The Vaping Weekly Podcast is back for Return Episode #4, where Michael McGrady has the pleasure of featuring Gregory Conley, a trained lawyer and the president of the American Vaping Association.
In this fourth episode of our second season, Gregory Conley speaks out about his concerns related to a recent letter U.S. Rep. Raja Krishnamoorthi sent to the Food and Drug Administration commissioner Stephen Hahn asking him to clear the market of all e-cigarette products during the global COVID-19 pandemic.
Also, we dig briefly into the PMTA deadline of September 9, 2020.
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Sent earlier this week, the letter addressed to Hahn, bases its arguments on recent data claiming that vaping increases one’s risk of contracting Covid-19 and suffering symptoms. “This is true in vapers as young as 13, which is particularly concerning, given that young people are increasingly driving the spread of COVID-19, threatening the health and safety of Americans of all ages.”
Moreover, the letter goes on to ask Hahn whether he can confirm that all this will be done withing a week, by August 18th. Written by Rep. Raja Krishnamoorthi (D-IL), chairman of the House Committee on Oversight and Reform’s Subcommittee on Economic and Consumer Policy, the letter was written on behalf of the subcommittee.
A study linking vaping to Covid
Making vaping products unavailable would just push smokers back to smoking.
The data prompting the letter was derived from a study reporting a relationship between Covid and vaping, saying that vapers are between five to seven times more at risk of contracting the virus.
“We thought that we’d see some relationship. We did not expect to see a five to seven times more likely relationship. That’s huge,” said Bonnie Halpern-Felsher, professor of pediatrics and director of research in the division of adolescent medicine at Stanford University in California, who led the new study.
Published in the Journal of Adolescent Health, the study also found that respondents who reported vaping in the past 30 days were 2.6 times more likely to be tested for Covid-19.
“About half of the sample was sheltering in place — because we did ask that — but that doesn’t mean they’re not in the backyard with a friend sharing their vaping product,” Halpern-Felsher said, adding that this increased risk to be diagnosed with Covid-19 could be tied to exposure to the coronavirus from sharing products, touching your face more or possibly breathing in droplets containing the virus through the aerosols of an e-cigarette. More research is needed. “We don’t know. These are hypotheses,” Halpern-Felsher said. “I actually think it’s all of the above.”
“..Also, many vapers with respiratory diseases have seen a curtailment of their symptoms by vaping, and by stopping vaping we would have seen a rise in acute exacerbation in respiratory disease. This would have been extremely detrimental to the national health system at a time when you have ICU beds occupied and not available for anything else,” he said earlier this year.”Dr. Ricardo Polosa
Meanwhile, tobacco harm reduction experts keep pointing out that given that e-cigarettes are known to be safer than cigarettes, switching to vaping is still recommended for smokers. Additionally, data has indicated that making vaping products unavailable would just push smokers back to smoking.
Banning e-cigs whilst leaving cigarettes available is a recipe for disaster
With this in mind, award winning Dr. Riccardo Polosa, who is a world-renowned scientist and researcher on vaping and tobacco harm reduction, had explained why it would be ridiculous to close outlets that sell safer alternatives, whilst leaving combustible cigarettes available for sale.
“Most importantly, hundreds of thousands of vapers would have been at risk of gatewaying back to smoking. It was an issue of public health in my opinion. Also, many vapers with respiratory diseases have seen a curtailment of their symptoms by vaping, and by stopping vaping we would have seen a rise in acute exacerbation in respiratory disease. This would have been extremely detrimental to the national health system at a time when you have ICU beds occupied and not available for anything else,” he said earlier this year.
The Voke device has been in the making for years. It has been licensed as a medical and safer alternative to smoking by the Medicine and Healthcare products Regulatory Agency (MHRA). Voke delivers rapid nicotine, offering rapid relief from cravings without heat, combustion or vapour, yet as in the case of vaping, the administration of Voke mimics that of smoking, likely making it easier an easier NRT for smokers to transition to than say patches or gum.
