Dr. Mark Tyndall MD ScD FRCPC
Infectious Diseases and Public Health Physician, Expert Advisor on Harm Reduction to VITA
The world has changed in a very short period of time with the arrival of COVID-19. As leading public health experts and organizations focus on the containment and ultimate elimination of the virus, the need for accurate and timely information to guide the public response is critical. To date, the public health messaging has focused on preventing transmission through travel bans, stay-at-home recommendations, business closures, physical distancing, and hand washing. In Canada, the public has largely lined up behind this messaging and there has been a “flattening of the curve” for new infections.
We continue to learn more about the clinical manifestations of the virus. While there are still many unanswered questions, age over 60, underlying illness, obesity and compromised lung function have all been associated with more serious outcomes including prolonged ICU stays and death. As we wait for antiviral treatments and ultimately a vaccine against COVID-19, clinicians are doing everything possible to ease the severity of illness and reduce the death rate. One of the few clinical interventions available would be to reduce or stop exposure to cigarette smoking before a COVID-19 infection. Public health officials have included this messaging in the overall COVID-19 response and from what we know about every other respiratory infection, this is excellent advice.
Unfortunately, the message around smoking cessation and the COVID-19 response has often included vaping. Without substantiating evidence, some public health officials have advised the public not to vape. Despite showing no evidence that vaping is associated with either becoming infected with COVID-19 or associated with worse clinical outcomes. The FDA recently altered its stance on the relationship between vaping products and Covid-19, saying that “E-cigarette use can expose the lungs to toxic chemicals, but whether those exposures increase the risk of Covid-19 is not known”. This unproven association has been picked up by multiple media sources and has compounded a false narrative that there really isn’t much to be gained by quitting smoking if you are going to vape. This is extremely misleading as even in the short-term, lung function improves when people transition to vaping. During a time when the threat of acquiring a serious lung infection is very real, adult smokers should be encouraged to seek out a less harmful alternative to smoking cigarettes. Messaging to the contrary goes directly against harm reduction, and the fact that vaping is a much less harmful source of nicotine.
A message of abstinence will not be successful, even during a global pandemic. In fact, people addicted to nicotine are likely to increase their use during times of stress and isolation. Opportunities to smoke have also opened up, as many smoking restrictions are no longer in play as people are staying away from work and public spaces. Vaping has also been impacted by mandatory store closures. While alcohol and cannabis stores were included in the essential services category across the country, only Alberta included vape shops. This has greatly limited access to vaping products. While it is too early to determine just how many people have returned to smoking cigarettes because of access issues, it has been damaging to people who vape as well as public health in general. Certainly, the lack of access has created a situation where very few smokers are able to transition to vaping.
In a time when we have so few tools to manage the clinical course of COVID-19 infection, reducing exposure to cigarettes at a population level should be a priority. Vaping is the most successful tool that we currently have to get people away from smoking cigarettes. This global pandemic has made smoking cessation more urgent now than ever before.
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