In 2018, former FDA commissioner Scott Gottlieb called teen vaping "an epidemic" as teens took up the habit in record numbers. While 2020 gave us an actual pandemic that has eclipsed the "epidemic" of teen vaping, scientists have warned that it was only a matter of time before the two trends met.
New research suggests they already have.
A study released by scientists at Stanford University suggests that vaping is linked to higher chances of having Covid-19 symptoms. This finding was published Tuesday in the journal Adolescent Health.
Based on an analysis drawn from 4,351 vapers, smokers, non-users, and dual users, the team estimates that vapers were five times more likely to have been diagnosed with Covid-19 compared to non-vapers. Dual users (people who smoked and vaped) were seven times more likely to have had a Covid-19 diagnosis.
The paper suggests that there's a trend between vaping and positive coronavirus diagnosis, but it can't really explain why the connection exists.
For now, the authors propose that vapers might be more at-risk for getting Covid-19 because of evidence suggesting that vaping can increase the risk of respiratory diseases in general. It's also possible that it can lead to bad coronavirus habits – like sharing vapes or touching your face.
Bonnie Halpern-Felscher, the study's senior author and a professor of adolescent medicine at Stanford explains that even young adults need to realize that vaping is putting them at risk.
"I really hope that all youth and young adults who vape hear this evidence and decide to quit, or not start in the first place," Halpern-Felscher tells Inverse.
More likely to get tested, more likely to be sick – The study is based on a sample of people between 13 and 24-years-old who answered questions about their vaping habits and Covid-19 diagnoses (or lack thereof) between May 6 and May 14. The sample was about equally split between people who had vaped before (50.2 percent had vaped) and those who had never done so (49.8 percent had never vaped before.)
Importantly, people who had vaped before were more 3.3 likely to get a Covid-19 test in the first place (those who had vaped in the past 30 days were 2.6 more likely to get a test). That may reflect the fact that testing was reserved for those showing symptoms in early March, but has since been opened up to a wider pool of applicants.
If you dive into the population of people that have been tested, however, there's still a clear trend between e-cigarette use and Covid-19. Amongst all of those who were tested (vapers and non-vapers alike), vapers were five times more likely to be diagnosed with Covid-19.
The patterns held when authors adjusted for other factors linked to Covid-19 like sex and race. They also adjusted their results to account for obesity, a risk factor that may apply to young adults more so than chronic diseases like high blood pressure.
A short history of vaping and Covid-19– In March, scientists told Inverse that smokers would like face heightened risk for severe Covid-19. That month, a small study on Chinese patients suggested that smokers were 14 times more likely to progress to severe forms of disease. A May 2020 meta-analysis of 19 papers also suggested that smoking was linked to severe Covid-19 progression.
Vaping, though, has remained an open question. Vaping sidesteps some of the traditional issues that come from burning tobacco, but it comes with its own risks: Animal models have shown that exposure to cigarette vapor can impair the lung's defenses against bacteria and viruses. In humans, vaping has been linked to DNA damage in the lung or wheezing.
Panagis Galiatsatos, a spokesperson for the American Lung Association, told Inverse in June that vaping has the same "biological plausibility" of causing severe Covid-19 that smoking does, but the studies that examine it specifically have yet to develop.
This study addresses how vaping may increase the risk of disease, but it can't tell us how people fare once they get the Covid-19 – a big missing piece of the puzzle considering that 27.5 percent of high schoolers vaped in 2019.
"We don't know anything about the mechanisms by which e-cigs and Covid-19 are linked," says Halpern-Felscher, though they do have some hypotheses.
"E-cigarette use harms your lungs and your immune system, thus possibly making you more at risk for other lung injury, including a virus like Covid-19 that would harm your lungs further," she explains.
For now, the connection between getting Covid-19 and vaping is becoming more robust, despite the questions that remain.
"Young people may believe their age protects them from contracting the virus or that they will not experience symptoms of COVID-19, but the data show this isn't true among those who vape."
Methods: An online national survey of adolescents and young adults (n 1⁄4 4,351) aged 13e24 years was conducted in May 2020. Multivariable logistic regression assessed relationships among COVID-19 related symptoms, testing, and diagnosis and cigarettes only, e-cigarettes only and dual use, sociodemographic factors, obesity, and complying with shelter-in-place.
Results: COVID-19 diagnosis was five times more likely among ever-users of e-cigarettes only (95% confidence interval [CI]: 1.82e13.96), seven times more likely among ever-dual-users (95% CI: 1.98 e24.55), and 6.8 times more likely among past 30-day dual-users (95% CI: 2.40e19.55). Testing was nine times more likely among past 30-day dual-users (95% CI: 5.43e15.47) and 2.6 times more likely among past 30-day e-cigarette only users (95% CI: 1.33e4.87). Symptoms were 4.7 times more likely among past 30-day dual-users (95% CI: 3.07e7.16).
Conclusions: COVID-19 is associated with youth use of e-cigarettes only and dual use of e-cigarettes and cigarettes, suggesting the need for screening and education.