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Letter: Defending vaping puts kids’ health at risk

Posted Mar 17, 2020 at 4:11 AM

 

Recently The Dispatch took the highly unusual step of printing side-by-side op-eds both expressing the same opinion in opposition to a bill in Congress that would restrict kid-friendly flavors in nicotine and tobacco products.

Both pieces were shocking in their denial of facts and their blithe repetition of tobacco industry talking points. The Centers for Disease Control report that 6 million middle school and high school kids are using addictive nicotine, nearly three times the rate of just a few years ago. Vaping is fueling this epidemic with cheap, disposable, sweet-flavored products loaded with nicotine chemically altered to make it a more palatable starter for kids.

The Reversing the Youth Tobacco Epidemic Act has strong support of the American Association of Pediatrics, the American Medical Association, the American Cancer Society, the American Heart Association, the American Lung Association, the Campaign for Tobacco Free Kids, Truth, the American Public Health Association and hundreds of other organizations trying to stem the epidemic of teen vaping. That the new dean of OSU’s College of Public Health publicly disputed their position is alarming.

This important bill has passed the U.S. House, and it now moves to the Senate where the lead sponsor is Ohio’s Senator Sherrod Brown.

Let me add as a footnote that early analysis shows tobacco users are 14 times more likely to suffer serious illness and death from COVID-19 than non-smokers. Any inhaled nicotine paralyzes the lungs’ cleansing system. There was never a better time to quit smoking and vaping.

 

Rob Crane, MD,

Professor of Clinical Family Medicine, Ohio State University, Columbus

 

What happens to people’s lungs when they get coronavirus?

Respiratory physician John Wilson explains the range of Covid-19 impacts, from no symptoms to severe illness featuring pneumonia

Respiratory physician John Wilson explains the range of Covid-19 impacts. This image shows a CT scan from a man with Covid-19. Pneumonia caused by the new severe acute respiratory coronavirus 2 can show up as distinctive hazy patches on the outer edges of the lungs, indicated by arrows.
Respiratory physician John Wilson explains the range of Covid-19 impacts. This image shows a CT scan from a man with Covid-19. Pneumonia caused by the new severe acute respiratory coronavirus 2 can show up as distinctive hazy patches on the outer edges of the lungs, indicated by arrows. Photograph: AP

What became known as Covid-19, or the coronavirus, started in late 2019 as a cluster of pneumonia cases with an unknown cause. The cause of the pneumonia was found to be a new virus – severe acute respiratory syndrome coronavirus 2, or Sars-CoV-2. The illness caused by the virus is Covid-19.

Now declared as a pandemic by the World Health Organisation (WHO), the majority of people who contract Covid-19 suffer only mild, cold-like symptoms.

WHO says about 80% of people with Covid-19 recover without needing any specialist treatment. Only about one person in six becomes seriously ill “and develops difficulty breathing”.

So how can Covid-19 develop into a more serious illness featuring pneumonia, and what does that do to our lungs and the rest of our body?

How is the virus affecting people?

Guardian Australia spoke with Prof John Wilson, president-elect of the Royal Australasian College of Physicians and a respiratory physician.

He says almost all serious consequences of Covid-19 feature pneumonia.

Wilson says people who catch Covid-19 can be placed into four broad categories.

The least serious are those people who are “sub-clinical” and who have the virus but have no symptoms.

Next are those who get an infection in the upper respiratory tract, which, Wilson says, “means a person has a fever and a cough and maybe milder symptoms like headache or conjunctivitis”.

He says: “Those people with minor symptoms are still able to transmit the virus but may not be aware of it.”

The largest group of those who would be positive for Covid-19, and the people most likely to present to hospitals and surgeries, are those who develop the same flu-like symptoms that would usually keep them off work.

A fourth group, Wilson says, will develop severe illness that features pneumonia.

He says: “In Wuhan, it worked out that from those who had tested positive and had sought medical help, roughly 6% had a severe illness.”

