As the coronavirus continues to keep billions of people on lock down around the world, rumors are circulating on vaping websites and forums about how vaping might affect susceptibility to the virus.
Since most vapers are ex-smokers, does our past love affair with combustible cigarettes still put us at risk? Will vaping make us more susceptible to complications from the virus? Some have even put forth the theory that propylene glycol (PG) may be an effective defense against COVID-19.
Since coronavirus is dominating our lives these days, here at Kai's Virgin Vapor we decided to do a deep dive into the science in order to separate rumor, fact and fiction about coronavirus and vaping.
It's pretty easy to trace where this rumor started. The Mayor of New York City, Bill de Blasio, said as much during a press conference on Sunday, March 8th.
"People who smoke or vape are at higher risk. If you are a smoker or a vaper that does make you more vulnerable. If you are a smoker or a vaper this is a very good time to stop that habit and we will help you,” de Blasio told a roomful of reporters.
Is there any truth to this statement?
De Blasio's theory may have come from early reports out of China that more men than women were falling ill due to COVID-19 infection. Some people theorized that this could be due to the vast difference in smoking rates between the sexes in China. While nearly 50% of Chinese men smoke cigarettes, only about 2% of women do.
That's a reasonable enough theory, but is there any other support for it?
Looking at Italy, a country that has been hit especially hard by COVID-19, we find that even greater gender differences in coronavirus infection played out. Nearly 60% of coronavirus cases were diagnosed in men and men accounted for more than 70% of deaths according to Italy's National Health Institute. However, in Italy, the discrepancy between the sexes when it comes to smoking is far less pronounced than it is in China. In Italy, 26.0% of men and 17.2% of women smoke cigarettes, a fact which tends to lend less credence to the smoking-as-cause theory. If smoking were the cause of increased male susceptibility to the virus, you would expect to see a less pronounced difference in illness rates between the sexes in Italy since men there are only about 9% more likely to be smokers than women.
Moreover, data swings even further in the opposite direction in South Korea. There, only 39% of coronavirus cases were diagnosed in men versus 61% in women. The death rate was still slightly skewed in favor of women, however, with 54% of deaths in men versus 46% in women. When you compare this data to smoking rates, the potential correlation between smoking and coronavirus gets even weaker. As of 2011, 47.3% of South Korean men were smokers, versus only 6.8% of women. In fact, "South Korea has the highest male smoking rate of all countries in the Organization for Economic Cooperation and Development (OECD), but the lowest female smoking rate," noted another study. If smoking was the cause of greater male vulnerability in other countries, you'd expect to see that trend continue strongly in South Korea and that wasn't the case.
Global Health 50/50, a research institute that looks at gender differences when it comes to health on a global scale, undertook a study to see if they could determine why some countries were showing an increased risk to men from coronavirus infection. The study found "a mixed picture, with three countries reporting more cases among women, and nine finding more cases among men." However, the study did find that death rates were higher in men, with a difference as high as 50% in six countries. While 50% sounds scary, we are still talking about relatively small numbers in most countries: 3.1% of men versus 2% of women in France, for example, or 1.5% of men versus 0.8% of women in South Korea.
The study points out that there are many factors that could lead to these differences. Higher rates of smoking among men could be one explanation, but men also tend to have higher rates of heart disease, hypertension and other preexisting conditions that could put them at greater risk. However, it seems gender also really can play a role.
"The immune system differences between men and women are well-described, and are known to contribute to responses to infectious diseases," noted the study. This finding is supported by another study which looked at a different coronavirus, the SARS virus, and found that male mice were far more likely to die when infected. However, when the ovaries of female mice were removed, they suffered the same fate as the males.
Bottom line, demographic correlations are not strong enough to create a completely clear picture. However, it is just common sense that healthier lungs are always a good idea, especially when it comes to a virus that attacks this particular organ.
“If you’ve got a group of men who...have chronic lung disease as a result of the smoking, and then get exposed to corona infection, it seems as if they are more likely to suffer from severe corona infection, and be at risk of death,” said Sarah Hawkes, professor of global public health at University College of London and co-director of Global Health 50/50 which carried out the study. If you're interested, you can find an up to date chart showing current illness and death rates by gender on Global Health 50/50's website.
So far we have only looked at more general extrapolations based on population data. What about actual studies following smokers or vapers who contract coronavirus? The coronavirus outbreak is still a very new phenomenon so extensive scientific studies are not yet available. However, we were able to track down one study published in the Chinese Medical Journal on February 28, 2020.
The study followed 78 patients who were confirmed to have the coronavirus and whose symptoms had already progressed to COVID-19 induced pneumonia. The study followed up with the patients two weeks after admission to the hospital. The study found that the condition of 11 of the patients, or 14.1%, had deteriorated during that two weeks. Meanwhile, 67 patients, or 85.9%, had improved or stabilized.