Moreover, the device looks a lot like a packet of cigarettes, including a rectangular box, and a plastic cigarette which slots into it. The price is also similar, with 20 charges costing £11.99. All these features combined are likely to make this product a very effective NRT, hence why harm reduction and public health experts, and vaping advocates alike, have been in full support of it.
However, the same entities are now disappointed, as the makers of Voke, Kind Consumer, have resorted to an unethical way of marketing the product. The New Nicotine Alliance (NNA) has pointed out that a slide presentation by the company is claiming that Voke is preferable to e-cigarettes because there have been “numerous recent cases of lung disease and death in individuals who use vape products.”
Sharing misinformation – an act of disservice to smokers around the world
The more nicotine alternatives there are on the market, the higher the chances for the millions of smokers to find a smoking cessation product that best suits their needs.
This sharing of misinformation is not only a case of unethical marketing, but also a serious act of disservice to the millions of smokers who are still looking around in search of their preferred safer nicotine alternative. Recognised health bodies such as the CDC have long confirmed that the cases of lung disease and death that the Voke marketing campaign is referring to, had nothing to do with the use of regulated vaping products, but with the consumption of illicit THC.
The NNA emphasised that it is unethical of Kind Consumer to spread these inaccurate facts in order to place their device in a preferable position. “We realise that business is business and Kind Consumer wish to differentiate their new product from vaping, but repeating information that they know very well is false is not the way to do this. It is especially scurrilous when you consider that they are using the fraudulent information to raise significant levels of funding to the tune of tens of millions of pounds,” said the NNA.
The more NRTs, the better
Just like anyone who has harm reduction at heart, including us here at the Vaping Post, the NNA has long pointed out that the more nicotine alternatives there are on the market, the better it is for everyone, as the millions of smokers around the world stand a better chance of finding a product that best suits their needs. “There is room in the safer nicotine market for many players, and we would ordinarily welcome Voke adding a new option for smokers wishing to quit.”
However, trying to achieve success by throwing shade on a competitor is unacceptable. “However, they should not be trying to build their success by shoving vaping under a bus. Kind Consumer should instruct their fund-raisers and marketers to abandon this approach. It is unhelpful and shameful opportunism. If their product has merit, they should not have to sink to employing baseless scare stories which have deterred large swathes of smokers from switching away from lit tobacco.”
Vapers use the devices to substitute cigarettes in everyday life, such as after a meal, while watching a movie at home, etc, therefore allowing use in smoking bars is futile.
H4183 was approved in December 2019 by a vote of 127 to 31, and set in place a harsh 75% tax and flavour ban. The bill also allows the police to seize vehicles in which they find untaxed vaping products. A police officer who “discovers an untaxed electronic nicotine delivery system in the possession of a person who is not a licensed or commissioner-authorized electronic nicotine delivery system distributor may seize both the product and the ‘receptacle’ in which it is found, “including, but not limited to, a motor vehicle, boat or airplane in which the electronic nicotine delivery systems are contained or transported.”
With regards to flavoured vaping products, use is still allowed in a handful of state licensed “smoking bars.” However, this is more tragic than it may sound to those who do not vape: vapers use the devices to substitute cigarettes in everyday life, such as after a meal, when driving to work, or while watching a movie at home. To these individuals allowing use in smoking bars is futile.
Vapers turning to illicit products
It was precisely such bans and the ridiculous prices of THC products, that led users to purchase the cheap and unregulated versions, which then caused EVALI.
Meanwhile, testimony at the Massachusetts Department of Revenue’s Illegal Tobacco Task Force has revealed how flavored e-cig users are responding to the ban, and non surprisingly the task force concluded the ban will lead to “an increase in smuggling activity and black-market sales.”
“I’m concerned that placing an added burden and tasking law enforcement with the enforcement of flavour bans will only stand to create a significant new black market, this includes both cross-state border smuggling and counterfeit tobacco,” said Charles Giblin, a retired special agent in charge of the New Jersey treasury’s office of criminal investigation.
“At the onset, you’ll start to see an increase between Massachusetts and New Hampshire in smuggling and illegal importation via the internet of counterfeit flavored cigarettes from countries including China and Paraguay. They will skyrocket almost incredibly instantaneously,” he said. “Another underestimated source will be Canadian First Nations reservation cigarette manufacturers, who are rather robust.”