The WHO says the elderly and people with underlying problems like high blood pressure, heart and lung problems or diabetes, are more likely to develop serious illness.

How does the pneumonia develop?

When people with Covid-19 develop a cough and fever, Wilson says this is a result of the infection reaching the respiratory tree – the air passages that conduct air between the lungs and the outside.

He says: “The lining of the respiratory tree becomes injured, causing inflammation. This in turn irritates the nerves in the lining of the airway. Just a speck of dust can stimulate a cough.

“But if this gets worse, it goes past just the lining of the airway and goes to the gas exchange units, which are at the end of the air passages.

“If they become infected they respond by pouring out inflammatory material into the air sacs that are at the bottom of our lungs.”

If the air sacs then become inflamed, Wilson says this causes an “outpouring of inflammatory material [fluid and inflammatory cells] into the lungs and we end up with pneumonia.”

He says lungs that become filled with inflammatory material are unable to get enough oxygen to the bloodstream, reducing the body’s ability to take on oxygen and get rid of carbon dioxide.

“That’s the usual cause of death with severe pneumonia,” he says.

How can the pneumonia be treated?

Prof Christine Jenkins, chair of Lung Foundation Australia and a leading respiratory physician, told Guardian Australia: “Unfortunately, so far we don’t have anything that can stop people getting Covid-19 pneumonia.

“People are already trialling all sorts of medications and we’re hopeful that we might discover that there are various combinations of viral and anti-viral medications that could be effective. At the moment there isn’t any established treatment apart from supportive treatment, which is what we give people in intensive care.

“We ventilate them and maintain high oxygen levels until their lungs are able to function in a normal way again as they recover.”

Wilson says patients with viral pneumonia are also at risk of developing secondary infections, so they would also be treated with anti-viral medication and antibiotics.

“In some situations that isn’t enough,” he says of the current outbreak. “The pneumonia went unabated and the patients did not survive.”

Is Covid-19 pneumonia different?

Jenkins says Covid-19 pneumonia is different from the most common cases that people are admitted to hospitals for.

“Most types of pneumonia that we know of and that we admit people to hospital for are bacterial and they respond to an antibiotic.

Wilson says there is evidence that pneumonia caused by Covid-19 may be particularly severe. Wilson says cases of coronavirus pneumonia tend to affect all of the lungs, instead of just small parts.

He says: “Once we have an infection in the lung and, if it involves the air sacs, then the body’s response is first to try and destroy [the virus] and limit its replication.”

But Wilson says this “first responder mechanism” can be impaired in some groups, including people with underlying heart and lung conditions, diabetes and the elderly.

Jenkins says that, generally, people aged 65 and over are at risk of getting pneumonia, as well as people with medical conditions such as diabetes, cancer or a chronic disease affecting the lungs, heart, kidney or liver, smokers, Indigenous Australians, and infants aged 12 months and under.

“Age is the major predictor of risk of death from pneumonia. Pneumonia is always serious for an older person and in fact it used to be one of the main causes of death in the elderly. Now we have very good treatments for pneumonia.

“It’s important to remember that no matter how healthy and active you are, your risk for getting pneumonia increases with age. This is because our immune system naturally weakens with age, making it harder for our bodies to fight off infections and diseases.”

  • Due to the unprecedented and ongoing nature of the coronavirus outbreak, this article is being regularly updated to ensure that it reflects the current situation at the date of publication. Any significant corrections made to this or previous versions of the article will continue to be footnoted in line with Guardian editorial policy.

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Vaping Could Compound Health Risks Tied to Virus, FDA Says

 
 Updated on 
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Vaping may leave users with underlying health conditions at higher risk of serious complications if they contract the respiratory disease caused by the novel coronavirus, the Food and Drug Administration said.

