In March, the number of coronavirus cases in New York state surpassed 25,000. It's also the month that Daniel, a 31-year-old software engineer and New York City resident, dismantled his JUUL and snapped the battery in half.
Daniel* has been JUULing since 2016 when a friend introduced him to the electronic cigarette. Four years, and a self-described full-blown JUUL addiction later, coronavirus hit New York City. It has now been called an "epicenter of the pandemic." Mayor Bill de Blasio compelled smokers and vapers to quit early on:
"If you are a smoker or a vaper this is a very good time to quit the habit and we will help you," he said in a March 8 press conference.
For Daniel, that announcement was a catalyst. He bought nicotine gum. He tried to limit how often he used his JUUL.
"I had resolved myself to quit as soon as I saw the announcement. At the time, there wasn't a lot of literature about the COVID-19 risks of JUULing, so I was a little unsure if it was worth the risk to my mental health to quit during a time of global crisis," he tells Inverse.
"I know that chances are if I get this virus, I will suffer very badly."
Ongoing research on COVID-19 has crystallized one thing: the illness goes straight for the lungs. A small, preliminary study on 78 patients in China found that smokers were 14 times more likely to progress to a more severe form of COVID-19.
The pandemic ultimately pushed Daniel to dispose of his JUUL completely. That was a smart choice, comments Panagis Galiatsatos, an associate professor at Johns Hopkins who studies pulmonary and critical care medicine. He is also the national spokesperson for the American Lung Association.
"If you want to be prepared for a pandemic, 100 percent you should quit right now," Galiatsatos tells Inverse. "That way, if you do unfortunately catch COVID-19, you won’t suffer dire consequences from it."
Living and working during the COVID-19 quarantine is already anxiety-inducing. Many have turned to creature comforts — or at least the digital versions of them. But for vapers and smokers, their chosen creature comfort poses a major risk especially because of the unique nature of this pandemic. It's no secret that vaping and smoking aren't good for you, but their related ill effects can seem like long-off threats. COVID-19 makes the nebulous imminent.
That sense of imminency provided the extra motivation people like Daniel needed to quit. But it doesn't, however, point to an answer for a very difficult question: How exactly do you quit while in the world is retreating into quarantine?
The drive to quit in quarantine: explained
"At this point, everything is anecdotal," Myers tells Inverse.
Online, those anecdotes abound. Posts on subreddits like r/leaves (a marijuana-based subreddit), r/stopsmoking, and r/Coronavirus reference the virus as an impetus for quitting. On March 16 a Twitter account called @QuitforCovid started retweeting doctors describing the risks COVID-19 poses to smokers and vapers.
What is clear is the additional risk that smokers have during this pandemic, Myers says.
"There has been consistency in the reports from experts, indicating that people who smoke in particular are more vulnerable to the coronavirus crisis."
Smokers are turning to the internet for support. One of them is Bridget*, 46, a smoker from Antigua who turned to Reddit's r/stopsmoking for support.
Bridget has been smoking since she was 16. She has tried to quit smoking before. Bridget's most successful prior attempt was during the four months she was pregnant with her daughter — now, COVID-19 is her new motivator.
"We are quite exposed and scared," she tells Inverse. "I know that chances are if I get this virus, I will suffer very badly. My husband might possibly die — he has had lung issues in the past."
Antigua has only three confirmed COVID-19 cases. But it's a small and isolated place. She says she and her husband worry about how quickly the virus may spread.
"I said to myself, 'that's it — I'm quitting.' I have to do this for my family and I have to do this for myself."
Why smoking can make COVID-19 worse
Her fears are based in fact: There is clear evidence that smoking can affect the body's ability to fight the virus, explains Sven Eric Jordt, a professor at Duke University who has studied e-cigarettes and asthma.
Smokers are at risk, in part because the habit damages cilia, hair-shaped cells in the lungs that move in tandem and shuttle out mucus and dirt, Jordt tells Inverse.
"This mechanism is essential to clear viruses, bacteria and toxic particles we inhale," he explains.
That damage, in the long run, can make a COVID-19 infection not only harder to shake but should it progress, more dangerous, Galiatsatos adds.
"While everyone is susceptible to catch COVID-19, the symptoms they cause are dependent on your status of health, and your lung health," Galiatsatos explains. "It’s likely that those patients [smokers] when they catch COVID-19 will have more dire symptoms."
Unlike Daniel, who had a moment of truth after an announcement, Bridget started to suspect she might be when she heard the virus affected lung function. She's been following the outbreak since the beginning, but it took until this week to pull the trigger and give up smoking.
As of today, she hasn't had a cigarette since last Thursday.
Why vaping can also put you in danger
Vaping does not expose the user to the same chemicals that come from combustible tobacco. But the habit still poses risks during this pandemic, partially due to the way that aerosolized chemicals, like those in flavorings, affect lung cells.
"They're likely to have more dire consequences."
For instance, some vaping has been linked to DNA damage or to the death of mouth bacteria that make up the oral microbiome (and may influence immune health, one study warns). Jordt is particularly wary of vape flavors and explains that some flavor chemicals (found in the vapor of e-cigarettes) disrupt the ability of cilia to keep the lungs healthy, increase "virus counts" in mice, and suppress immunity to viruses in humans.
Still, Galiatsatos notes that there's scant research that connects COVID-19 and e-cigarettes directly. But based on previous research pointing to cell toxicity, and his own clinical experience, he would urge vapers to quit too.
"Those who use electronic cigarettes are putting themselves in a position that when they catch COVID-19, they're likely to have more dire consequences than those that do not use electronic cigarettes," he says.
So, how can one actually quit?
Quitting during a pandemic does pose unique challenges, Galiatsatos acknowledges. The triggers to smoke or vape — like anxiety or stress — are at an all-time high. Nicotine promises a temporary relief, that "feels really nice" says Daniel.
"But at the end of the day, it's more important to stay safe and healthy, especially during a time where smoking or vaping can put you at a higher level of risk," he continues.
Both Daniel and Bridget have used friends, family and the Internet to keep themselves on track. For Daniel, nicotine gum has proved crucial — as has the encouragement of others (something he has to resign himself to online, given the order to practice social distancing). He and his girlfriend also play video games together, which helps.
"That has surprisingly been good at distracting me from the cravings and keeping me going," he says. "The resources I need are really just encouragement, and of course, nicotine gum to quell the strongest cravings."
Bridget has also reached out for online support as she tries to quit smoking. That's in part why she posted her first bluntly honest message (seen below) on the r/stopsmoking subreddit: It was a public declaration of her intent.
Online forums have always existed. But in the wake of the pandemic, traditional quitting platforms are trying to adapt to a new, socially-distanced society, says Myers. That's a process that has gone more smoothly in some places than in others. For instance, thenysmokefree.com quitline has been "scaled down" during the COVID-19 crisis.
"There have been cases where things have been scaled back," Myers says. "We're concerned about that."
But for the most part, he adds, most quitlines are operating normally. He points to national quitlines like those at smokefree.gov, the North American Quitline Consortium, the American Lung Association's quitline, and the American Cancer Association's quitline.
What truly people need, is support Myers says. And support can take many forms.
"If anything, my hope is that people are spending more time with their families and they have a greater opportunity to reinforce each other," Myers says.
Quitters may not be able to meet in person, but solidarity is still something a computer or phone can provide. In the meantime, Daniel and Bridget are hanging in there:
"At least knowing I'm not the only one going through it is helpful," Bridget says.
*Identifying details changed.