Can Vaping Make Covid-19 Symptoms Worse?

Before the novel coronavirus took over the nation’s headlines and our lives, another health concern was in the news: vaping-related illnesses and deaths.

The impact of SARS-CoV-2, the virus that causes Covid-19, has far surpassed the 2019 vaping-related outbreak, which caused more than 2,800 hospitalizations and nearly 70 deaths.

There are now over 1.4 million confirmed coronavirus infections worldwide and around 390,000 of them are in the U.S., according to Johns Hopkins University. But there may be a place where Covid-19 and vaping converge. There’s no definitive evidence yet, but health experts believe people who smoke cigarettes or marijuana may be at a higher risk for complications from coronavirus infections, and that could include also people who vape, according to the National Institute on Drug Abuse.

More research is needed on the impact of both vaping and smoking on infections with the novel coronavirus, says Albert Rizzo, MD, chief medical officer of the American Lung Association. “It would be reasonable to think that any condition that potentially affects the lungs, be it chronic or acute effects from such behavior as smoking or vaping, regardless of the ingredients inhaled, could play a role in making someone more susceptible to complications from the [coronavirus],” Dr. Rizzo says. (Here are 10 silent symptoms of lung disease in general).

What we know about Covid-19

In late 2019, Covid-19 became known on a global scale, as the outbreak began in Wuhan, China. The sum of scientific knowledge on the virus is only three months old. And it’s also ever-changing.

Common symptoms of Covid-19 include fever, cough, and shortness of breath. The virus primarily spreads from person to person through respiratory droplets when people are in close contact, says the Centers for Disease Control and Prevention (CDC). It can also be transmitted before an infected person has symptoms and by touching a surface contaminated with the coronavirus and then touching your face. (To clean and disinfect your home or business, here are 9 EPA-registered coronavirus cleaning products.)

So far, the groups at higher risk for serious illness and dying from the novel coronavirus seem to be individuals over the age of 65, people with underlying health conditions (like diabetes, lung disease, and heart disease) as well as people who have weakened immunity, according to the CDC. (Although healthcare workers are at risk too, and anyone, even healthy young people, can get seriously ill from the virus.) It’s known that smoking cigarettes can cause chronic lung diseases like chronic obstructive pulmonary disease (COPD), which is a known risk factor for Covid-19 complications, but it can also increase the risk of type 2 diabetes and cause heart disease, says the American Lung Association.

“Having a preexisting chronic condition, especially a lung disease, appears to increase the chances that someone will experience more severe complications from Covid-19,” says Dr. Rizzo. The evidence surrounding vaping, both nicotine and/or cannabis, is still too early to draw firm conclusions, he adds. Although, “there is evidence of potential harm.”

Covid-19 is also affecting younger people and there’s been anecdotal evidence that this may be because this age group is more likely to be vaping, says Len Horovitz, MD, a pulmonary specialist with Lenox Hill Hospital in New York City. This is purely conjecture, he adds, although chronic inflammation in the lungs from vaping could set you up for more trouble. (Here are 8 vaping statistics that may shock you.)

What vaping does to your lungs

The dangers of vaping are not as well documented as those due to smoking, mainly because vaping hasn’t been around as long as smoking. But in 2019, health officials noticed a rise in serious respiratory illnesses among people who vape, particularly those who use vape liquid containing tetrahydrocannabinol (THC), the active ingredient in cannabis.

The outbreak of EVALI—e-cigarette or vaping product use-associated lung injury—peaked in September 2019 and has since declined. It was primarily tied to traces of the additive vitamin E acetate in vape products.

As a vitamin supplement or ingredient in skin care products, vitamin E acetate does not cause harm, but when inhaled, it can interfere with normal lung function. A February 2020 study published in The New England Journal of Medicine suggests the chemical’s harmful effect occurs when it’s heated in devices, like e-cigarettes. Heated vitamin E acetate causes the formation of ketene, a compound that, depending on its concentration, could potentially irritate the lungs and damage alveoli, the tiny air sacs in the lungs.