Rich Marianos who served 27 years at the U.S. Bureau of Alcohol, Tobacco, Firearms and Explosives told the task force that “the illegal tobacco trade along Interstate 95 on the East Coast is a $10 billion industry that is already working to fill the void created by Massachusetts’ new law.”
EVALI is a clear example of the risks in consuming illicit products
The expansion of the black market and the subsequent availability of unregulated vaping products poses a great threat to public health. The CDC had confirmed that the infamous outbreak of the serious lung disease called EVALI was in fact caused by the consumption of unregulated THC products purchased on the black market.
“The latest national and state findings suggest products containing THC, particularly those obtained off the street or from other informal sources (e.g. friends, family members, illicit dealers), are linked to most of the cases and play a major role in the outbreak,” reported the CDC.
Ironically, it was the lack of such information and the inaccurate association of the disease to regulated vaping products that prompted many states like Massachusetts to ban flavored vape products, even though there was no evidence the lung disease was connected to nicotine-based vape products. In fact, it was precisely such bans and the ridiculous prices of THC products, that led to users to purchase the cheap and unregulated versions.
U.S. Rep. Raja Krishnamoorthi, D-Ill., sent a letter Dr. Stephen M. Hahn, the commissioner of the Food and Drug Administration (FDA), requesting that all e-cigarette products be removed from the market in light of the COVID-19 pandemic
Krishnamoorthi wrote his letter, citing a new study released in the Journal of Adolescent Health, which covers the results of an online national survey of teenagers and young adults, aged from 13 to 24 years, set out through May of 2020. Key results indicate that among this sample, a COVID-19 diagnosis was very likely for the users of just e-cigarettes—at least five times more likely. Dual users are seven times more likely.
“The science is now in: e-cigarette users are much likelier to be diagnosed with COVID-19 and to experience symptoms,” wrote Krishnamoorthi to Hahn. “While we are not writing today to address the safety of e-cigarettes for adult smokers following the deadly spread of COVID-19, it is evident that the youth vaping epidemic has combined forces with the Coronavirus pandemic, creating a much deadlier foe that demands FDA action.”
He further requests of Hahn: “In view of this national study proving our worst fears, I respectfully reiterate my call on FDA to clear the market of all e-cigarettes for the duration of the coronavirus crisis. It is the only responsible path forward.”
The good representative cites a study as the “seminal” scientific proof behind the harm spectrum introduced by vaping and cigarette use among youth during the COVID-19 pandemic. Vaping and smoking can irritate the lungs and further exacerbate the opportunity to contract a potentially deadly respiratory disease like the novel coronavirus disease. However, there’s still no justification to lobby for policies that would directly impact the health of adult users who use smoke-free products like e-cigarettes to keep from smoking cigarettes—especially when the science isn’t necessarily “settled.”
if more public health activists had embraced e-cigarettes instead of opposing them and more smokers had been encouraged to switch, there would be less mortality from COVID-19 today.
My friends at Inside Sources (where I am also a contributor) interviewed Boston University School of Public Health’s Michael Siegel, a professor of community health sciences and a physician trained in preventative medicine. Siegel told them that anti-tobacco harm reduction messaging impacts the ability and the credibility of public health institutions working to counter the rapid pace of the novel coronavirus disease.
“It’s absolutely true that if more public health activists had embraced e-cigarettes instead of opposing them and more smokers had been encouraged to switch, there would be less mortality from COVID-19 today,” Siegel said in his Inside Sources interview.
This is a profound belief.
My mind is easily unsettled, though. It has been a very long-time since I graced the pages of Vaping Post through the written word. The events of the world have seen a catastrophic turn, especially concerning the state of the economy.
Barring these over-politically charged times, we are stuck dealing with the coming eve of the Food and Drug Administration’s premarket tobacco applications regulatory pathway deadline of September 9, 2020. This is already an extension of a deadline that was made for May 12 of this year, per an order from a federal magistrate.
