The effective response to a pandemic requires limiting and slowing the spread of a virus. That in turn requires providing people with sound, evidence-based information about what causes coronavirus transmission. Above all, it is essential that health care professionals and institutions are able to focus their time and resources on those with the greatest medical need.
Spreading misleading information about what could increase the risk of virus-caused respiration infections can and has led people to panic and seek medical care they don’t need at the expense of those that do.
In particular, several media outlets and public health organizations have promoted the fear that vaping causes or increases the risk of COVID-19, an assertion first made by New York City Mayor Bill DeBlasio.
Most recently, Bloomberg ran a story: “Vaping Could Compound Health Risks Tied to Virus, FDA Says.” People with underlying health issues, such as heart or lung problems, may have increased risk for serious complications from Covid-19,” Michael Felberbaum, an FDA spokesman, said in an email Friday in response to questions from Bloomberg. “This includes people who smoke and/or vape tobacco or nicotine-containing products.”
“E-cigarettes can damage lung cells,” Felberbaum said.
Focusing on vaping when much the population is still seeking certainty about social distancing, testing and other introduces confusion where clarity is needed. Spreading unsubstantiated claims that vaping will increase the risk of COVID-19 is uncalled for. Especially by the FDA.
The fact that the FDA allowed such an unqualified and unscientific statement is puzzling. There was no scientific study or evidence accompanying the statement. In particular, the blanket assertion lacked any context, conflating vaping, smoking and heart or lung problems as equally at risk. Relative to other health related factors such as diabetes, heart conditions and COPD, how much additional risk does vaping generate? Should people who vape as a way to reduce smoking stop vaping? Should they switch from vaping to smoking?
Further, the FDA spokesman’s claim that vaping damages lung cells was unqualified and stated in the absence of any supporting data. This too sows panic about the relative contribution of smoking or e-cigarettes to the risk or severity of coronavirus.
The fact that a press spokesman made a scientific assertion ( “E-cigarettes can damage lung cells”) and was reported without contextual information as medical advice from the FDA is both dishonest and dangerous.
To be clear, the National Academy of Sciences report: Public Health Consequences of E-Cigarettes concluded there was substantial evidence that e-cigarette aerosols can induce acute endothelial cell dysfunction and promote the formation of reactive oxygen species/oxidative stress.
But the same study also made clear that the “generation of reactive oxygen species and oxidative stress induction is generally lower from e-cigarettes than from combustible tobacco cigarette smoke” and that the long-term consequences and outcomes on these parameters with long-term exposure to e-cigarette aerosol are uncertain.
Indeed, the FDA spokesman and Bloomberg – like many other media accounts and statements fail to distinguish between long- and short-term risk, between research conducted on mice or human tissue samples and real-world data, gathered from human beings. Rather, articles singling vaping out as a risk factor for COVID-19 applies the “linear no-threshold hypothesis” which presumes that toxic “causation is a linear process, meaning that there is no safe dose and that damage occurs at a constant rate as exposure increases.”
For example, a New York Post article entitled “Vaping May Be A Cause of Coronavirus Cases in Young Americans”, quotes a blog by Stanton Glantz, director of the Center for Tobacco Research Control & Education at University of California San Francisco: “Vaping affects your lungs at every level. It affects the immune function in your nasal cavity by affecting cilia which push foreign things out...[T]he ability of your upper airways to clear viruses is compromised.”
Glantz, whose research on the link between e-cigarettes and heart disease has been retracted, fails to make the distinction between short term and long-term exposure or between smoking and e-cigarettes on what is called nasal mucociliary clearance. Again, these distinctions are important, especially when deciding what public health messages should be conveyed.
The distinction is important for two reasons. First, it is well known that years and decades of chronic smoking are needed for the development of lung diseases. And even among smokers, it takes at least a decade or longer of consistent smoking for COPD to develop. Most studies conclude that "prolonged tobacco use is associated with respiratory symptoms and COPD after controlling for current smoking behavior."
One recent study found that e-cigarette (ECs) "use may aid smokers with COPD reduce their cigarette consumption or remain abstinent, which results in marked improvements in annual exacerbation rate as well as subjective and objective COPD outcomes." That was followed by another analysis in 2018 that concluded, "EC use may ameliorate objective and subjective COPD
outcomes and that the benefits gained may persist long-term. EC use may reverse some of the harm resulting from tobacco smoking in COPD patients.
Finally, most young adults are switching from cigarettes to e-cigarettes. Few non-smokers are starting to vape. Rather, the decline in smoking tracks with the increase in the use of e-cigarettes. As for the so-called gateway effect (vaping being the first step to smoking), a recent study concluded that less than 1 percent of young people who have vape then go on to smoke regular cigarettes. If anything, young vapers are less likely to go on to smoke regular cigarettes than their peers who try out other tobacco products first. Even if long term use of vaping does contribute to health problems, having people who would otherwise smoke us e-cigarettes, is likely to reduce the overall risk of diseases associated with more serious COVID-19 complications.
E-cigarettes are an alternative to smoking cigarettes. They are less harmful than combustible tobacco. The vast majority of young adults who use ECs are using them to reduce the amount they smoke. Such a shift is associated with reduced exposure to the biomarkers that, over the long term, increase an individual’s risk of cancer, heart disease, and COPD.
With regard to COVID-19, the relative contribution of smoking as a factor is unclear. Smoking is associated with a higher risk of being hospitalized for or dying from complications related to COVID-19. But high-risk patients are also more likely to be over age 70 and have a history of diabetes, heart disease or COPD. Research clearly shows that e-cigarette use reduces the consumption of chemicals contained in combustible tobacco that lead to such health problems.
The FDA’s statement was irresponsible and can lead people to believe that vaping is a significant risk factor for COVID-19 at the expense of other habits clearly related to the risk of transmission or severity of disease.