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| Smokers and Vapers May Be at Greater Risk for Covid-19 | Smokers and Vapers May Be at Greater Risk for Covid-19 |
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| Anxious times — like a pandemic — can lead to unhealthy but self-soothing habits, whether it’s reaching for a bag of potato chips, more chocolate or another glass of wine. But some stress-reducing behaviors are alarming to medical experts right now — namely vaping and smoking of tobacco or marijuana. | Anxious times — like a pandemic — can lead to unhealthy but self-soothing habits, whether it’s reaching for a bag of potato chips, more chocolate or another glass of wine. But some stress-reducing behaviors are alarming to medical experts right now — namely vaping and smoking of tobacco or marijuana. |
| Because the coronavirus attacks the lungs, this is exactly the moment, they say, when people should be tapering — or better yet, stopping — their use of such products, not escalating them. | Because the coronavirus attacks the lungs, this is exactly the moment, they say, when people should be tapering — or better yet, stopping — their use of such products, not escalating them. |
| ”Quitting during this pandemic could not only save your life, but by preventing the need for your treatment in a hospital, you might also save someone else’s life,” said Dr. Jonathan Winickoff, director of pediatric research at the Tobacco Research and Treatment Center at Massachusetts General Hospital. | ”Quitting during this pandemic could not only save your life, but by preventing the need for your treatment in a hospital, you might also save someone else’s life,” said Dr. Jonathan Winickoff, director of pediatric research at the Tobacco Research and Treatment Center at Massachusetts General Hospital. |
| On Thursday, Dr. Winickoff joined the Massachusetts attorney general, Maura Healey, to issue an advisory alerting the public and particularly young people that smoking and vaping can also exacerbate the risks of spreading Covid-19. | On Thursday, Dr. Winickoff joined the Massachusetts attorney general, Maura Healey, to issue an advisory alerting the public and particularly young people that smoking and vaping can also exacerbate the risks of spreading Covid-19. |
| “You bring this device or cigarette to your mouth to inhale and you do so repeatedly,” explained Dr. Winickoff, who is also a professor at Harvard Medical School. “You touch the cartridge. You put it next to your face. You are spreading whatever is in your hand into your body. At the same time, many of my patients who smoke or vape have increased coughing or expectorating. And that’s a recipe for increased spread.” | “You bring this device or cigarette to your mouth to inhale and you do so repeatedly,” explained Dr. Winickoff, who is also a professor at Harvard Medical School. “You touch the cartridge. You put it next to your face. You are spreading whatever is in your hand into your body. At the same time, many of my patients who smoke or vape have increased coughing or expectorating. And that’s a recipe for increased spread.” |
| Studies already amply show that cigarette smoking weakens the immune system and compromises lung function. Research into the health effects of vaping is limited because the devices are relatively new, but studies suggest that e-cigarettes may cause inflammation in the airways and lungs. | Studies already amply show that cigarette smoking weakens the immune system and compromises lung function. Research into the health effects of vaping is limited because the devices are relatively new, but studies suggest that e-cigarettes may cause inflammation in the airways and lungs. |
| Flavored tobacco products, which teenagers and young adults find particularly alluring, can exacerbate lung infections, studies have found. Smokers and vapers, then, may be more susceptible to coronavirus infection, the Massachusetts advisory emphasizes, and once infected, such patients might also have a tougher time resisting an attack of Covid-19. Studies in mice have shown that vape-exposed mice are more susceptible to viral and bacterial infections, noted Robert Tarran, a professor of cell biology and physiology at the University of North Carolina. | Flavored tobacco products, which teenagers and young adults find particularly alluring, can exacerbate lung infections, studies have found. Smokers and vapers, then, may be more susceptible to coronavirus infection, the Massachusetts advisory emphasizes, and once infected, such patients might also have a tougher time resisting an attack of Covid-19. Studies in mice have shown that vape-exposed mice are more susceptible to viral and bacterial infections, noted Robert Tarran, a professor of cell biology and physiology at the University of North Carolina. |
| Some people have questioned whether unexpectedly high numbers of younger people who have become seriously ill with Covid-19 are connected in some way with their predilection for vaping and marijuana. | Some people have questioned whether unexpectedly high numbers of younger people who have become seriously ill with Covid-19 are connected in some way with their predilection for vaping and marijuana. |