“People with underlying health issues, such as heart or lung problems, may have increased risk for serious complications from Covid-19,” Michael Felberbaum, an FDA spokesman, said in an email Friday in response to questions from Bloomberg. “This includes people who smoke and/or vape tobacco or nicotine-containing products.”

“E-cigarettes can damage lung cells,” Felberbaum said.

 

Some health experts have speculated that vaping is causing younger patients in the U.S. to be hospitalized with Covid-19 at a higher rate than anticipated. Felberbaum declined to comment on whether the FDA was investigating a possible connection.

2020-united-states-coronavirus-outbreak-inline

 

Earlier this week, Nora Volkow, director of the National Institute on Drug Abuse, wrote a blog post warning that the coronavirus “could be an especially serious threat to those who smoke tobacco or marijuana or who vape.”

E-cigarettes have been touted by some as less risky than smoking. But any increased harm associated with Covid-19, and the FDA’s direct language linking the products to lung damage, could boost detractors who have raised questions about the potential that vaping can lead to health problems.

Last year, some vapers began coming down with a mysterious and sometimes deadly lung illness. Those cases have been linked to products containing THC, the active ingredient in marijuana.

The FDA under President Donald Trump originally took a largely hands-off approach to regulating e-cigarettes, but began to change course in 2018 to stem an epidemic of youth use. After multiple delays, e-cigarette makers have until May to apply to the FDA for clearance to continue marketing their products. None have received FDA approval to market themselves as less risky than smoking.

(Updates with additional context in first paragraph)

Coronavirus Infection Likely Worse for Vapers and Smokers

UPDATED 01 APRIL 2020

Health experts claim vaping makes your lungs more vulnerable, which could increase your risk of contracting severe infections, like the coronavirus.

Smokers and vapers who are infected with the new coronavirus could possibly expect a more severe infection, health experts warn.

Many advisories have focused on the risk facing older people, those with chronic conditions such as diabetes, and people with compromised immune systems, such as cancer patients. But doctors also caution that users of electronic cigarettes and tobacco are more in danger from the new coronavirus than the average healthy person.

If you vape, “you’re going to make lungs more vulnerable to severe infection,” said Dr Panagis Galiatsatos, an American Lung Association spokesman who is also director of the tobacco treatment clinic at Johns Hopkins Hospital, in Baltimore.

Vaping introduces toxic chemicals that harm lung cells and change their metabolism, Galiatsatos said, and it also curbs the body’s immune system.

Higher odds of disease progression

Data from China’s coronavirus outbreak showed infected smokers and residents of cities with high levels of air pollution had more severe symptoms, he said. Galiatsatos predicted use of e-cigarettes will have the same effect.

A study of 78 patients with Covid-19 pneumonia in Wuhan, China, published recently in the Chinese Medical Journal, listed history of smoking as one factor contributing to poorer patient outcomes.

Stanton Glantz, director of the University of California, San Francisco (UCSF) Center for Tobacco Control Research and Education, cited that study in a recent online UCSF commentary.

“The odds of disease progression (including to death) were 14 times higher among people with a history of smoking,” he wrote, calling on the public to stop smoking and vaping, and to also steer clear of second-hand smoke.

Because vaping is a recent phenomenon, less is known about its harmful long-term effects than about smoking tobacco, which has been studied for decades.

But e-cigarettes have come under growing scrutiny since last year when more than 2 000 cases of severe lung damage and death were reported among vapers. Most of those cases were associated with products containing an additive called vitamin E acetate, and THC, the psychoactive component of marijuana, according to the US Centers for Disease Control and Prevention.

Higher rate of hospitalisation

As cases of Covid-19 continue to spread, the consequences for smokers and vapers should soon be clear. But evidence pointing to poorer outcomes already exists.

Dr Sucharita Kher, director of the outpatient pulmonary clinic at Tufts Medical Center in Boston, said animal studies have shown e-cigarette vapour “adversely affects the lung cells’ ability to fight against a virus”.