The U.S. District Court for the District of Maryland, however, changed the May 12 deadline permitting the FDA and numerous e-cigarette and vapor product manufacturers a few more months to attempt to comply with the mandates of the court and the Tobacco Control Act of 2009. The act, naturally, gave the FDA power to regulate all types of consumer products that contain nicotine and tobacco, including alternatives to combustible cigarettes like vaporizers, snus, and heat-not-burn devices like IQOS.
I digress, though. Considering the number of challenges facing the overall industry, we need to be prepared for a crisis. But, I am but one person to say such things.
In October 2018, Singapore’s Ministry of Health (MOH) had announced that it would be introducing standardised packaging for tobacco products, including cigarettes, cigarillos, cigars, beedies (thin cigarettes wrapped in a leaf), ang hoon (loose tobacco leaves) and other roll-your-own tobacco products, as part of ongoing efforts to reduce local smoking rates.
The regulations includes a clause requiring graphic health warnings that cover at least 75% of the packet.
“Tobacco use is a major cause of ill-health and death in Singapore,” said the MOH in a press release at the time. “More than 2,000 Singaporeans die prematurely from smoking-related diseases annually. Daily smoking prevalence amongst Singaporeans has been fluctuating since 2004, with no clear pattern of sustained decline.”
The measure has finally gone into effect, and besides plain packaging, meaning that all logos, colours, images and promotional information on the packaging of tobacco products should be removed, it includes a clause requiring graphic health warnings that cover at least 75% of the packet.
Anyone caught not complying to this regulation can face a fine of up to $10,000 and/or a jail sentence of up to six months. The MOH emphasized the fact that a year’s notice was given before setting in place the measure, giving tobacco manufacturers, importers, wholesalers and retailers time to adjust and prepare for the new measures.
The government to subsidize NRTs
Meanwhile, earlier this year Senior Parliamentary Secretary at the Ministry of Home Affairs and Ministry of Health, Mr. Amrin Amin, had announced new smoking cessation pilot programmes. He explained that Singaporean smokers enrolling in these programmes would be entitled to full subsidies for nicotine replacement therapy (NRT) in order to help them quit smoking.
Sharing details about the initiative during the MOH budget debate in March, Amin said that the programme aims to reach approximately 10,000 smokers. Applicants would benefit from intensive behavioural support, follow-up for up to a year and a three-month NRT supply.
The video shows Hishammuddin sneaking a vape behind his face mask while his colleague, Transport Minister Dr Wee Ka Siong, is speaking during Parliamentary proceedings. After the video was leaked, Hishammuddin, apologised on Twitter promising not to vape during Parliament proceedings again. “Sorry, I didn’t realise – it’s a new habit. I apologise to the Dewan and promise not to do it again,” he tweeted.
An approximate 25% of Malaysia’s population smokes, and this high rate can be partly attributed to the lack of harm reduction initiatives by local lawmakers.
In October 2018, former health minister Dr Dzulkefly Ahmad had declared Parliament as a non-smoking area, while in April 2019, Health Minister Datuk Seri Dr Dzulkefly Ahmad, had announced a new bill regulating cigarettes and e-cigarettes in the same way. “The new bill will underline all regulations and controls on e-cigarettes and vapes, including the sales guidelines,” he said at the time.
To this effect, Hishammuddin was forced to pay a fine. Generally, anyone caught breaking the regulation incurs a maximum of RM500 (US$119) compound and can be fined up to RM10,000 (US$2,387) or face imprisonment of up to two months, or both.
Tobacco harm reduction remains disregarded
Malaysia retains a very harsh stance towards vaping and not long ago Health Minister Dzulkefly Ahmad, has even mentioned that a total vape ban was being considered. “A detailed study is required to review the need for enforcing a total ban on the sale of electronic cigarettes and vapes,” he said, adding that the ministry had set up a committee to look into the matter.
Meanwhile, an approximate 25% of Malaysia’s population smokes, and this rate can be partly attributed to the lack of harm reduction/smoking cessation initiatives, by local lawmakers. Last year shadow finance minister and former minister of youth and sports Khairy Jamaluddin, had expressed his opinion about the use of e-cigarettes as harm reduction tools. “I’m more for harm reduction, which means you try to minimise the negative effects. It’s the idea that certain addictions can be re-routed towards less-harmful, non-lethal behaviour,” said Jamaluddin.