| “I am a firm believer that one plus one equals two. Until I have the evidence to believe otherwise, I believe it is critically important for us to help people quit inhaling anything into their lungs that could be causing any type of inflammation, as the coronavirus will only find an inviting environment otherwise,” said Dr. Carolyn Dresler, a former associate director of medical and health sciences for the Center for Tobacco Products at the Food and Drug Administration, during a webinar last week for Action on Smoking and Health, an international nonprofit group. | “I am a firm believer that one plus one equals two. Until I have the evidence to believe otherwise, I believe it is critically important for us to help people quit inhaling anything into their lungs that could be causing any type of inflammation, as the coronavirus will only find an inviting environment otherwise,” said Dr. Carolyn Dresler, a former associate director of medical and health sciences for the Center for Tobacco Products at the Food and Drug Administration, during a webinar last week for Action on Smoking and Health, an international nonprofit group. |
| A recent study in the New England Journal of Medicine found that Chinese coronavirus patients who smoked were more than twice as likely as those who didn’t to have severe infections from Covid-19. And smoking has been identified as a factor in patients who became ill in 2012 with MERS, another coronavirus. | A recent study in the New England Journal of Medicine found that Chinese coronavirus patients who smoked were more than twice as likely as those who didn’t to have severe infections from Covid-19. And smoking has been identified as a factor in patients who became ill in 2012 with MERS, another coronavirus. |
| Another signal points to the vulnerability of smokers to this coronavirus. The virus seems to attack the body by attaching to a binding receptor called angiotensin-converting enzyme-2, or ACE-2. Tobacco use may increase the expression of ACE-2. That is why doctors and researchers speculate that smokers may become infected with more copies of the virus than other patients. | Another signal points to the vulnerability of smokers to this coronavirus. The virus seems to attack the body by attaching to a binding receptor called angiotensin-converting enzyme-2, or ACE-2. Tobacco use may increase the expression of ACE-2. That is why doctors and researchers speculate that smokers may become infected with more copies of the virus than other patients. |
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| About 34 million adult Americans smoke cigarettes, according to recent data, and some five million middle- and high-school students report having vaped nicotine and marijuana products. | About 34 million adult Americans smoke cigarettes, according to recent data, and some five million middle- and high-school students report having vaped nicotine and marijuana products. |
| A frightening outbreak of life-threatening lung illnesses tied to vaping last summer was eventually tied to vaping marijuana oils that contained the additive vitamin E acetate. But doctors say at least 15 percent of the patients reported having vaped only nicotine products. | A frightening outbreak of life-threatening lung illnesses tied to vaping last summer was eventually tied to vaping marijuana oils that contained the additive vitamin E acetate. But doctors say at least 15 percent of the patients reported having vaped only nicotine products. |
| Dr. Winickoff, a pediatrician, said that prudence about marijuana products was also advisable: “Inhaling combusted or vaped cannabis products can damage lung cells, may increase viral replication, and does affect the ability to fight off infection,” he said.“Clean air is what the lungs should be inhaling, especially during a global pandemic.” | Dr. Winickoff, a pediatrician, said that prudence about marijuana products was also advisable: “Inhaling combusted or vaped cannabis products can damage lung cells, may increase viral replication, and does affect the ability to fight off infection,” he said.“Clean air is what the lungs should be inhaling, especially during a global pandemic.” |
| Updated June 30, 2020 | |
| Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days. | |
| Scientists around the country have tried to identify everyday materials that do a good job of filtering microscopic particles. In recent tests, HEPA furnace filters scored high, as did vacuum cleaner bags, fabric similar to flannel pajamas and those of 600-count pillowcases. Other materials tested included layered coffee filters and scarves and bandannas. These scored lower, but still captured a small percentage of particles. | Scientists around the country have tried to identify everyday materials that do a good job of filtering microscopic particles. In recent tests, HEPA furnace filters scored high, as did vacuum cleaner bags, fabric similar to flannel pajamas and those of 600-count pillowcases. Other materials tested included layered coffee filters and scarves and bandannas. These scored lower, but still captured a small percentage of particles. |
| A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico. | A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico. |
| The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth. | The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth. |
| The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave. | The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave. |