She added that smokers also have a higher rate of hospitalisation for influenza, another viral respiratory infection.

But Kher added that the Chinese data do not prove smoking caused worse outcomes for Covid-19 pneumonia patients. They do, however, show a link. There’s much to learn about the virus, she said.

“We have to interpret it with caution,” she explained.

Vaping substances that contain THC or nicotine “definitely has short-term health consequences,” said Dr Alexa Mieses, a family doctor in Durham, North Carolina, who expects studies will eventually show similar long-term links.

Researchers know tobacco smoking has long-term consequences, including chronic obstructive pulmonary disease (COPD), emphysema or cancer, she said, but no long-term studies have yet been done on vaping.

A threat to overall health

“My gut … or I should say, my medical education, leads me to believe” years of e-cigarette use will eventually be linked to these or similar outcomes, Mieses said.

“First and foremost, vaping and smoking don’t just affect your respiratory system, but pose a threat to your overall health,” she said.

Mieses and Kher recommended people who wish to quit vaping contact their family doctor for help.

Kher noted that vaping has not been shown to be an effective smoking-cessation aid and e-cigarette users are more likely to become tobacco smokers. She said seven drugs have been approved by the US Food and Drug Administration to help people quit smoking, but there is no approved medicine for those wanting to quit e-cigarettes.

“I highly recommend they talk to their doctors and try to quit vaping or try to cut down,” she said.

 

READ | Coronavirus: Basic protective measures

READ | Coronavirus | Concerns about if, and how it spreads in the air? Here are the facts

READ | Undetected cases may be driving coronavirus spread

Image credit: iStock

COVID-19: Potential Implications for Individuals with Substance Use Disorders

March 23, 2020

As people across the U.S. and the rest of the world contend with coronavirus disease 2019 (COVID-19), the research community should be alert to the possibility that it could hit some populations with substance use disorders (SUDs) particularly hard. Because it attacks the lungs, the coronavirus that causes COVID-19 could be an especially serious threat to those who smoke tobacco or marijuana or who vape. People with opioid use disorder (OUD) and methamphetamine use disorder may also be vulnerable due to those drugs’ effects on respiratory and pulmonary health. Additionally, individuals with a substance use disorder are more likely to experience homelessness or incarceration than those in the general population, and these circumstances pose unique challenges regarding transmission of the virus that causes COVID-19. All these possibilities should be a focus of active surveillance as we work to understand this emerging health threat.

Coronavirus Disease 2019 (COVID-19)

Image by CDC/ Alissa Eckert, MS; Dan Higgins, MAMS

This illustration, created at the Centers for Disease Control and Prevention (CDC), reveals ultrastructural morphology exhibited by coronaviruses. Note the spikes that adorn the outer surface of the virus, which impart the look of a corona surrounding the virion, when viewed electron microscopically. A novel coronavirus, named Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2), was identified as the cause of an outbreak of respiratory illness first detected in Wuhan, China in 2019. The illness caused by this virus has been named coronavirus disease 2019 (COVID-19).

 

NIH has posted a compilation of updates for applicants and grantees, including a Guide Notice on administrative flexibilities and accompanying FAQs.

 

SARS-CoV-2, the virus that causes COVID-19 is believed to have jumped species from other mammals (likely bats) to first infect humans in Wuhan, capital of China’s Hubei province, in late 2019. It attacks the respiratory tract and appears to have a higher fatality rate than seasonal influenza. The exact fatality rate is still unknown, since it depends on the number of undiagnosed and asymptomatic cases, and further analyses are needed to determine those figures. Thus far, deaths and serious illness from COVID-19 seem concentrated among those who are older and who have underlying health issues, such as diabetes, cancer, and respiratory conditions. It is therefore reasonable to be concerned that compromised lung function or lung disease related to smoking history, such as chronic obstructive pulmonary disease (COPD), could put people at risk for serious complications of COVID-19.

