Electronic Cigarette Use Is Not Associated with COVID-19 Diagnosis

Abstract

This analysis tested the hypothesis that current e-cigarette use was associated with an increased risk of SARS-CoV-2 infection in patients seeking medical care. E-cigarette and conventional cigarette use were ascertained using a novel electronic health record tool, and COVID-19 diagnosis was ascertained by a validated institutional registry. Logistic regression models were fit to assess whether current e-cigarette use was associated with an increased risk of COVID-19 diagnosis. A total of 69,264 patients who were over the age of 12 years, smoked cigarettes or vaped, and were sought medical care at Mayo Clinic between September 15, 2019 and November 30, 2020 were included. The average age was 51.5 years, 62.1% were females and 86.3% were white; 11.1% were currently smoking cigarettes or using e-cigarettes and 5.1% tested positive for SARS-CoV-2. Patients who used only e-cigarettes were not more likely to have a COVID-19 diagnosis (OR 0.93 [0.69-1.25], P = .628), whereas those who used only cigarettes had a decreased risk (OR 0.43 [0.35-0.53], P < .001). The OR for dual users fell between these 2 values (OR 0.67 [0.49-0.92], P = .013). Although e-cigarettes have the well-documented potential for harm, they do not appear to increase susceptibility to SARS-CoV-2 infection. This result suggests the hypothesis that any beneficial effects of conventional cigarette smoking on susceptibility are not mediated by nicotine.

Symptoms COVID 19 Positive Vapers Compared to COVID 19 Positive Non-vapers

“…Whereas previous studies have shown no association with greater risk for being infected with COVID-19 for those individuals who vape (use e-cigarettes). 14 This analysis of clinical data collected from COVID-19 positive patients revealed a higher frequency of COVID-19 symptoms among those individuals who vape when compared to those who do not vape. Using logistic regression, we identified a significantly higher frequency of Covid-19 symptoms such as headaches, myalgia, anosmia/dysgeusia, chills, lightheadedness, chest pain, nausea/vomiting, and diarrhea among those individuals who used only e-cigarettes; whereas those who vaped and smoked had a significantly higher occurrence of dyspnea and ED visits (related and not related to COVID-19).…”

“… 9 - 12 An article published by Gaiha et al 13 in July 2020, concluded that COVID-19 was “five times more likely among ever users of c-cigarettes and 7 times more likely amongst dual users.” However, another study found that using e-cigarettes did not pose an increased risk for COVID-19. 14 There have been several letters and publications 15 , 16 which have been critical of the quality of data and analysis used by Gaiha et al 13 Aside from the content and potential harms of e-cigarettes, sharing of vaping devices has been raised as a potential concern for the spread of COVID-19.…”

COVID-19 Vaccination Uptake and Hesitancy Among Current Tobacco Users

“…7,8 Generally, individuals who live in rural regions, have lower income or education, and racial and ethnic minorities are less willing to receive the vaccine. [9][10][11][12][13] Consistent evidence from numerous countries finds that smokers are less likely than non-smokers to be infected by COVID-19, [14][15][16][17] but if infected, smokers have had higher disease severity. 18,19 Typically, more severe cases result in higher usage of healthcare resources, including longer hospital stays, which makes it important to understand vaccination perceptions and hesitancy among tobacco users to help avert overloading the healthcare system.…”

Instigators of COVID-19 in Immune Cells Are Increased in Tobacco Cigarette Smokers and Electronic Cigarette Vapers Compared With Nonsmokers

“…Levels of cotinine, the metabolite of nicotine, are comparable in smokers and vapers. 10 ECIG vaping has variably been associated with increased risk, 11 and no increased risk, 12 for COVID-19 diagnosis.…”