| So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement. | So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement. |
| Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks. | Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks. |
| A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study. | A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study. |
| The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April. | The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April. |
| If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.) | If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.) |
| If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others. | If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others. |
| Last month, the New York State Academy of Family Physicians called for a ban on sales of tobacco and e-cigarettes in the state during the pandemic. Already smoke shops are being shut down in many states because they are not deemed to be “essential” businesses. But some public health officials note that other retailers that sell cigarettes and vaping devices, such as gas stations and grocery stores, are still permitted to do so. | Last month, the New York State Academy of Family Physicians called for a ban on sales of tobacco and e-cigarettes in the state during the pandemic. Already smoke shops are being shut down in many states because they are not deemed to be “essential” businesses. But some public health officials note that other retailers that sell cigarettes and vaping devices, such as gas stations and grocery stores, are still permitted to do so. |
| In defending such bans, public health experts say that behaviors associated with these products can provoke the spread of the virus. Wafting smoke and vapor may contain virus particles. Tobacco chewers tend to spit on the street. People often share e-cigarettes and cigarettes. And in using the products, consumers touch their faces frequently, increasing both their chances of becoming infected and then transmitting the virus. | In defending such bans, public health experts say that behaviors associated with these products can provoke the spread of the virus. Wafting smoke and vapor may contain virus particles. Tobacco chewers tend to spit on the street. People often share e-cigarettes and cigarettes. And in using the products, consumers touch their faces frequently, increasing both their chances of becoming infected and then transmitting the virus. |
| One pushback to such bans, similar to that echoed among decisions to categorize wine and spirits as “essential” and permit their sales, is that so many people are addicted to cigarettes and e-cigarettes that they would be immediately thrown into the miseries of withdrawal. | One pushback to such bans, similar to that echoed among decisions to categorize wine and spirits as “essential” and permit their sales, is that so many people are addicted to cigarettes and e-cigarettes that they would be immediately thrown into the miseries of withdrawal. |
| But Dr. Winickoff of Harvard noted that it is nicotine that people are addicted to, not cigarettes or e-cigarettes per se. | But Dr. Winickoff of Harvard noted that it is nicotine that people are addicted to, not cigarettes or e-cigarettes per se. |
| “Use the nicotine patch for a baseline level of nicotine and then add in nicotine gum or lozenge for breakthrough cravings,” he said. “That’s the best way to use those products. Combining them will quadruple your chances of success.” | “Use the nicotine patch for a baseline level of nicotine and then add in nicotine gum or lozenge for breakthrough cravings,” he said. “That’s the best way to use those products. Combining them will quadruple your chances of success.” |
| Dr. Alicia Casey, who directs the pulmonary vaping program at Boston Children’s Hospital, noted that one obstacle that had prevented her teenage patients from quitting was the omnipresence of the devices at school and parties. She had hoped that the enforced social distancing would help them quit. | Dr. Alicia Casey, who directs the pulmonary vaping program at Boston Children’s Hospital, noted that one obstacle that had prevented her teenage patients from quitting was the omnipresence of the devices at school and parties. She had hoped that the enforced social distancing would help them quit. |
| “But I do often see that they’re more anxious now, and they’re vaping more frequently,” she said. “If parents notice that happening, they should speak with their kids about the risks of Covid-19 and other pulmonary complications to vapers.” | “But I do often see that they’re more anxious now, and they’re vaping more frequently,” she said. “If parents notice that happening, they should speak with their kids about the risks of Covid-19 and other pulmonary complications to vapers.” |
| “I had a couple of teenagers this winter who had more trouble with influenza than they should have,” Dr. Casey continued. “Since Covid-19 can be similar to a severe influenza, I worry about those underlying lung issues from vaping.” | “I had a couple of teenagers this winter who had more trouble with influenza than they should have,” Dr. Casey continued. “Since Covid-19 can be similar to a severe influenza, I worry about those underlying lung issues from vaping.” |
| Sheila Kaplan contributed reporting. | Sheila Kaplan contributed reporting. |