Teens and young adults who use tobacco products appear more likely to contract the novel coronavirus, according to a new paper, a finding that adds to conflicting data on the links between smoking, vaping and COVID-19.
More than 6% of young people age 13 to 24 who reported both smoking and vaping in the past month said they had tested positive for COVID-19, compared with less than 1% of those who had never used, according to the study in the Journal of Adolescent Health. The paper was based on the results of an online survey of 4,351 people posted on gaming sites, social media and other websites.
“Bottom line, if you use e-cigarettes and cigarettes, you are so much more likely to be diagnosed with COVID,” said Bonnie Halpern-Felsher, the senior author of the paper and a professor of pediatric medicine at Stanford University focused on teen e-cigarette use.
The susceptibility of teens and young people to COVID-19 is a question of increasing urgency as schools in the US begin to re-open. Infections among US kids have climbed, jumping 40% in late July, according to the American Academy of Pediatrics and the Children’s Hospital Association. Children have accounted for 8.8% of all US virus cases to date.
Concerns about the health risks of vaping have also increased. Health officials in the US have described teen e-cigarette use as an epidemic and taken steps to rein in flavored products that were popular with younger people. A lung ailment later linked to contaminated THC vaping products sickened thousands of Americans last year. Makers of e-cigarettes must submit their products to the Food and Drug Administration for authorization by Sept 9.
Rep. Raja Krishnamoorthi, a Democrat from Illinois and chairman of a House oversight subcommittee, urged the FDA to remove e-cigarettes from the market for the duration of the pandemic, citing the study’s results.
Researchers around the world have sought to determine whether tobacco use influences a person’s risk of getting COVID-19 and how sick they will become. Observational studies found smokers accounted for only a fraction of hospitalizations, though it appears they are more likely to experience severe disease or death, according to the World Health Organization.
Not all of the Stanford study’s findings were consistent, said Ray Niaura, a professor at New York University specializing in tobacco dependence. For example, respondents who said they used tobacco products in the past month were less likely to test positive for the coronavirus than those who said they had tried smoking or vaping at least once in the past.
Young people who used both e-cigarettes and cigarettes were at the greatest risk of testing positive, followed by those who vaped exclusively.
Surveys aren’t ideal research tools because they rely on people responding accurately and there is no way to verify answers. Results may also be skewed if the sample isn’t completely random.
The Stanford study wasn’t designed to show how tobacco products increase the risk of getting infected, and there isn’t enough evidence to say the products themselves, rather than some other factor associated with smoking or vaping, are responsible.
Halpern-Felsher said tobacco users may have weaker immune systems, or that bringing an object up to one’s mouth and sharing it with friends could allow germs to spread more freely. Gathering with friends or being more willing to take health risks could play a role, she said.
“Do I think there are strong associated risks? Absolutely,” Halpern-Felsher said.
Lack of data
Other efforts to home in on the risks have struggled. Melodi Pirzada, chief of pediatric pulmonology at NYU Winthrop Hospital, scrapped plans to conduct a study using electronic medical records from her hospital on Long Island because there wasn’t enough data.
While clinicians were asked whether a patient used e-cigarettes, the field was left blank in more than 60% of the records she reviewed. Pirzada said fewer of her teen patients may be vaping because schools are closed for now and parties are on hold.