Virginia-based vaping retailer and e-liquid manufacturer AVAIL Vapor announced today that a PMTA for a flavored e-liquid submitted by AVAIL has been accepted by the FDA for substantive review. All vaping manufacturers must submit PMTAs (Premarket Tobacco Applications) by Sept. 9 for products they intend to sell on the legal market after that date.
AVAIL says the application is the first of “numerous applications that AVAIL plans to file” before the deadline, “which will enable AVAIL to provide a wide-ranging flavor portfolio” to customers. The company did not release the names of all products submitted, but confirmed that its mixed berry flavor Mardi Gras was among them.
Today’s announcement from AVAIL marks the first known example of a flavored, bottled e-liquid (or open-system vaping product of any kind) being accepted for further study by federal regulators. Reaching the substantive review stage means that the products submitted may remain on the market for up to one year, or until the agency issues a final decision on whether they may be legally marketed.
Acceptance of the AVAIL submission for further review is important in two ways. First, it means that at least some bottled e-liquid will be available legally after the Sept. 9 PMTA deadline. Second, it indicates that the FDA will at least make a pretense of reviewing open-system products and bottled e-juice in flavors other than tobacco.
The Tobacco Control Act and the FDA’s Deeming Rule (which made vaping products subject to tobacco regulation) are both carefully designed to make it difficult for small businesses and open-system vaping products to successfully meet the required standard of being “appropriate for the protection of public health.” Because they can be used in tens of thousands of configurations (making every combination impossible to test), the FDA could have simply refused to review any of them.
Until now, the only products made by an independent vaping manufacturer known to be accepted for substantive review have been E-Alternative Solutions’ Leap and Leap Go devices, and prefilled, sealed Leap pods. EAS announced on July 8 that their Leap PMTA submissions had been accepted for substantive review.
Juul Labs announced its PMTA submission in July, and all of the tobacco companies that sell vaping products have submitted applications, the most recent being Imperial Brands/Fontem Ventures’ myblu. Except for Juul, all of those companies can finance the cost of their PMTA submissions with cigarette sales. That is not the case for small, independent vaping businesses.
While AVAIL was rightfully celebrating its successful completion of the first step toward PMTA approval, Arkansas e-liquid manufacturer eJuice Monkeys was making its own announcement—one that is likely to be repeated by many small vaping companies in the coming weeks.
“Though we have been fully compliant every step of this journey, we will not be submitting the PMTAs (Pre-Market Tobacco Applications) required to remain compliant,” the company announced. “Preparing enough PMTAs to survive is not only cost-prohibitive for 98% of vapor product businesses, it is an extraordinarily complex, time-consuming undertaking, making success nearly impossible for all but the large corporations. Big tobacco manufacturers have the resources to prepare and to submit half a dozen PMTAs for the limited number of products they want to offer vapers (a relatively minor cost, that’s recovered easily enough when you’re the only players in town). We simply do not have the resources to accomplish this and survive.
“But we’re not alone. The vast majority of vape businesses are in the same position. In a decade businesses and groups have built an industry from nothing, changed lives, fought the good fight, stayed the course, and now prepare to turn a page. We consider ourselves in very good company.”
By Kit Ramgopal, Cynthia McFadden and Conor Ferguson
Before coronavirus, pulmonologists, pediatricians and parents were busy battling a different nationwide health crisis: the “epidemic” of teen vaping. Last year, over five million high school and middle school students reported using e-cigarettes, inhaling mysterious nicotine-filled juices with little sense of the long-term effects.
So when an unfamiliar virus began sending scores of patients to the hospital with failing lungs, doctors wondered whether there would be consequences for the newly addicted generation.
On Tuesday, researchers at the Stanford University School of Medicine published a study which may confirm the fears of parents and doctors across the nation. Vaping is not just a small risk for coronavirus. Among teens and young adults who were tested, those who had used e-cigs were five to seven times more likely to be infected than non-users.
