After careful review of more than 800 research papers on e-cigarettes, the National Academies of Sciences, Engineering and Medicines’ evidence-based clinical guidelines concluded that there is “moderate evidence” for increased cough and wheeze in adolescents who use e-cigarettes.[1] In addition, nicotine-containing e-cigarette aerosols have the potential to adversely impact several host defence mechanisms in the lungs. Independent of nicotine, exposure to particulates and flavorings in e-cigarette aerosols could also potentially impair lung function.[1] Meanwhile, the Forum of International Respiratory Societies, a collaborative of nine international professional organizations that was created to promote respiratory health worldwide, published a position statement in 2018 warning that exposure to e-cigarette aerosol in adolescence and early adulthood can result in pulmonary toxicity.[2]

With the growing evidence of potential risk factors related to the COVID-19 pandemic, the immediate health effects of e-cigarette vaping have become apparent and are alarming. Also, the new evidence suggests COVID-19 and other respiratory infections will not only increase the risk of developing complications from the coronavirus but will increase chances of spreading it to others. Some American states are even issuing specific health advisories on vaping and COVID-19.[3] The evolving knowledge is especially worrisome, and in light of this evidence, serious efforts should be made to increase public awareness of the harmful effect of e-cigarette use. Physicians should step up and redouble their cessation and counseling efforts.

Smoking and vaping also seem to be associated with poor survival; therefore, we need to bring sensible policies to protect our young people from devastating effects of COVID-19. The American Academy of Family Physicians recently developed clinical guidance to highlight the well-known risk. People who smoke or use e-cigarettes have a significantly higher risk of contracting respiratory infections like the coronavirus, and people with decreased lung function caused by smoking or vaping are more likely to develop serious complications caused by infections. According to Dr Barbara Keber, president of the New York State Academy of Family Physicians, “Now more than ever, it is critical for the State and medical community to take actions to prevent our youth from ever using these highly addictive, deadly products, and to help our patients to reduce their risks through FDA-approved cessation and telehealth during this pandemic.”[4]

The Canadian Paediatric Society has developed a COVID-19 resource for the health care community. The society encourages pediatricians and other health professionals who work with adolescents, youth, and families to communicate the message that smoking and vaping may increase the risk of acquiring the COVID-19 infection.[5]

According to scientific evidence, COVID-19 could be a serious threat to those who smoke e-cigarettes, combustible tobacco, or marijuana. Moreover, smoking or vaping increases people’s vulnerability to severe illness once infected, and anything that makes the lungs less healthy will weaken our survival chances against COVID-19.

We strongly believe that the recent evidence needs to be appropriately reflected in COVID-19 prevention and control efforts. Further, this information should be widely circulated as an emerging clinical guideline in order to assist front-line physicians’ informed clinical decision making efforts to treat COVID-19.
—Aki Nilanga Bandara, BSc
Founding Chair, Global coalition to empower adolescent and youth on harmful therapeutic interventions to prevent combustible tobacco use
Instructor, UBC Faculty of Land and Food System
—Mehara Seneviratne, Senara Wanniarachchi, BSc, and Ricky Jhauj, BKin
Coordinators, Global coalition to empower adolescent and youth on harmful therapeutic interventions to prevent combustible tobacco use
—Vahid Mehrnoush, MD
Senior Advisor, Global coalition to empower adolescent and youth on harmful therapeutic interventions to prevent combustible tobacco use
Section of Trauma, Acute Care, and Global Surgery, Vancouver General Hospital, UBC

References

1.    National Academies of Sciences, Engineering, and Medicine, et al. Public health consequences of e-cigarettes. Washington, DC: National Academies Press; 2018.

2.    Ferkol TW, Farber HJ, La Grutta S, et al. Electronic cigarette use in youths: A position statement of the Forum of International Respiratory Societies. Eur Respir J 2018;51:1800278.

3.    Commonwealth of Massachusetts, Office of Attorney General Maura Healey. COVID vaping advisory. Accessed 30 April 2020. www.mass.gov/doc/covid-vaping-advisory [14].

4.    New York State Academy of Family Physicians. Statement by NYSAFP on link between tobacco use and COVID-19. Accessed 30 April 2020. www.nysafp.org/News/What-s-New/COVID-19-Resources [15].

5.    Chadi N, Bélanger R. Canadian Paediatric Society. COVID, youth, and substance use: Critical messages for youth and families. Accessed 30 April 2020. www.cps.ca/en/blog-blogue/covid-youth-and-substance-use-critical-messages-for-youth-and-families [16].