Since the pandemic in March, the US began to rise in full force, speculation about the connection between vaping and Covid-19 has flourished. The Food and Drug Administration and the National Institute on Drug Abuse have both issued warnings. Anecdotal reports of young vapers descending with severe coronavirus infections began to grow. But there was very little research to support a connection.
Now, a study published today in The Journal of Adolescent Health finally provides data showing a relationship between e-cigarette use and Covid-19 risk. Stanford University researchers show that teens and young adults ages 13 to 24 who use e-cigarettes are five times more likely to be diagnosed with Covid-19 than their non-vaping peers. Those who are dual users – people who smoke both traditional and electronic cigarettes – are seven times more likely to test positive for the virus, the researchers found.
“I knew there was going to be a relationship,” says coauthor Bonnie Halpern-Felsher, a professor of pediatrics at Stanford University who studies the use of tobacco for youth. “I did not expect it to be so strong of a relationship.”
Studies have already linked smoking to higher susceptibility to severe Covid-19 infections, but previously no population-based studies have examined the link between e-cigarette use and Covid-19 in adolescents and young adults. The question researchers want to answer was twice: Were e-cigarette smokers more likely to test for SARS-CoV-2? And were they more likely to test positive? “The answer is sounds yes” to both parts of the question, says Halpern-Felsher.
The researchers collected their data through an online survey posted on spaces such as social media and gaming sites. More than 4,000 teens and young adults from all 50 states responded, completing the roughly 15-minute survey. Researchers then weighted the samples to reflect the racial and ethnic, gender, LGBTQ status, and age formation of the United States population.
The questionnaire, which was sent out in early May, asked respondents whether they had ever used regular or electronic cigarettes; whether they have used them for the last 30 days; or they were tested for Covid-19; and whether their test results returned positive. The researchers also checked for other Covid-19 risk factors, such as whether the respondents lived near a hotspot of coronavirus; whether they were underweight or overweight, which may affect lung function; and for their socio-economic status, which can affect how well people can socially distance themselves. Finally, the researchers determined that dual users who had smoked in the last 30 days were not only more likely to test positive, but they were also nine times more likely to test in the first place.
The survey did not examine why users decided to test. Users may confuse the effects of vaping – extra mucus, coughing, or shortness of breath – with Covid-19 symptoms. But the high rate of positive test results may indicate that vapers are more vulnerable to the virus itself.
That said, this study simply illustrates a correlation between e-cigarette and cigarette use and positive diagnosis of Covid-19. As the authors state in the paper, their findings “show that e-cigarette use and dual use of e-cigarettes and cigarettes are significant underlying risk factors for COVID-19 that have not been shown before.” But on their own, this paper cannot prove if they are more biologically susceptible to infection in the first place, or if they are more likely to have severe infections.
Still, Halpern-Felsher has a few theories as to why this overlap exists. Smokers may have more lung damage, making them more susceptible to the virus. Or they may often touch their hand to their mouth as other people, or share weapons, thereby increasing their chances of being exposed in the first place. Or it could be that the virus is spreading through the aerosols vapers exhalation. ‘Those are all hypotheses,’ she says. “Someone has to follow it.”
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