Watch Cynthia McFadden on NBC Nightly News with Lester Holt tonight for more on this story
“We were surprised,” said Dr. Bonnie Halpern-Felsher, professor of pediatrics at Stanford University and the study’s senior author. “We expected to maybe see some relationship …. but certainly not at the odds ratios and the significance that we’re seeing it here.”
The study is the first national population-based look at connections between vaping and coronavirus in young people, based on surveys of over 4,351 participants ages 13 to 24 from all 50 U.S. states, the District of Columbia and three U.S. territories. Among tested participants, young people who had ever used e-cigs were five times more likely to be diagnosed with coronavirus, while those who had used both e-cigs and regular cigarettes within the previous 30 days were 6.8 times as likely to be diagnosed with the disease.
“This is yet another piece showing that e-cigarettes are harmful to our health, period,” said Halpern-Felsher.
There could be several reasons for vapers’ heightened transmission risk. E-cigarettes can damage lungs and alter the immune system, making each coronavirus exposure more likely to trigger an infection, experts say. It is also possible that the aerosol emitted from e-cigarettes could have droplets containing coronavirus, Halpern-Felsher said, which could then be spread to another person or re-inhaled into one’s lungs. Many vaping social norms — hand-to-mouth contact, passing e-cigs between friends — are also high-risk pandemic behavior. It’s hard to exhale a cloud of smoke with a mask on.
More research is needed to understand the medical relationship between coronavirus and vaping, experts say. But the risk is clear, even when variables like race, sex, state COVID-19 rates and compliance with shelter-in-place orders are taken into account. The researchers say they hope these findings will prompt regulators to toughen regulations on these devices. Vaping is no longer just a personal risk, the study shows, but also a public health risk.
“Using e-cigs is sort of like the anti-mask,” said Dr. Jonathan Winickoff, professor of pediatrics at Harvard Medical School and MassGeneral Hospital for Children. “If we can control vaping in youth, we’ve gone part of the way in helping curb the pandemic.”
Widespread concern for teen vapers
Sophia Beerel, one of Winickoff’s patients, was 14 when she took her first hit of an e-cigarette — a candy-sweet head rush with no warnings and seemingly few consequences. It started with an impulsive hit of a classmate’s device during a science class bathroom break.
“I knew it was more than water,” said Beerel, now 16. “I knew it was a type of juice. I wasn’t aware to the extent of how much nicotine was in it. I didn’t even know what nicotine was at that point.”
“I was like, whatever… better than cigarettes,” she continued. “That’s what people were saying.”
So began a multi-year battle with nicotine addiction. She ignored her parents’ “nicotine talk” and lit candles at home to mask the smell of her exhales. At 15, she tried to quit and felt sick with withdrawal symptoms like jitters, nerves and shakes. It was only when she lost her luggage stocked with pods during a five-week vacation that she was forced to quit cold turkey.
Sophia Beerel, now 16, has struggled with a vaping addiction that began when she was just 14 years old.Courtesy of the Beerel family
Beerel says she has mostly stopped using e-cigarettes, down from a pack of pods roughly every 10 days (equivalent to about four packs of cigarettes) to an occasional nostalgic hit. But when the pandemic began, Beerel wondered if her old habit was going to put her at additional risk.
“I think it’s scary for everyone,” said Beerel. “I did have thoughts like how much of my lungs are compromised.”
It troubles Winickoff, her doctor, as well. Over the past few years, Winickoff has seen kids he began treating as babies turn to e-cigarettes — teenagers who lose their breath after a flight of stairs, athletes who have lost the stamina to play sports and many, many photos of damaged lungs. But he says he has never been more worried about teen tobacco use than right now.
“This is a dangerous convergence of two different crises — the epidemic of youth e-cigarette use combined with the pandemic of COVID-19,” said Winickoff.
The Stanford study sheds new light on just how problematic the mix could be. Participants who used cigarettes and e-cigarettes in the previous 30 days were also almost five times more likely to experience COVID-19 symptoms like coughing, fever, tiredness and difficulty breathing.
