An electronic nicotine delivery system (ENDS), also called an “e-cigarette” or “vape,” is a relatively new and rising trend. While science has clearly shown the dangers of tobacco cigarette smoke, we know little about the potential benefits or risks of e-cigarette use, particularly in this COVID-19 pandemic era.
Vape – COVID-19
“Vape” was Oxford’s Word of the Year in 2014. It rose in popularity as a way to distinguish a new activity, the use of e-cigarettes, from “smoking.” Vape originated as an abbreviation of vaporize. Oxford defines it as:
- Noun: An electronic cigarette
- Verb: To inhale and exhale the vapor produced by an electronic cigarette
ENDS devices are designed to emulate traditional tobacco cigarettes, so the user has a similar sensory, behavioral and social experience. An e-cigarette has three main parts: a rechargeable battery, an atomizer or vaporizing compartment, and the container which holds the “e-juice.” The ingredients and composition of this liquid are unregulated. In addition to nicotine, e-juice contains artificial flavor, flavoring carriers propylene glycol and vegetable glycerin which hold the nicotine and flavoring in suspension, and distilled water.
The e-cigarette was invented by a pharmacist in China whose father had died from lung cancer as a result of smoking. Hon Lik’s wanted to provide a safer, cleaner way for users to inhale nicotine as they sought to quit smoking altogether. His invention appeared in the US market in 2007.
A smoker uses a flame from a match or lighter to ignite dried tobacco leaves wrapped in paper. The smoker inhales the fumes through the mouth into the lungs, where the nicotine is absorbed into the bloodstream. To utilize an ENDS device, the user either presses a button or inhales from the device. The resulting airflow causes the vaporizing chamber to covert the liquid nicotine to a vapor, which the user inhales.
When exhaled, this vapor condenses, forming a visible fog. The tobacco in conventional cigarettes contains over 7,000 chemicals, many of which are toxic. While we do not know all the substances in e-juice formulations, researchers suggest that there are potentially fewer toxic compounds.
Adults who take up vaping are almost always already tobacco users. There are four main reasons they turn to e-cigarettes: to help with nicotine cravings; in the quest to find a less toxic alternative to tobacco; to avoid relapse to smoking actual cigarettes; and in the attempt to cut down or quit smoking altogether. These adults may indeed benefit from not consuming the toxic chemicals found in tobacco.
The other population of vape users is much more concerning – adolescents. In 2018, 20% of high school students reported using e-cigarettes in the past month, up from less than 15% the prior year. More high school students vape than smoke and the use of e-cigarettes is higher among secondary school students than adults. Dual-use of cigarettes and e-cigarettes is reported by more than 70% of high school cigarette smokers. E-cigarettes pose significant and avoidable risks to adolescents and young adults.
Areas of the brain that help make decisions and control impulses do not fully develop until after adolescence. This late development leads young people to take more risks with their health and safety, including exposing their developing brain to nicotine. These risks include a permanent reduction of impulse control, mood disorders, long-term addiction to nicotine, and changes to how synapses are formed, harming regions of the brain that govern learning and attention span.
The combination of recent high-tech design, a wide variety of appealing flavors like chocolate and candy, easy availability at retail and online, and their use by celebrities all make e-cigarette use highly desirable to youth and young adults.
While nicotine is the drug in legitimate e-juice formulations, black market e-juice can be infused with THC compounds from cannabis Sativa, which produce a high when ingested. Due to confusing state and federal legislation regarding the legality of marijuana use, much of the more easily acquired THC e-juice has additional contamination that produces serious side effects in addition to the known impacts of THC such as temporary psychosis and long-lasting mental disorders.
Before COVID-19 started to dominate our news feed, much of our news concerned about the impact of vaping on young people. We heard the term “EVALI,” which is an awkward acronym for “E-cigarette or Vaping Product-use Associated Lung Injury.” We saw images of ravaged teens in hospital beds using oxygen to survive. The CDC identified vitamin E acetate, a thickening agent often used in THC e-juice, as a chemical of concern among people with EVALI, since it was found in the lung fluid samples of all EVALI patients examined.
A 17-year-old high school athlete received the first double lung transplant, which was necessitated by his vaping. He was admitted to the hospital on Sep 5, 2019, and his rapidly declining condition put him on the transplant list Oct 8. Emergency room visits related to EVALI sharply increased through August 2019, peaked in September, and then began slowly declining as awareness of the vitamin E acetate connection grew.
With the COVID-19 pandemic taking over the daily news cycle early in 2020, vaping all but disappeared as an area of concern. The recent release of a study from Stanford Medicine is bringing e-cigarette use back to the forefront. There is a much higher risk of contracting COVID-19 among teens and young adults who vape versus their peers who do not. The research found that e-cigarette users are five to seven times more likely to be infected by the virus. Young people believe their age protects them from COVID, or that they will have only mild symptoms if they do contract it, but this is not true among those who vape.
Only time will tell how much impact vaping has on our overall health. On the surface, it seems safer than smoking tobacco. Scientific evidence indicates significant risk factors, especially for younger users, particularly when the coronavirus attacks their respiratory systems.