Public Health

The CDC's Shift From Vaping to COVID-19 Highlights the Crucial Differences Between Real and Metaphorical Epidemics

The agency's scaremongering about e-cigarettes undermined its credibility on the eve of a true public health crisis.

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The U.S. Centers for Disease Control and Prevention (CDC), an agency that is currently focusing on the core mission reflected in its name, until recently was darkly warning us about a very different kind of "epidemic": an increase in e-cigarette use by teenagers, coupled with an outbreak of vaping-related lung injuries. The first concern did not involve any sort of disease; the latter did, but unlike COVID-19, the condition that the CDC dubbed "e-cigarette, or vaping, product use-associated lung injury" (EVALI) was not a contagious illness caused by a microorganism. And contrary to the CDC's misleading nomenclature and dangerously misguided initial advice, the two developments appear to be completely unrelated.

The CDC's switch from vaping to COVID-19 highlights the moral and practical differences between actual epidemics and metaphorical epidemics of risky behavior, both of which fall under the all-encompassing umbrella of "public health." Even within that framework, which is built around minimizing morbidity and mortality, the CDC's conflation of EVALI with vaping in general was counterproductive, impeding the harm-reducing shift from conventional cigarettes to nicotine delivery systems that are far less dangerous. By fostering confusion about the relative hazards of smoking and vaping, the CDC damaged its credibility on the eve of a public health crisis in which policy makers and the rest of us are expected to rely on its expertise.

Vaping is something people choose to do. In that respect it resembles many other phenomena that activists, politicians, bureaucrats, and academics have described as epidemics or public health problems, including smoking, overeating, using illegal drugs, riding a motorcycle or bicycle without a helmet, gambling, playing violent video games, and watching violent movies or pornography. COVID-19, by contrast, is something that happens to people. They do not consciously choose to be infected, although they can do things that increase or decrease that risk.

While there is plenty of room for debate about the legality, propriety, and effectiveness of specific policies aimed at curtailing the spread of COVID-19, there is a stronger argument for coercive measures when we are confronted by a potentially deadly disease that moves from person to person. That argument is much less compelling when we are talking about self-regarding actions that may lead to disease or injury but do not inherently endanger other people.

The habit of describing nearly anything that large numbers of people do as an epidemic, depending on whether it might compromise their health or whether others view it as pernicious, elides this crucial distinction. If protecting public health is presumed to be a legitimate function of government, an open-ended definition of that term is a prescription for constant political meddling in personal choices through taxes, regulations, and prohibitions as well as state-sponsored propaganda. Likening choices to contagious diseases invites the government to act as if those choices, and the personal tastes and preferences underlying them, morally matter as much as a virus's evolutionary imperative to survive and reproduce by infecting human hosts.

Once a particular pattern of behavior has been defined as an epidemic, that framing can lead to policies that make no sense even if you accept the collectivist calculus at the heart of the "public health" mission. That is what happened with drug prohibition, which is ostensibly aimed at reducing the harm associated with drug use but in practice increases the hazards faced by people who defy it, exposing them not only to the risk of arrest but also to black-market violence, potentially deadly variability in quality and potency, and communicable diseases fostered by a legal environment in which sanitary injection equipment is hard to obtain and risky to possess.

That is also what happened with vaping, which the CDC was predisposed to view as problematic, a prejudice that colored its depiction of EVALI. Even though it was clear early on that vaping-related lung injuries overwhelmingly involved black-market cannabis products, the CDC repeatedly intimated that legal, nicotine-delivering e-cigarettes might kill you. That message endangered public health by implying that people—teenagers as well as adults—would be better off smoking, which is demonstrably not true.

Only belatedly did the CDC recalibrate its guidance to focus on the potential hazards of "THC-containing e-cigarette, or vaping, products, particularly from informal sources like friends, family, or in-person or online dealers." It also foregrounded a warning that "adults using nicotine-containing e-cigarette, or vaping, products as an alternative to cigarettes should not go back to smoking"—advice that surely is equally sound for teenagers who are vaping rather than smoking.

We have to hope that the CDC's COVID-19 recommendations are more scientifically grounded than its initial scaremongering about e-cigarettes. I assume they are. But when public health agencies stray beyond their central mission and allow moral panics to affect their advice, they undermine the public trust that is vital at a time like this.