Trying to zero in on risk factors for more severe coronavirus symptoms, the study then looked at the 11 patients who had continued to deteriorate in the hospital. It found that the average age for these patients was significantly higher (average age of 67 in deteriorating patients versus average age of 37 in patients who were improving or stabilizing). No surprise there since we know that older individuals are at significantly higher risk of developing serious symptoms from coronavirus infection.
However, they also found that those patients with a history of smoking were significantly more likely to deteriorate after hospital admission. Of the group that deteriorated, 27.3% were smokers or ex-smokers while only 3% of the group that improved were smokers.
"Several factors that led to the progression of COVID-19 pneumonia were identified, including age, history of smoking, maximum body temperature on admission, respiratory failure, albumin, C-reactive protein," the study concluded.
Dr. Konstantinos Farsalios, author of more than 70 studies and articles in international peer-reviewed scientific journals on the topics of smoking, tobacco harm reduction, and e-cigarettes, pointed out on his blog that, while, yes, the study found 14-fold higher odds of disease progression among smokers, there were only a total of 5 smokers included in the study of which 3 showed disease progression. That sample size is so small that it's impossible to draw any meaningful conclusions from it.
"The data are too weak to make any recommendation," Farsalinos said of the study. The study also didn't include any vapers so there is no scientific evidence to date that vaping can worsen coronavirus outcomes.
Farsalinos took issue with the fact that Mayor de Blasio was not basing his statements on scientific evidence, has zero background in public health and is well known, along with others, for his "dogmatic, biased political stance against tobacco harm reduction and e-cigarettes." Farsalinos noted that Mayor de Blasio had been part of the push to wrongly blame vaping for last year's so called "vaping illness" that was actually caused by tainted black market marijuana cartridges.
"None of these people has ever publicly apologized or publicly admitted their mistake which caused so much confusion that still Americans believe that e-cigarettes, not illicit marijuana oils, were responsible for the epidemic. None seems to care about the damage in public health caused by these past statements, with many vapers relapsing to smoking and smokers being discouraged from switching to e-cigarettes based on unprecedented misinformation that was propagated by politicians," Farsalinos wrote on his blog.
It seems that Mayor de Blasio is once again drawing anti-vaping conclusions without credible scientific backing for his statements.
Bottom line: there's no scientific evidence to date that vaping will make you more susceptible to the coronavirus or more likely to progress to COVID-19 induced pneumonia. However, there is some data to suggest that a history of smoking can be detrimental.
This rumor comes from an article in the Global Times published on March 2nd entitled, "Flu, vaping or novel coronavirus: experts suspect the US might have failed to identify causes of deaths."
The article quotes a couple of experts, all of whom are doctors or medical directors based in China. The individuals quoted suggest that the outbreak of the so-called "vaping illness" in the United States last year, which the CDC has definitively linked to adulterated black market marijuana cartridges, might in fact have been an early outbreak of coronavirus that went undiagnosed.
"Some experts have been doubting if the COVID-19 cases have been mixed among respiratory illnesses which have similar symptoms, including a mysterious e-cigarette-caused lung disease, in the US without being tested out," the article states.
But just who is publishing the Global Times? According to Wikipedia, the Global Times is "a daily tabloid newspaper under the auspices of the Chinese Communist Party's People's Daily newspaper, commenting on international issues from a nationalistic perspective." So perhaps the reporting is not completely objective.
In fact, this is not the first time individuals associated with the Chinese government have suggested that the United States might perhaps bear responsibility for the coronavirus outbreak. A foreign ministry spokesman even went so far as to suggest the U.S. army brought the coronavirus to Wuhan. It seems that the State Department has gotten so irritated by what it sees as a blatant "global disinformation campaign" that it has summoned the Chinese ambassador. It seems that he has some splainin' to do!
While it's understandable that China might feel a tad sensitive about being ground zero for the viral pandemic currently causing so much misery around the world, there's no excuse for piling onto the "blame vaping" bandwagon!
Bottom line: There's no evidence to suggest that the so-called vaping illness of last year was actually an early outbreak of corona virus.
Some people are claiming that PG is an anti-viral. If true, should we all start vaping PG to ward off the virus? Could vaping save the world from coronavirus?
This rumor appears to have originated when someone came across an old Army Medical Bulletin published by the U.S. Army Medical Department in January of 1949. The information is intriguing.
"Numerous chemicals have been employed as aerosols and vapors for the purpose of disinfecting air," noted the Bulletin. "Hypochlorites, propylene and triethylene glycol, lactic acid, alpha-hydroxy acids, resorcinols, and alkyl resorcinols all have been found to be highly germicidal when dispersed as vapors," the Bulletin stated.