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“I think our findings have a very strong message to health care providers, parents, and teens,” Halpern-Felsher said. “If you are vaping and smoking, this is yet another sign that these products are hurting your body and your lungs.”
An FDA spokesperson could not comment on the specifics of the study but said the agency will review it. In a statement, the spokesperson noted that people who smoke cigarettes may be at increased risk of infection and worse outcomes due to COVID-19. They said it is not yet known whether the same is true for e-cigarettes.
“E-cigarette use can expose the lungs to toxic chemicals, but whether those exposures increase the risk of COVID-19 or the severity of COVID-19 outcomes is not known,” the spokesperson said. “However, many e-cigarette users are current or former smokers, and cigarette smoking increases the risk of respiratory infections, including pneumonia. Irrespective of COVID-19, e-cigarettes should never be used by youth, young adults, and pregnant women or adults who do not currently use tobacco products.”
The Stanford study did not analyze a possible connection between COVID-19 diagnosis and use of conventional cigarettes for study participants. This may be because most nicotine-using youth either use e-cigs only or both e-cigs and traditional cigarettes, according to Halpern-Felsher, but few use conventional cigarettes alone.
‘A one-two punch’
The Stanford study focuses mainly on transmission, but experts’ concerns regarding e-cigs extend beyond that. A July study from the University of San Francisco suggests smoking, including e-cigarettes, doubles young adults’ risk of getting seriously sick with coronavirus — the “most prevalent factor” in young adults’ medical vulnerability for severe COVID-19 illness.
It’s a factor that Colin Finnerty, 21, can’t get out of his head. In March, Finnerty became one of the first people in his county to come down with coronavirus, he said. Doctors identified a small pneumonia infection in his bottom left lung, he said, and it spread to both sides in just two days. He spent six days on oxygen in the hospital, isolated, worried he was going to die.
Colin Finnerty began vaping at age 17, which he worries may have contributed to his severe coronavirus symptoms.Courtesy of the Finnerty family
“Being a 21-year-old, I should not be spending six days in the hospital for lung complications,” Finnerty said. “I was told so much that, statistically, I was in the clear. But I learned very shortly that was wrong.”
Finnerty looks nothing like the prototypical coronavirus patient. He is generally healthy, works at a ski resort and spends his free time swimming, skateboarding and snowboarding. But he has also been addicted to vaping since he was 17. For over three years, he was vaping from the second he woke up to the second he went to bed, he said.
Data is lacking on the medical connection between coronavirus and vaping. But Finnerty still worries that his e-cigarette addiction may have turned his coronavirus diagnosis into a battle for his life.
“It’s just weird to think that maybe if I hadn’t bought that first [e-cigarette] … then maybe it wouldn’t have happened,” said Finnerty. “Or at least not happened as brutally as it ended up happening,”
Existing research suggests that a smoker’s lungs are especially ripe for coronavirus infection, according to Winickoff. Smoking can paralyze the lungs’ cilia — little hair-like fibers that sweep away mucus and pathogens — making them less effective as guards against dangerous infections. It can also make it easier for coronavirus to bind in the lung, Winickoff said, so a smaller dose of virus is more likely to cause an infection.
“For smokers, it essentially takes less virus to cause disease,” Winickoff said. “And in general, the higher the viral load, the bigger the problems…. So it’s really a one-two punch there.”
E-cigarettes can also weaken the immune system and appear to cause underlying conditions like asthma which may make it harder to fight the virus. And tobacco and nicotine are just the beginning, some worry. No one is systematically checking what’s inside many of these devices, a large portion of which now come from factories overseas. Experts have found substances like carcinogens, heavy metals, herbicides, toxic chemicals and chemicals known to cause heart and lung disease.
The Centers for Disease Control told NBC News it does not currently list e-cigarette use as a medical condition that increases risk for severe COVID-19 infection.
The CDC said it does not comment on externally led studies, such as the new Stanford study, but is currently collecting its own data on vaping and COVID-19.
“As more data on tobacco-related indicators are reported, including smoking status and e-cigarette use, CDC will continue to release these findings to help inform evidence-based recommendations for the general public, clinicians, and health departments,” the agency said in a statement to NBC News.
