ASH Webinar on Coronavirus, Human Rights and Tobacco
April 2, 2020
Statement from Carolyn Dresler, MD, MPA
A question that is pertinent to this webinar, is: what is the impact or effect of tobacco use on the diagnosis, treatment or survival from the coronavirus?
I will start with the bottom line – we do not have the scientific evidence to be definitive. HOWEVER, we do have much knowledge and common sense.
To start off – are people who smoke/vape more likely to get coronavirus? We don’t know the answer, however, people who smoke cigarettes are putting something into their mouths multiple times per day. The same is true for e-cigarettes. People who use waterpipes are sharing those tips with other people. This practice is not in line with keeping our hands away from our faces.
Next, we know that smoking cigarettes causes lung disease, specifically chronic bronchitis and emphysema. The USA CDC has stated that the ‘underlying medical conditions’ that increase the risk of severe disease and death from the coronavirus consist primarily of diabetes, chronic obstructive pulmonary disease (which is chronic bronchitis and emphysema) and cardiovascular disease. Smoking is in a longer list of ‘underlying conditions’ – but, note that smoking cigarettes does contribute to diabetes and cardiovascular disease – besides COPD. Thus, current smoking of cigarettes is a risk – because it is an important cause of the underlying conditions that lead to more severe disease or death from COVID. STOPPING smoking works to reverse or stop many of the acute aspects of lung and cardiovascular disease – before they become more chronic (and, less reversible).
One of the big questions is whether ‘vaping’ or use of e-cigarettes causes the same risk. Current research, particularly in animals, but there is some research in humans – shows vaping DOES cause inflammation in the airway and lungs. We do not have long term studies of people who have vaped (and not smoked cigarettes) to understand the longer-term damage to the lungs. However, it is expected that there will be longer term damage, because short term damage has been shown. Of course, a current question is – will vaping cause as bad of lung disease as cigarette smoking. We just don’t have that long-term data. However – in the face of such a critical disease such as COVID – who thinks that is a relevantly valid question TODAY? This is what I would call common sense – to answer a question for today. We know that smoking and vaping causes inflammation in the lungs. We recently – as recent as about 6-9 months ago, had an epidemic of deaths from people who vaped. Yes, this epidemic was blamed on marijuana, or vitamin E or black-market products. But there were still people who died, from vaping who did not use any of those three products. I’m not sure the research environment had completed their question of what was the cause of all of those vaping injuries and deaths – when, the coronavirus epidemic hit us in the USA.
Dr. Nora Volkow, the Director of the National Institute of Drug Abuse stated: “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.”
I had a question put to me earlier this week: are we seeing younger cases of COVID-19 in Colorado because we have such a high rate of youth use of e-cigarettes – the highest in the USA – or, we also have marijuana that is legal to buy and use. Again – we do not have the data.
However, I am a firm believer of 1 + 1 = 2, until I have evidence to the otherwise. I believe that it is critically important for us to help people to quit inhaling anything into their lungs that could be causing any type of inflammation, as the coronavirus will only find an inviting environment otherwise.
And, I would like to make a broader comment also: we’ve now seen what a global pandemic can mean for all of us, and I am sure there will be more in our future. Therefore, let us make sure that we endorse and support the right to health and the right to correct and accurate information. AND, let us re-double our efforts to help people quit and youth not to start – so, that we can be healthier before these health disasters arrive. As a healthcare provider NONE of us want to be placed in a decision-making situation on who gets supportive or curative care or gets onto a ventilator because they smoke or vape.
What are the respiratory effects of e-cigarettes?
BMJ 2019; 366 doi: https://doi.org/10.1136/bmj.l5275 (Published 30 September 2019)
Cite this as: BMJ 2019;366:l5275