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  1. According to Wikipedia Consultant The individuals who have gone to vaping in the wake of smoking for a long time may, on the off chance that they get COVID-19, be more gravely influenced by it than the individuals who have never smoked. In any case, neither vaping nor nicotine itself, are probably going to have a lot of effects.

    1. Is this a deep spam? I don’t see how wikipedia consultant is relevant to your comment.

      1. Wikipedia for sure is not a valid resort of informations but you must have a good time here oma seks until you get some mor relevant informations

      2. Looks like a spammer handle.

  2. It is a government institution. It lies.

    1. Government always lies. Try to relieve stress in times of isolation with the help of my site https://xoma.nl/

  3. Gun violence and obesity aren’t infectious diseases, yet the bureaucrats at the CDC starting devoting time and resources to these “epidemics” in recent years. Mission creep is a problem here for the CDC.

    1. Mission creep is a problem here for the CDC.

      Actually, it’s an epidemic for the government.

    2. I also have to wonder if they had stayed focused on their actual mission instead of wasting resources on bullshit like vaping and guns if maybe they had been able to respond faster and more efficiently to an actual pandemic.

      Probably not, they are a government bureaucracy after all, but still…

    3. It is and it appears they don’t know what to do when a real disease shows up. Viruses don’t respond to your intersectional bullshit.

  4. We have to hope that the CDC’s COVID-19 recommendations are more scientifically grounded than its initial scaremongering about e-cigarettes.

    Serious question, Jacob: Are there any published analyses justifying bans on gatherings of more than 50, 150, 250, or whatever the heck some bureaucrat pronounces?

      1. Thanks, De — interesting and useful. However, I’m looking for something more along the lines of a system of differential equations with gathering size a parameter.

        1. These are discrete events involving agents with complex behaviors; you’d use discrete event simulation to see the effects of various interventions. Theory is useless.

          1. Computer model simulations prove nothing. They are pure confirmation bias for whoever built the model.

      2. Great reference. Thanks

  5. Strange how an institution that allows its biases to affect its conclusions so much so that it begins to be perceived to be issuing opinions rather than facts loses its credibility and its trust with the public. A reputation for telling the truth, of fairly and dispassionately reporting just the facts, can easily be destroyed and who knows how long it may take to regain that reputation?

    1. “…A reputation for telling the truth, of fairly and dispassionately reporting just the facts, can easily be destroyed and who knows how long it may take to regain that reputation?”

      The FAA.
      That concludes my list of government agencies which, to my knowledge and to date, have avoided politicizing or inappropriately expanding its mission.
      Once the CDC claimed ‘gun violence’ was a ‘disease’ requiring its attention, your question became applicable, and the answer is a mystery to me.

      1. The FAA doesn’t have such a reputation either. Look at what the FAA is doing to regulate drones.

  6. It’s funny seeing Sullum write of someone else undermining their credibility…

  7. I wonder if there is anyone left in public health anymore who understands real diseases or epidemics that are not simply behaviors they disapprove of

    1. Yes there are

      1. Your cite is missing.

      2. Your cite is still missing; you seem to be a bullshitter posting bullshit, as you proved last night.

  8. This is all becoming frustrating and scary. I feel that if the US had done more aggressive with early testing some of what looks to me like panic response may not have been necessary.

    Washington just closed all restaurants, bars as of yesterday, now they’ve added a whole bunch of businesses to the list. Canada closed it’s borders (something something Trudeau something open borders), Europe is going into lockdown, I’m hearing rumours of curfews etc. This disease concerned me and I felt there was a serious underreaction from US health authorities. They waited too long and now we’re in what looks like a severe overreaction.

    1. Careful, Paul. If you talk about testing being beneficial, you will get called a leftist. It doesn’t help at all to know who has the virus you are trying to stop.

      Where I am, all schools have been cancelled in the entire state. All restaurants, bars, coffee shops are take out only. N California is soon to be called for a total lockdown of non essential businesses and travel. Would have been nice to be proactive prior to this, but now that the spread is uncontained, expect more drastic measures.

