Alicia Casey, a pulmonologist also at Boston Children’s Hospital who works with kids and teens and was not part of this study, says she’s seen similar problems in healthy teens who couldn’t fight off other viral infections. “We definitely saw this with the flu this year,” she says. “Why are these teenagers having so much trouble with the flu? An otherwise-healthy high school athlete should not have trouble and shouldn’t have chronic respiratory problems either.” Casey says that vaping is associated with damage to the lower respiratory tract, so it makes sense that vapers with underlying damage to their respiratory system would have trouble fighting off an infection to that system.
Casey adds that the Stanford paper is particularly concerning given that data from a 2019 national survey indicates that more than a quarter of high school students use e-cigarettes. “We may have a lot of young people struggling with this,” she says, especially as states begin to reopen and kids go back to school or start to see their friends more often.
Levy points out that some risk factors may also be behavioral. “The way I see it, nicotine vaping is a marker for other kinds of behaviors that all may increase risk,” she says. Like Halpern-Felsher, she notes that teens and young adults who vape may share vape pens, that smoking involves a lot of hand-to-mouth contact, and that it creates aerosols, all of which could increase the risk of passing the virus. Plus, people may also be vaping marijuana or drinking—if they’re feeling less inhibited, they may forget to follow protocols like wearing a mask or social distancing. “That’s why it’s so frightening,” Levy says. “They’re more likely to behaviorally get themselves into trouble, and then they’re also more likely to experience worse outcomes.”
But while the exact mechanism of how vaping and Covid-19 are correlated is still unknown, there’s already political pressure on legislators to act. Representative Raja Krishnamoorthi, chairman of the House Subcommittee on Economic and Consumer Policy, cited the study in a letter to the FDA published today, asking the agency to take e-cigarettes off the market during the pandemic, writing that it is “evident that the youth vaping epidemic has combined forces with the Coronavirus pandemic, creating a much deadlier foe that demands FDA action.”
Halpern-Felsher says both physicians and young e-cigarette users should pay attention to the survey findings. “We’re hoping there’s a prevention message out there: Adolescents, young adults, take note that this is going to put you at risk,” she says. She also urges healthcare providers to regularly ask young people about their vaping and smoking habits. That will help determine who is at risk. Meanwhile, being able to track the number of people who both use e-cigs and come in for Covid-19 testing and treatment will also help researchers figure out whether vaping contributes to more severe coronavirus infections. “We definitely need more data,” she says.
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