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March 25, 2020

Coronavirus and Vaping: Fear, Confusion, Disinformation and Lies

Surgeon General Jerome Adams told The Today Show Monday that vaping might be a reason serious American coronavirus infections may skew toward younger age groups than in some other countries. If they do, that is.

NBC’s Savannah Guthrie said that among the coronavirus cases in New York, 53 percent “were actually young people between the ages of 18 and 49, which, of course, is very different than the earlier understandings of this virus.” She asked the Surgeon General if young people are “more at risk than previously thought.”

“There are theories,” Adams told Guthrie, “that it could be because we know we have a higher proportion of people in the United States and also in Italy who vape.”

It is possible that young Americans will be proven to be victims of the virus or the disease more often than their counterparts around the world. It’s also possible that the lack of widespread testing is hiding the real demographic trends. In some countries, young people are widely infected but have tended to show fewer symptoms of COVID-19, the disease caused by the virus (the virus itself is technically named SARS-CoV-2).

In every country with a large number of cases, the oldest age groups have the worst outcomes from the disease—and that’s also the case here. Until there is a serious effort to test all segments of the population—including people who aren’t visibly sick—we can’t really know if any specific age group is more likely to carry the virus, or more likely to get sick from it.

Because there are more people in the younger age brackets, the number of cases in them appears higher. In reality, the U.S. age distribution of victims is not unusual. When the numbers are adjusted for the populations of the different age groups, the age range of American COVID-19 patients looks much like those in other countries.

Since most states have been unable to test many of their citizens, it’s reasonable to assume that many Americans in their twenties and thirties are also often symptom-free carriers. They aren’t counted because they haven’t been tested (or quarantined). That is why the current trend in the most affected states has been to institute severe social distancing measures. There is a fear among public health officials that many young people will spread the virus to their at-risk parents and grandparents before they become noticeably ill (if they ever do).

All that said, there is no proven mechanism by which nicotine vaping would make a user more likely to become infected with the coronavirus—or cause worse outcomes if they were. As we explained two weeks ago, existing research on vaping and the immune system is scanty and based on rodent studies and experiments on disembodied cells. No real conclusions can be drawn from what is known now.

It’s possible that vaping somehow reduces the immune response and makes vapers more prone to becoming viral hosts, but there is no research proving a connection. That said, there is also no real evidence to show that vaping prevents infections, although a series of studies from the 1940s seem to show that vaporized propylene glycol can kill airborne bacteria and viruses when a room is carefully infused at the correct temperature. Many vapers have interpreted those studies as proof that vaping protects users from infections.

Surgeon General Adams has, like his predecessor, been eager to manufacture problems caused by vaping. An early adopter of former FDA commissioner Scott Gottlieb’s “teen vaping epidemic” narrative, Adams has gone out of his way on multiple occasions to disparage vaping. His recently issued report on smoking cessation (actually created and edited by the CDC Office on Smoking and Health) concluded that “there is presently inadequate evidence to conclude that e-cigarettes, in general, increase smoking cessation.”

Surgeons General are appointed by Presidents, and don’t have any real power, aside from running the U.S. Public Health Service Commissioned Corps. The office gained fame and respect through the actions of a few of its occupants, especially Luther Terry, who oversaw the first comprehensive U.S. government report on the dangers of smoking in 1964.

Like most of his recent predecessors, Jerome Adams has been eager to follow the lead of the public health officials who run the FDA and CDC—and to take cues from the statements of the President who appointed him. His early positions on the coronavirus pandemic mirrored Trump’s—almost flippant—and rose in pitch to match the President’s growing concern.

The SG’s worry over vaping and COVID-19 doesn’t seem to be inspired by anyone in the administration, although it’s always possible that the committed anti-nicotine crew in the CDC Office on Smoking and Health is preparing to draw some reckless public conclusion about vaping and the coronavirus. It’s likely Adams’ own idea—a chance to get teenagers to stop vaping out of disinformation-driven fear. CDC has its own problems, having just bungled the roll-out of coronavirus testing.

CDC is also fresh off its terrible mismanagement of last year’s “EVALI” outbreak, when the agency spent months misleading the public about what precisely was causing thousands of horrific “vaping related” lung injuries. CDC had enough information as early as August to warn cannabis oil vapers that every clue pointed toward vitamin E acetate as the culprit, but instead continued to warn against using “e-cigarettes.” At least 68 people died.