      On another note, I was wondering where my elderly parents were getting their skepticism of covid 19 from. Just had to turn on fox news to find out. Typical “Just asking questions here” fake patriotic Aussie-American propaganda telling people it’s not that bad, or wait it might be, but the government is still hiding something from you and they can’t tell you to take precautions anyway: https://www.foxnews.com/opinion/steve-hilton-on-coronavirus-dr-fauci-officials-must-answer-the-big-question-americans-are-asking

      1. A leftist? I thought I’d get called an alt-righty. I have no idea what makes anyone anything anymore.

        Either way, I took some heat over my concerns with CV19, but I was careful to not advocate for any specific policy regarding social-distancing, closing businesses or banning gatherings. But I felt that comprehensive testing was a good idea so we could get better real world numbers which would help better inform our reaction.

        It went from “who gives a fuck” to “omfg it’s the zombie apocalypse!!11!” in 48 hours.

        No I’m more scared of the economic consequences than I am of the virus. How the fuck is some McDonald’s employee, living from paycheck to paycheck supposed to weather this shit?

        1. “It went from “who gives a fuck” to “omfg it’s the zombie apocalypse!!11!” in 48 hours.”

          Yeah, and according to DOL, questioning that sudden panic is “fake patriotic Aussie-American propaganda”.
          Once more:
          The current panic and near shut-down of the US economy is far more dangerous to the population than the disease seems to be.
          Even now:
          “Coronavirus USA Update: US Death Toll Hits 85; 4,558 Confirmed Cases”
          https://www.ibtimes.com/coronavirus-usa-update-us-death-toll-hits-85-4558-confirmed-cases-2941146

          ‘Bout the average death-toll from a week-end’s gang activity in Chicago…

        2. This exactly.

          The cure will be worse than the disease. The best economy any of us have ever known has been trashed in 4 weeks time. Trillions of dollars of wealth have been destroyed. Everyone is affected from high school kids with their first jobs to their parents who just watched the 529 for the kid’s college fund get decimated by 1/3 or more, to the guy on the verge of retirement who just saw their retirement fund get decimated, to the public sector worker with money in his union’s retirement fund get decimated.

          Restaurants are closed by law.

          Massive numbers of people will not recover well, or it will take a long time to do so.

          All because of the flu.

          1. “…All because of the flu.”

            I have tried several times to respond in support of you comment. Reason’s amazingly fucked-up software gives me a ‘error’ message, not identifying the ‘error’; likely some of the math symbols. Welsh, you really are an incompetent piece of shit; next year, the check arrives with a value of $0.00. Please resign and let someone competent run the show; you suck. Really, you suck.

            Regarding your comment, suffice to say the numbers of articles regarding the actual disease are minuscule compared to those dealing with the politico- and media-fueled panic. No one seems to care that the death rate is far smaller than ANY infectious disease the CDC tracks.
            Further, any examination of the economic cost/benefit ratios resulting from the ‘brave’ stances of the politicos are not minuscule; they are non-existant.

      2. “On another note, I was wondering where my elderly parents were getting their skepticism of covid 19 from. Just had to turn on fox news to find out. Typical “Just asking questions here” fake patriotic Aussie-American propaganda telling people it’s not that bad, or wait it might be, but the government is still hiding something from you and they can’t tell you to take precautions anyway: https://www.foxnews.com/opinion/steve-hilton-on-coronavirus-dr-fauci-officials-must-answer-the-big-question-americans-are-asking

        Yes, questioning panic responses and expecting honest answers is “fake patriotic Aussie-American propaganda”.
        To fucking ignoramuses…

      3. Careful, Paul. If you talk about testing being beneficial, you will get called a leftist.

        Well, fortunately, we have reason to resolve such questions.

        What benefits does an individual have from getting tested under current guidelines (i.e., after they get symptoms)? How would they behave differently?

    2. From early December, through to when China finally admitted they had an issue nobody was doing anything. But the virus was going just about everywhere it could. I doubt a total worldwide lockdown at the end of January would have made a difference.

  9. The Protection of Mice against Infection with Air-borne Influenza Virus by Means of Propylene Glycol Vapor.
    They have now extended their observations to the effect of propylene glycól vapour on influenza virus. Vapour was employed instead of an aerosol because it has been found that the glycols are much more active in this form, very much smaller amounts being required for effective air sterilization.
    https://www.cabdirect.org/cabdirect/abstract/19422701086

    Preliminary experiments were made to determine the amount of atomized virus suspension required to produce regular infection of mice followed by extensive lung consolidation and death within 4 to 10 days. Mice were then exposed to this lethal concentration of virus in a chamber into which propylene glycol vapour had been introduced; they regularly failed to contract the infection.

