Rep. Raja Krishnamoorthi (D–Ill.), who chairs the House Oversight Subcommittee on Economic and Consumer Policy, wants the Food and Drug Administration (FDA) to ban e-cigarettes as a COVID-19 hazard. He cites a new study that supposedly shows "e-cigarette users are much likelier to be diagnosed with COVID-19 and to experience symptoms." But contrary to what you may have read, that is not what the study actually found.
In May, Shivani Mathur Gaiha and two other Stanford researchers conducted an online survey of 4,351 Americans between the ages of 13 and 24, asking about smoking, vaping, and COVID-19 testing, symptoms, and diagnoses. They found that participants who had ever used e-cigarettes alone were five times as likely to be diagnosed with COVID-19 as people who never used nicotine products, a difference that was statistically significant. Yet participants who had vaped during the previous 30 days were less than twice as likely to have tested positive for COVID-19, and that difference was not statistically significant.
Reporting their results in the Journal of Adolescent Health, Gaiha et al. suggest "potential reasons" why vaping might increase the risk of contracting COVID-19. "Heightened exposure to nicotine and other chemicals in e-cigarettes adversely affects lung function," they write. "COVID-19 spreads through repeated touching of one's hands to the mouth and face, which is common among cigarette and e-cigarette users. Furthermore, sharing devices (although likely reduced while staying at home) is also a common practice among youth e-cigarette users."
Such speculation seems premature in light of the finding that current vaping is not associated with a statistically significant increase in COVID-19 risk. Given the confidence interval, it may even be associated with a reduced risk. Meanwhile, the increased risk among people who had ever vaped was large and statistically significant. It is hard to see how the "potential reasons" suggested by the researchers can explain these puzzling results, which imply that people who are still vaping face a lower risk than people who have tried e-cigarettes but do not currently use them.
The study's findings regarding cigarette smokers are also scientifically improbable. People with a history of smoking (but not vaping) were 2.3 times as likely to have tested positive for COVID-19, while the risk ratio for people who had smoked in the previous 30 days was 1.5. Those results were not statistically significant. But even if they were, the implication, assuming these associations are evidence of a causal relationship, would be that former smokers should start smoking again if they want to reduce their COVID-19 risk.
The results for vapers who were also smokers fit the researchers' hypothesis a bit better. Participants who had ever been dual users were about seven times as likely to have tested positive for COVID-19, a difference that was statistically significant. Yet the risk ratio for current dual users, although also statistically significant, was slightly lower, meaning that continuing to vape and smoke did not increase the odds of being infected.
Taking these results at face value, one might conclude that people who currently vape and smoke can dramatically reduce their COVID-19 risk by abandoning e-cigarettes and smoking more. That hardly seems like sound medical advice, since smoking is indisputably much more hazardous than vaping. Furthermore, the risk of death among young people infected by the COVID-19 virus, even when they develop symptoms, is negligible, especially when compared to the long-term risk of dying from smoking-related disease.
"If we are to believe these results have real-world implications, then we must believe that exclusively smoking or vaping poses no additional COVID-19 risks, but using both products greatly increases your risk," observes Gregory Conley, president of the American Vaping Association, a consumer group that supports e-cigarettes as a harm-reducing alternative to the conventional, combustible kind. "Furthermore, having ever used an e-cigarette in your life increases your COVID-19 risks, but having only vaped in the last 30 days does not. This is all scientifically illogical, and no serious health academic would draw conclusions from such contradictory data."
A USA Today story about the study ignores its counterintuitive implications. "A new study has found that vaping is linked to an elevated risk of COVID-19 among teenagers and young adults, providing more evidence of the harmful effects of electronic cigarettes," writes health reporter Adrianna Rodriguez. "Teens and young adults who vape are five times more likely to become infected with the coronavirus compared with those who did not use e-cigarettes." She does not mention that teens and young adults who continue vaping somehow magically eliminate that risk, which should be a red flag for anyone who thinks vaping makes people more likely to get COVID-19.
Rodriguez compounds her journalistic malpractice by invoking the condition that officials at the Centers for Disease Control and Prevention call "e-cigarette, or vaping, product use associated lung injury" (EVALI). Despite that misleading name, those lung injuries are associated with black-market THC vapes, not the legal, nicotine-delivering e-cigarettes that were the subject of the study Rodriguez is discussing. Although EVALI has nothing to with COVID-19 risk among nicotine vapers, it gives Rodriguez another spurious excuse to warn us about "the harmful effects of electronic cigarettes."
Rep. Krishnamoorthi, who was already using COVID-19 as a pretext for urging the FDA to ban e-cigarettes last spring, is likewise unfazed by Gaiha et al.'s illogical results. On April 1, he notes in a letter to FDA Commissioner Stephen Hahn, "I called on the FDA to clear the market of all e-cigarettes, temporarily, for the duration of the coronavirus crisis." Back then, the "FDA declined to act, citing the need for more evidence that vaping is a risk factor for contracting coronavirus." But now, Krishnamoorthi says, "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."
Krishnamoorthi claims "the science is now in: e-cigarette users are much likelier to be diagnosed with COVID-19 and to experience symptoms." But judging from the study on which the congressman is relying, that is true only if people stop using e-cigarettes. If they keep vaping, their COVID-19 risk goes back down. That suggests taking e-cigarettes away from vapers, as Krishnamoorthi wants the FDA to do, will foster the spread of COVID-19. If you don't buy that, you have to consider the possibility that something is seriously wrong with the study he thinks clinches his case.
Update: Brad Rodu, a tobacco harm reduction advocate who is a professor of medicine at the University of Louisville in Kentucky, calculates that Gaiha et al.'s claims about an elevated COVID-19 risk among people who had ever used e-cigarettes exclusively or ever used them together with conventional cigarettes were based on just five and three diagnoses, respectively. "Because my estimates are approximate (they might be one lower or higher)," he writes, "I asked the senior author to provide actual numbers. She declined."