the current coronavirus pandemic should serve as a message for smokers to stop smoking quickly and take immediate action to reduce their risks of viral transmission.
And if doing it right away seems like too much of a chore, at least other steps need to be taken, like regularly disinfecting electronic cigarettes and cannabis-smoking devices.
Smokers and vapers also need to be more aware of secondhand smoke and generated clouds, avoid generating large clouds in public from vaping tricks, and follow clean indoor air laws. Social distancing could be extended to steam generated to maintain a distance of 2 meters from others in public spaces, or to smoking and vaping only in confined spaces. Active research is ongoing but difficult to conduct while simultaneously treating a pandemic, and many questions about the risks to tobacco smokers and e-cigarettes and those around them will be answered over time.
Finally, covid-19 presents a teaching moment to break the nicotine addiction cycle and accelerate our nation toward the goals of quitting and vaping.