    1. So… vaping protects you from virus infection?

      1. According to this study, at least for mice, it would appear so.

        Thirty-two control mice all died in 6-10 days with extensive lung consolidation, whereas 32 mice exposed in the glycol chamber all remained well and showed normal lungs when killed on the 8th day.

      2. “So… vaping protects you from virus infection?”

        I hope “Are You a Vaper?” gets added to questionnaires given to Covid-19 test-takers and hospitalizations. And that its results indicate a strong prophylactic property. And that the government is then forced to encourage the puchase of e-cigarettes and refills by compensating buyers for their costs. A scene I’d like to see.

        1. And I will see Elvis and Bigfoot riding a unicorn before that happens. I am actually in Massachusetts right now, where they banned the sale of vapes from Sept-Dec. Dont think I have seen more people smoking here since I was a kid in the early 1980s, but no vapes to be found still. Coincidentally, all the states with the highest number COVID-19 cases (California, Massachusetts, NY, Washington) are among the most hostile to vaping or smoking.

      3. Great reference. Thanks
        Vaping for sure can not protects you from virus infection but it is good for many other things. Try to relieve stress in times of isolation with the help of oma sex and vaping to you will need for sure.

    2. Delicious if true.

  10. You’ll know it’s a crisis when the stores are out of beer, wine and liquor. Thankfully , I am well prepared for it.

    1. Loaded up on champagne yeast, sugar, charcoal, and copper tubing?

      1. No, but, I do have 11 types of cheeses.

      2. Did your daddy run whiskey in a big black dodge?
        Bought in an auction at the Mason lodge?

        1. No , I buy my wine , beer and whiskey already bottled. I assume your just being a ass like always.

          1. That was a responece to de, but you are clearly not a Steve earle fan

            1. Papaw Pettimore didn’t use no champagne yeast.

            2. For once Rev

              I am. Not many folks here hard core country fans.

  11. If the CDC had spent the time, efforts, and money they spent on vaping, firearms and assorted other issues instead on known communicable diseases we might be better off.

    If only because we would know that those avenues of inquiry are not fruitful.

    1. Yes

      Medicine could care less about trauma and acquired pulmonary disease.

      Sleep well.

      1. Yes, but you can try to relieve stress in times of isolation with the help of my site https://xoma.nl/

  12. “…the CDC damaged its credibility…”

    BOOM! Headshot.

  13. Here are the facts:
    COVID19 does not make healthy children ill.
    COVID19 is the same as a serious cold in healthy adults 9 to 60
    COVID19 can kill seniors and individuals with immune disease

    1. Well then it’s no wonder Congress is freaking out, as they are old as fuck.

      1. Libertarians, however, see a glimmer of hope in that.

  14. “the condition that the CDC dubbed “e-cigarette, or vaping, product use-associated lung injury” (EVALI) was not a contagious illness caused by a micoorganism. “

    The very first finding reported. Because of that medicals were able to treat accordingly with steroids rather than antibiotics.

    Also the public was alerted to risk from THC vape products from black market providers. As a result many people have been spared morbidity and mortality.

    This is not at all the same.

    1. “Also the public was alerted to risk from THC vape products from black market providers. As a result many people have been spared morbidity and mortality.”

      By whom and when?
      And how many people, compared to, oh, the number of people who might have kept smoking?

      1. Nah Sevo and I will not respond to nonsense.

        So far as I am concerned weed should be straight up legal.

        I can’t even if I wanted to. Whatever. I went to college.

        So not the same now. It is a commercial product. There was a real outbreak and so far as is known it related to Vitamin E acetate and possibly other ingredients in oil vapes.

        That is proven and known. Best bet for folks who smoke it is just smoke the plant without all this crap added. Years have shown the toxicity is near non existent.

  15. Revert the name and the mission to the one it had fifty years ago — the Communicable Disease Center. Eliminate the Deputy Director for Non-Infectious Diseases and everything under his office.

    1. Good start; how long will it take for rational people to begin to credit CDC data?
      The SPLC doesn’t regain cred on the firing of one scumbag lefty.

  16. Pretty sure the initial bungling of the tests, as well as orders to stop private testing, undermined the CDC’s credibility more than being wrong about vaping did.

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  18. Drug prohibition is not and never has been “aimed at reducing the harms of drug use.” If it were it would have been abandoned long ago as an abject failure. Jacob Sullum has been reporting on drug policy long enough to know better.

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