It’s not clear if EVALI patients are more susceptible to Covid-19, and if so, if it puts them at risk for its respiratory-related complications and pneumonia.

Vitamin E acetate was more likely to be found in THC-containing products purchased from informal sources like family, friends, or online, rather than commercial vape products. However, there are other ingredients found in vape juice that can be harmful.

“The short-term impact [of vaping] is to suppresses the immune system and destroy cells, leading to vaping-related lung illness,” says Alexa Mieses, MD, a practicing family physician in Durham, North Carolina.

Flavored e-cigarettes are thought to increase the risk of popcorn lung or bronchiolitis obliterans due to exposure to the chemical diacetyl. (It’s found in many, but not all, flavored vape liquids.) The condition is called popcorn lung because it was first identified in workers in the manufacture of microwave popcorn, who developed the dangerous condition from inhaling the flavoring chemical. The chemical causes scarring and narrows already-tiny airways, making it hard to breathe, Dr. Mieses says.

Both smoking and vaping destroy the cilia (tiny hair-like structures) in the lungs which would normally protect the lungs by filtering out viruses and other matter, says the American Lung Association. (Here are 9 reasons to stop vaping.)

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What Covid-19 does to your lungs

About 80% of people who contract Covid-19 have mild symptoms, according to the March 26 issue of Morbidity and Mortality Weekly Report, which included data from China and the U.S. But, some patients can develop acute respiratory distress syndrome (ARDS), a life-threatening complication from Covid-19. This is when fluid builds up in the lungs, damaging alveoli. As a result, the lungs can’t fully fill up with air and not enough oxygen travels to the internal organs.

A March 2020 study published in the Journal of the American Medical Association found over 40 percent of people hospitalized for severe Covid-19 went on to develop ARDS. Signs of ARDS include shortness of breath and hypoxia (low oxygen levels in the blood). Patients who develop ARDS need to have supplemental oxygen and mechanical ventilation as soon as their symptoms start to show. In the JAMA study, over 50 percent of people diagnosed with ARDS died from the disease.

There have been no direct studies on Covid-19 and vaping. But, there has been research on the novel coronavirus and smoking. For example, a February 2020 study published in the Chinese Medical Journal found that men were 14 times more likely to have serious disease than women. Researchers hypothesize that this may be due to the much higher rate of smoking among Chinese men than women, according to a separate study published in The Lancet Respiratory Medicine. Furthermore, research in the New England Journal of Medicine suggests the risk of developing more severe Covid-19 symptoms is more than double for smokers versus non-smokers.

But, not all researchers agree. In a March 2020 meta-analysis, published in the European Journal of Internal Medicine, researchers revealed they did not find an association between being an active smoker and having more severe Covid-19 complications in people who were diagnosed with the disease. It’s important to note all of these studies vary in sample size and methodology, which can impact the findings.

Smoking, vaping, and the risk of Covid-19

As previously stated, there’s no direct research yet on whether smoking or vaping can up the risk of Covid-19. But, there are reasons to suspect these two habits could contribute to its spread.

The World Health Organization (WHO) points out that smoking involves repeatedly touching your fingers to your mouth, which is one of the main potential entry points for the virus. A contaminated hand, cigarette, or e-cigarette could allow you to transfer the virus from hands to mouth. A smoker who does not yet have symptoms of Covid-19 despite being infected may also be more likely to transmit the virus through smoker’s cough, according to Massachusetts General Hospital.

It can be difficult to quit smoking or vaping at any time, given that they deliver addictive chemicals like nicotine or THC. But quitting now, while Covid-19 is closing in around us, may be particularly beneficial. “A lot of research shows that if you quit smoking, you start to see benefits within 24 to 48 hours,” says Dr. Mieses. “The respiratory system starts to function better and you can extrapolate this to vaping as well.”

There are products to help you quit smoking (nicotine gum or patches), medications (bupropion and varenicline) as well as quit lines such as 1-800-QUIT-NOW from the American Cancer Society. Visit smokefree.gov for more on quitting vaping. The American Lung Association has moved its support groups online, with its “Quarantine Quitters.” Also, check out the 22 best ways to stop smoking.

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