Vape and COVID-19: what we don’t know so far

Weren’t you just waiting to see the words ‘vaping’ and ‘coronavirus’ in the same sentence? It appears that the virus has now infected discussion about the safety of using e-cigarettes and – unsurprisingly – it’s only leading to more confusion and uncertainty.

First up, Vape Business is not a medical journal, we don’t have any research to give you and will not make any recommendations here. This is just a quick guided tour of some of the vape/coronavirus discussions going on right now.

Last week, a spokesperson for New York mayor Bill de Blasio warned New Yorkers that smoking or vaping makes people more vulnerable to suffering severe illness once infected by coronavirus.

The mayor himself added: “If you are a smoker or a vaper that does make you more vulnerable,” de Blasio said, urging New Yorkers to seek help in quitting. “If you are a smoker or a vaper this is a very good time to stop that habit and we will help you.”

Reuters picked up the story and gave it’s a sense of authority with the headline ‘Smoking or vaping increases risks for those with coronavirus: NYC mayor’. Now Bill de Blasio might be a nice bloke but he is not a healthcare professional and his comments on vaping could be seen as a taking cynical free hit against the industry tying it to an exceptionally emotive issue like coronavirus.

In truth, the evidence that vaping has an effect on outcomes for coronavirus just isn’t there.

Even when it comes to the effects of smoking any effect is still only speculative. One Epidemiologist, Saskia Popescu, spoke to Business Insider giving what seems like a common-sense reply to how smoking might effect patients:

“Since COVID-19 is a respiratory disease and often causes pneumonia, having a history of smoking could increase the risk of more severe respiratory distress or pneumonia,” she said.

That has always been a risk with smoking.

Meanwhile, Dr Konstantinos Farsalinos – who runs a science blog which evaluates e-cigarette research – puts together some of the early research here, which only serves to muddy the waters on what effect it might have.

One reason a link between smoking and the virus was due to the differences in outcomes between men and women with coronavirus.

Dr Faralinos said: “A link between smoking and coronavirus infection was first suggested because more men were infected than women. One (unproven) hypothesis was that this was due to the much higher prevalence of smoking among Chinese men (48.4%) than among women (1.9%).”

But a paper in the Chinese Medical Journal which partly looked into this question was based on fewer than 80 patients and offered no clear conclusions.

Another paper which Faranolinos says can be use to indirectly look at this question comes from the New England Journal of Medicine.

Faralinos says: “Interestingly, only 12.6% of cases were current smokers, and 1.9% were former smokers. The number is really low considering two factors:

1. 99.1% of cases were ≥ 15 years old, thus they represent a population group that smokes tobacco cigarettes.
2. 58.1% of cases were male.

Considering an almost 50% smoking prevalence in males, one would expect that at least 29% of the cases would be smokers (even if smoking did NOT have an adverse effect on infectivity). Thus, the reported proportion of cases being smokers is low.”

None of this is really conclusive, but compared to evidence between vaping and coronavirus the evidence behind the smoking-coronavirus is relatively expansive. On e-cigarettes there is little to say.

The only evidence – and calling it evidence is a stretch – comes from the impact one key ingredient in vapour, aerosol propylene glycerol, can have on our lungs. None of this, it should be said, is based on studies of coronavirus (COVID-19).

Faralinos says: There is a lot of evidence that propylene glycol (one of the main ingredients in e-cigarette liquids) has anti-bacterial and anti-viral properties in aerosol form. Below is a list of studies I cited in the 2017 book on e-cigarettes that I wrote together with other colleagues:

Henle W, Zellat J. Effect of propylene glycol aerosol on air-borne virus of Influenza. Proc Soc Exper Biol Med 1941;48:544.

Robertson OH, Loosli CG, Puck TT, Bigg E, Miller BF. The protection of mice against Infection with air-borne Influenza virus by means of propylene glycol vapour. Science 1941;94:612.

Harris TH, Stokes Jr. J. The effect of propylene glycol vapour on the incidence of respiratory infections in a convalescent home for children: preliminary observations. Am J Med Sci 1942;204:430.

Harris TH, Stokes Jr. J. Air-borne cross infection in the case of the common cold: a further clinical study of the use of glycol vapours for air sterilization. Am J Med Sci 1943;200:631.

Robertson OH, Bigg E, Puck TT, Miller BF, Technical Assistance of Elizabeth A. Appell. The bactericidal action of propylene glycol vapor on microorganisms suspended in air. I. J Exp Med 1942;75:593 610.

Puck TT, Robertson OH, Lemon HM. The bactericidal action of propylene glycol vapor on microorganisms suspended in air: II. the influence of various factors on the activity of the vapor. J Exp Med 1943;78:387 406.

So here we are then. There is a lot speculation on where we stand with vaping, smoking and coronavirus and there are likely to be scare stories and misinformation everywhere you look. Hopefully this blog will crystalise for you the only thing we can be certain of: that nobody is completely sure of anything when it comes to the impact of this disease. Of course quitting smoking will do amazing things for your health and is always a sensible option – but that was as true six months ago as it is now. As always, we all have to make our own choices.