Just how germicidal are we talking about? PG vapor as well as triethylene glycol (TEG) vapor were tested in a children's convalescent home over a three-year period. During the periods of time that the vapors were being released, only 13 children came down with bronchitis, ear aches, sore throats or the common cold. During the periods when no vapors were being released, 132 cases of illness were reported. Additionally, the study found that the bacterial count on an exposed plate was reduced five fold by the vapors.
While this sounds pretty impressive, the Bulletin leaves out a lot of pertinent information. We don't know the relative effectiveness of PG versus TEG, we obviously don't know if the germicidal properties extend to coronavirus and we are left to wonder about the medical ethics of dosing sick children with "vapors" for three years. Moreover, some of the other recommendations published in the Bulletin leave one feeling less than impressed with the knowledge, scientific rigor or discrimination of the authors.
Under the heading, "The Case Against 'Nutrition,'" the authors complain about the word "nutrition," griping that it "denotes 'suckling.'" They also object to the word "nutritionist" on the grounds that it "gives rise...to a vision of a woman in a white uniform concerned with diet trays and attractive food preparation rather than a scientist."
The authors then go on to propose replacing the word "nutrition" with the word "trophology." They note that the new word "has dignity, and is certainly not ponderous." Um, not to contradict the U.S. Army but it's difficult not to conclude that one of the reasons that nutritionists today are not referred to as "trophologists" is precisely because the word is ponderous. In addition, any food related name that contains the word "trough" does not seem particularly dignified.
That notwithstanding, the results regarding PG were intriguing enough to send us scouring the internet to see if we could find any further support for PG's anti-microbial abilities. A study in the Journal of Experimental Medicine, published in 1942, entitled "The Bactericidal Action of Propylene Glycol Vapor on Microorganisms Suspended in Air" confirmed the Bulletin's findings.
"It has been found that propylene glycol vapor dispersed into the air of an enclosed space produces a marked and rapid bactericidal effect on microorganisms introduced into such an atmosphere in droplet form," noted the study. The study even gave exact concentrations.
"Concentrations of 1 gm. of propylene glycol vapor in two to four million cc. of air produced immediate and complete sterilization of air into which pneumococci, streptococci, staphylococci, H. influenzae, and other microorganisms as well as influenza virus had been sprayed," the study concluded.
Impressive stuff. But what does 1 gram of PG vapor in four million cc's of air really mean? There are 28.5 grams of PG in a one ounce bottle so a gram of PG is about 1 milliliter. Four million cc's (or cubic centimeters) works out to a space a bit over 13 feet by 13 feet. So vaping 1 milliliter of PG in a small room would just about do the trick.
However, before you announce to the world that you have found the cure for the coronavirus, it's important to step back and realize two things. First, none of these studies is actually pitting PG against the novel coronavirus, so, even if PG does have some anti-microbial properties, it may or may not have any effect on coronavirus specifically.
Second, these studies are all looking at PG diffused into the air. If you locked yourself in a small room and vaped heavily, maybe all that vapor haze would have some effect on the germ count in the air in your closet. But if you were locked in a small room alone, you also wouldn't come into contact with the coronavirus in the first place. In the real world, coronavirus is transmitted via droplets, either in the air or on surfaces. Unless you found a way to surround yourself in a PG fog bank at all times, being a vaper really isn't going to do much for you when you're at the grocery store fighting Uncle Bob for the last roll of toilet paper west of the Mississippi.
Additionally, a more recent study published in 2015 and entitled "Exposure to Electronic Cigarettes Impairs Pulmonary Anti-Bacterial and Anti-Viral Defenses in a Mouse Model," suggests that vaping may actually reduce anti-viral defenses in the lungs. The study only looked at the effect on mice and research confirming the findings is still ongoing, however, this study demonstrates that vaping PG to ward off coronavirus is not only untested but it could even have detrimental effects.
Logic dictates that, even if PG has some germ fighting power, the best thing you can do to reduce your chances of contacting coronavirus is not to vape PG but instead to do what the Centers for Disease Control and Prevention (CDC) and others recommend:
"The best way to prevent illness is to avoid being exposed to this virus," says the CDC.
Bottom line: Although some of the studies on PG are intriguing, using PG aerosol to combat coronavirus is unproven and impractical. Follow common sense guidelines to reduce your exposure to the virus, such as those recommended by the CDC.
If you are looking for specific advice when it comes to vaping and the coronavirus, Dr. Farsalinos has specifically studied vaping and has made his recommendations for reducing risk from coronavirus if you are a smoker or a vaper publicly available. He offered the following recommendations to smokers, vapers and anyone else concerned about the effects of smoking and vaping on coronavirus infection rates and disease severity:
Honestly, this is excellent advice even when there's not a viral pandemic on the loose!
If you need hand sanitizer, we've repurposed a portion of our facility to produce USDA certified organic hand sanitizer. It is extra strength hospital grade and smells wonderful! We're shipping it to customers around the country and donating it to food banks, at risk children and other non-profits to try to help out with the shortage.
Stay safe and healthy!
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