‘I honestly think the FDA has taken its eye off the ball’
A fivefold increase in coronavirus susceptibility is a scary statistic for young e-cigarette users, but experts say it should also be troubling to regulators. Over one in four high school students reported current e-cigarette use in last year’s National Youth Tobacco Survey. If schools reopen and teen vaping goes unchecked, transmission rates could increase, affecting teachers, parents and the community at large.
The results of the Stanford study underscore the need to clamp down on teen e-cigarette use, according to Halpern-Felsher.
“I honestly think that the FDA has taken its eye off the ball, really even before the pandemic,” Halpern-Felsher said.
Halpern-Felsher is not alone in this sentiment; regulation of e-cigarettes has been too slow and too limited for many advocates. This January, the FDA issued a ban on most flavored cartridges, including popular “gateway” flavors like mint and mango. But the ban gave exceptions to certain products, such as menthol and tobacco cartridges, flavored “open tank” e-juice and disposable e-cigarettes.
A new cast of brands has already grown in these loopholes. Throughout the pandemic, there have remained a rainbow assortment of workarounds for addicted youth, in flavors like cotton candy, banana and green apple candy.
In July, the FDA sent warning letters notifying 10 companies to pull flavored disposables and youth-appealing e-liquids from the market. In a statement to NBC News, an FDA spokesperson said its top priority “remains protecting youth from products that pose the greatest risk for initiation or use by minors.”
“The FDA continues to prioritize enforcement against e-cigarette products, specifically those most appealing and accessible to youth,” the agency spokesperson said. “We are concerned about the popularity of these products among youth and want to make clear to all tobacco product manufacturers and retailers that, even during the ongoing COVID-19 pandemic, the FDA is keeping a close watch on the marketplace and will hold companies accountable.”
But existing actions have not gone far enough, according to Halpern-Felsher.
“The cigarette market, it’s the Wild Wild West,” Halpern-Felsher said. “As soon as you get one product off the market, the next one comes on. … We need to stop the whack a mole, we need to regulate and stop the entire market of e-cigarettes.”
Rep. Raja Krishnamoorthi, D-Ill., who chairs the Subcommittee on Economic and Consumer policy, sent a letter to the FDA on Tuesday, citing the new Stanford study. He previously wrote the agency in April regarding the potential of e-cigarettes to exacerbate the coronavirus pandemic, but the FDA then declined to act, citing lack of conclusive evidence on the topic.
“Today, we have the evidence that the FDA was waiting for, and it can no longer deny the danger e-cigarettes pose during the coronavirus crisis,” wrote Krishnamoorthi. “[I]t is evident that the youth vaping epidemic has combined forces with the coronavirus pandemic, creating a much deadlier foe that demands FDA action.”
So far, patchwork regulation has shaken companies, but not addicts. E-cigarette brands may rise and fall, but the number of teen e-cigarette users has only risen in recent years.
While Beerel and Finnerty feel compelled to speak out against e-cigarettes, they both have struggled to ditch the habit completely. Finnerty, who says he has been diagnosed with PTSD after getting out of the hospital, urged others to take all possible steps to avoid his situation, including avoiding e-cigarettes.
“Easier said than done,” said Finnerty. “But I just hope that people consider that they are putting themselves at a much greater risk.”
Coronavirus is the latest in a long list of risks incurred by teen vapers. But the results of the Stanford study feel especially shocking, Beerel said. It’s not a distant risk. It’s not a small risk. And for teenagers living with parents and interacting with the community, it’s not just a personal risk either.
“It makes me at least really thankful that I haven’t gotten it yet, and a little bit concerned for both myself and my peers,” said Beerel. “Because COVID-19 is a nasty disease…it’s already so contagious. To think that it can be even more contagious based on vaping is really just shocking and scary.”
Kit Ramgopal
Kit Ramgopal is a reporter with the NBC News Investigative Unit.
Cynthia McFadden
Cynthia McFadden is the senior legal and investigative correspondent for NBC News.
Conor Ferguson
Conor Ferguson is a consumer investigative producer with the NBC News Investigative Unit.
