To ban or not to ban, that is the question over e-cigs during COVID-19 pandemic

Would it be appropriate to ban e-cigarettes for the duration of the COVID-19 pandemic? If you are Raja Krishnamoorthi, chairman of the US House of Representatives Subcommittee on Economic and Consumer Policy, you’ll answer that question with a heartfelt “Yes”.

Krishnamoorthi has written an open letter to Stephen Hahn, commissioner of the US Food and Drug Administration (FDA), repeating a call he made in April for a temporary e-cig prohibition. In the words of the Democrat representative: “The FDA declined to act, citing the need for more evidence that vaping is a risk factor for contracting coronavirus.”

He now offers what he believes is that evidence, in the form of what he calls “a seminal study” published this week in the Journal of Adolescent Health. That study, conducted by academics at California and Stanford universities, is based on a national online survey of young people aged 13-24 conducted in May.

It found that: “COVID-19 diagnosis was five times more likely among ever-users of e-cigarettes only, seven times more likely among ever dual-users [smokers who also vape], and 6.8 times more likely among past 30-day dual-users.”

While this all clearly sounds drastic to Krishnamoorthi, the researchers themselves are more circumspect in their conclusions as researchers are wont to be. They fall short of urging an outright ban, suggesting merely more education, more questions, and for the FDA “to effectively regulate e-cigarettes during the COVID-19 pandemic”. Whatever that may mean.


A bigger killer


Their conclusion that “e-cigarette use and dual use of e-cigarettes and cigarettes are significant underlying risk factors for COVID-19 that has previously not been shown” seems worth taking seriously. Together with Krishnamoorthi’s intervention, it has certainly led to a rash of headlines both sides of the Atlantic.

And it’s hard to argue with the recommendation that “youth-focused COVID-19 prevention messaging” should include reference to e-cig and dual use.

There do seem to be some questions about the reliability of the data used in the study. For instance, it has been pointed out that the given numbers imply that an implausibly high number of youngsters have been tested for COVID-19, suggesting perhaps that the terms of the survey were unclear or respondents were confused about whether they had been tested or not.

If the data is to be believed, it would suggest that dual use is a great deal more likely to lead to COVID-19 infection than either vaping or smoking alone. Which also seems implausible. It may be that dual users are more likely to be highly sociable and less likely to be rule-followers. Both of these things would make them more likely to contract COVID-19, but doesn’t mean that vaping, smoking or dual use caused it.

The whole study has an air of hearsay evidence about it. And there is another good reason to reject Krishnamoorthi’s argument for even a temporary e-cig ban. A reason that is apparently less glaringly obvious than it ought to be.

There can be little or no doubt that such a ban would lead to an increased uptake of smoking. And that is not only a risk factor for COVID-19 but in itself a bigger killer. Even in a country as badly infected as the US.

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