These mistakes, and the regular use of public health agencies to carry on political campaigns against unpopular behaviors, have likely contributed to the general mistrust of agencies like CDC and the Surgeon General’s office. According to The Economist, a poll taken last year found government health agencies in the United States among the least trusted by citizens.

“Last June polling by the Wellcome Trust, a charity, found that 78% of Canadians said they trusted government health advice,” said The Economist. “In Germany and Britain the number was over 80% and in South Korea a remarkable 86%. In Italy it was just 63%; in America, worryingly, lower still at 59%.”

The Surgeon General isn’t alone in trying to connect vaping and the coronavirus. Almost since the pandemic hit U.S. shores, so-called experts (and plenty of obvious non-experts) have been trying to frighten people away from e-cigarettes in the name of caution. By my count there have been more than 30 articles in newspapers and countless comments on TV news broadcasts trying to make the case for vaping having some effect on coronavirus infections or COVID-19.

Many of the articles quote anti-tobacco activist Stanton Glantz, a University of California-San Francisco professor, and the principal investigator at the FDA-funded tobacco control research group there. Glantz recently had a paper on vaping and heart attacks retracted by the Journal of the American Heart Association, and was twice accused of academic and sexual misconduct in the last couple years.

“We don’t have every little detail on this nailed down,” Glantz told Scientific American. “But based on what we know, generally, about smoking and e-cigarettes—and in particular about smoking and COVID-19 from people who are already sick, from one study in China—it stands to reason that you would lower your risk if you stopped doing these things.”

“Some of my pulmonary [colleagues] have noted people under 30 [with COVID-19] ending up in hospitals and a couple were [vapers],” Glantz claimed in a CNN article.

“In terms of immunosuppressant and inflammatory effects,” Glantz told the Daily Mail, “e-cigarettes might be doing more bad things than cigarettes—but both are really bad.”

Glantz’ specialty is assuming that known or suspected effects of smoking apply equally to vaping—or, at least, that his audience will accept that they do. In fact, those connections are tenuous at best, and based largely on mouse studies that can’t be assumed to apply to humans.

But it’s not just Glantz. Publications everywhere have no problem finding supposed experts to explain how terrible vaping must be for the lungs and immune system. After all, it looks like smoking—right? That is almost the level of the evidence presented in many cases.

The best headline of the epidemic (so far) is surely this one from MSNBC: Vaping: One of the Best Ways to Trash Your Lungs and Maybe Die if you Catch Coronavirus. That gem, written by the “Morning Joe Chief Medical Correspondent” Dr. Dave Campbell, closes with this warning: “Teens and young adults, Stop Vaping Now. It is not about protecting grandma or grandpa from the Coronavirus. The life you save may be your own.”

Monday. New York state senator Brad Hoylman tweeted that there was “mounting evidence” of a risk for vapers. Hoylman is trying to help push a ban of flavored vaping products through the legislature without debate. The ban has been sneakily inserted into a must-pass spending bill during the coronavirus confusion. (If you’re from New York State, please use CASAA’s call to action to oppose this awful legislation!)

The mis- and disinformation is getting thicker by the day, helped along by the spread of the worst articles on social media by accounts that should be concerned with their credibility but aren’t. World Health Organization “External Relations Officer” Alexey Kulikov—who has a PhD and an MD, according to his profile—regularly shares questionable vaping information. But yesterday he posted something useful, suggesting that smokers are at higher risk for infection because they repeatedly put their fingers on their lips.

That applies to vapers too, and is a good reminder that while there is a pile of misinformation about vaping and coronavirus, that doesn’t mean that the pandemic itself is fake or that the basic hygiene advice we’re hearing is wrong. It’s especially important for vapers to remember to wash their hands frequently and thoroughly, avoid touching their face, and use alcohol-based hand sanitizer when washing hands isn’t possible. Don’t shake hands, and definitely don’t share mods. Practice social distancing. Please stay healthy.

Smokers created vaping without any help from the tobacco industry or anti-smoking crusaders, and vapers have the right to keep innovating to help themselves. My goal is to provide clear, honest information about the challenges vaping faces from lawmakers, regulators, and brokers of disinformation. I recently joined the CASAA board, but my opinions aren’t necessarily CASAA’s, and vice versa. You can find me on Twitter @whycherrywhy

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