Co-occurring conditions including COPD, cardiovascular disease, and other respiratory diseases have been found to worsen prognosis in patients with other coronaviruses that affect the respiratory system, such as those that cause SARS and MERS. According to a case series published in JAMA based on data from the Chinese Center for Disease Control and Prevention (China CDC), the case fatality rate (CFR) for COVID-19 was 6.3 percent for those with chronic respiratory disease, compared to a CFR of 2.3 percent overall. In China, 52.9 percent of men smoke, in contrast to just 2.4 percent of women; further analysis of the emerging COVID-19 data from China could help determine if this disparity is contributing to the higher mortality observed in men compared to women, as reported by China CDC. While data thus far are preliminary, they do highlight the need for further research to clarify the role of underlying illness and other factors in susceptibility to COVID-19 and its clinical course.

Vaping, like smoking, may also harm lung health. Whether it can lead to COPD is still unknown, but emerging evidence suggests that exposure to aerosols from e-cigarettes harms the cells of the lung and diminishes the ability to respond to infection. In one NIH-supported study, for instance, influenza virus-infected mice exposed to these aerosols had enhanced tissue damage and inflammation.

People who use opioids at high doses medically or who have OUD face separate challenges to their respiratory health. Since opioids act in the brainstem to slow breathing, their use not only puts the user at risk of life-threatening or fatal overdose, it may also cause a harmful decrease in oxygen in the blood (hypoxemia). Lack of oxygen can be especially damaging to the brain; while brain cells can withstand short periods of low oxygen, they can suffer damage when this state persists. Chronic respiratory disease is already known to increase overdose mortality risk among people taking opioids, and thus diminished lung capacity from COVID-19 could similarly endanger this population.

A history of methamphetamine use may also put people at risk. Methamphetamine constricts the blood vessels, which is one of the properties that contributes to pulmonary damage and pulmonary hypertension in people who use it. Clinicians should be prepared to monitor the possible adverse effects of methamphetamine use, the prevalence of which is increasing in our country, when treating those with COVID-19.

Other risks for people with substance use disorders include decreased access to health care, housing insecurity, and greater likelihood for incarceration. Limited access to health care places people with addiction at greater risk for many illnesses, but if hospitals and clinics are pushed to their capacity, it could be that people with addiction—who are already stigmatized and underserved by the healthcare system—will experience even greater barriers to treatment for COVID-19.  Homelessness or incarceration can expose people to environments where they are in close contact with others who might also be at higher risk for infections. The prospect of self-quarantine and other public health measures may also disrupt access to syringe services, medications, and other support needed by people with OUD.

We know very little right now about COVID-19 and even less about its intersection with substance use disorders. But we can make educated guesses based on past experience that people with compromised health due to smoking or vaping and people with opioid, methamphetamine, cannabis, and other substance use disorders could find themselves at increased risk of COVID-19 and its more serious complications—for multiple physiological and social/environmental reasons. The research community should thus be alert to associations between COVID-19 case severity/mortality and substance use, smoking or vaping history, and smoking- or vaping-related lung disease. We must also ensure that patients with substance use disorders are not discriminated against if a rise in COVID-19 cases places added burden on our healthcare system.

As we strive to confront the major health challenges of opioid and other drug overdoses—and now the rising infections with COVID-19—NIDA encourages researchers to request supplements that will allow them to obtain data on the risks for COVID-19 in individuals experiencing substance use disorders.

This content is also available in Spanish – COVID-19: Las posibles implicaciones para las personas con trastornos por consumo de drogas.

 

Additional Links

Latest Information from the CDC on Coronavirus Disease 2019 (COVID-19)

For those with questions about how their state justice systems are adjusting operating procedures in response to COVID-19, The Marshall Project is tracking changes as they occur. Also, the Vera Institute of Justice has developed guidance for justice system adjustments to COVID-19.

 

This page was last updated March 2020