Can Vaping Increase Your Coronavirus Risk?

The possible health risks and consequences of vaping are well-known—but how might it affect your risk of COVID-19?

When the novel coronavirus (COVID-19) first began spreading in the U.S., there was a huge push to avoid contracting and transmitting the illness largely to protect older people and immunocompromised folks. Of course, it's still important to look out for these populations. But with time and more data, researchers are learning that even young, otherwise healthy people can experience serious cases of COVID-19.

In a recent report, researchers from the Centers for Disease Control and Prevention (CDC) analyzed a sample of roughly 2,500 reported COVID-19 cases between February 12 and March 16 and found that, among the approximate 500 people who required hospitalization, 20 percent were between 20 and 44 years old.

That was a wake-up call for younger Americans, but it also raised some questions. Considering that other coronaviruses and similar virus-related respiratory illnesses don't typically hit young adults that hard, why are so many young people being hospitalized for COVID-19? (

Obviously, there could be (and probably are) several factors at play here. But one question that's come up is this: Could vaping—a trend in young adults, in particular—increase the risk of coronavirus complications?

For now, it's just a theory that requires more investigation. Regardless, though, doctors are warning that vaping could indeed increase the risk of coronavirus complications. "Any medical condition that affects the lungs, like asthma or chronic obstructive pulmonary disease (COPD), can lead to worse outcomes with COVID-19, so it certainly seems that something that causes injury to the lungs like vaping can do the same," says Kathryn Melamed, M.D., a pulmonary and critical care physician at UCLA Health.

"Vaping can potentially cause some inflammatory changes in the lungs that, if infected with COVID-19 at the same time, the individual may have more trouble combating the infection or develop more severe illness when infected," adds Joanna Tsai, M.D., a pulmonologist at The Ohio State University Wexner Medical Center.

What happens to your lungs when you vape?

Research on vaping is relatively limited, given that it's still a somewhat new way of smoking. "We're still learning a lot about what vaping does to the lungs, similar to how it took decades to find the true consequences of using traditional cigarettes," explains Dr. Melamed.

As of now, the CDC takes a pretty broad stance on vaping. While the agency states that e-cigarettes aren't safe for teens, young adults, pregnant women, and adults who currently don't smoke, the CDC's stance is that "e-cigarettes have the potential to benefit adult smokers who are not pregnant" when they're used as a "complete substitute" for regular cigarettes and smoked tobacco products.

However, vaping has been linked to several health risks, including a serious lung condition called "e-cigarette, or vaping, product use-associated lung injury" (aka EVALI), particularly in people who vape liquid that contains vitamin E acetate and THC, the cannabis compound that gives you a high. EVALI, which was first identified in 2019, can cause symptoms like shortness of breath, fever and chills, cough, vomiting, diarrhea, headache, dizziness, rapid heart rate, and chest pain. Though the illness is still new (and therefore unpredictable), it's thought that a whopping 96 percent of people with EVALI require hospitalization, according to the American Lung Association (ALA).

Not all people who vape contract EVALI, though. In general, vaping causes inflammation in the lungs sparked by the aerosolized droplets that you breathe in, says Frank T. Leone, M.D., director of the University of Pennsylvania's Penn Stop Comprehensive Smoking Treatment Program. "The lungs are the body's first line of defense against inhaled threats, including viruses, and so it is packed with inflammatory cells ready to do battle," he explains. "The aerosol [from vaping] stimulates ongoing low-grade inflammation that has the potential to cause scarring damage to the lung in the long-term." (Another possible consequence of vaping: popcorn lung.)

Vaping can also cause inflammation to monocytes (white blood cells that help the immune system destroy invaders). That "could conceivably make it easier for infections to take hold," explains Dr. Leone. What's more, vaping can enhance the infection-causing capability of certain bacteria, potentially allowing for more severe bacterial pneumonia to take root after a viral infection, he says.

And how does COVID-19 affect your lungs, again?

In general, COVID-19 causes an inflammatory reaction in the lungs, says Robert Goldberg, M.D., a pulmonologist with Mission Hospital in Mission Viejo, California. In severe cases, that inflammation can lead to acute respiratory distress syndrome (ARDS), a condition in which fluid leaks into the lungs and deprives the body of oxygen, according to the ALA.

COVID-19 may also cause tiny, microscopic blood clots in the lungs, which can similarly make it hard to breathe, adds Dr. Leone. (

"In the face of these insults, the lungs have lots of trouble transferring oxygen to the blood the way they're supposed to," explains Dr. Leone.

So, what does the research say about vaping and COVID-19?

Important caveat: As of now, there are no data directly linking vaping to severe cases of coronavirus. However, the virus is still new, and researchers are learning about how it behaves and what behaviors can put you at a higher risk for severe complications from the virus.

That said, some early (read: preliminary and not peer-reviewed) data have found associations between cigarette smoking and more severe cases of COVID-19. One review of studies from China, published in the medical journal Tobacco Induced Diseases, found that COVID-19 patients who smoked were 1.4 times more likely to have severe symptoms of the virus and 2.4 times more likely to be admitted to an ICU, need a ventilator, and/or die compared to non-smokers. Another study published in The Lancet focused on 191 COVID-19 patients, also in China. Of those patients, 54 died, and of those who died, 9 percent were smokers, while 4 percent of those who survived smoked, according to the study's findings.

Again, this research looked at smoking cigarettes, not vaping. But it's possible that the findings could apply to vaping as well, says Dr. Melamed. "Inhalation of e-cigarette aerosol is similar enough to [cigarette smoking] in this context to warrant similar concern," notes Dr. Leone.

Some doctors are seeing a possible connection between vaping and more severe forms of COVID-19 in the field, too. "I recently had a 23-year-old patient who needed to be on a ventilator for more than two weeks—her only comorbidity was that she vaped," says Dr. Goldberg. (

Plus, the potentially harmful effects of vaping on the lungs are, in some ways, concerningly similar to the way COVID-19 attacks this part of the body, adds Dr. Leone. With vaping, ultra-fine particles in the aerosol move from air spaces in the lungs to the tiny blood vessels in the lungs, he explains. "It turns out, COVID-19 is being associated with tiny clots in the lungs, in exactly these blood vessels," he says. "I worry that the aerosol [from vaping] may predispose to clotting."

What's the medical community's stance on vaping right now?

In short: Please don't vape. "Regardless of whether we're in the midst of a global pandemic or not, I would advise everyone not to pick up the habit of vaping or to try quitting if they're already vaping," says Dr. Tsai. "A global pandemic that causes a respiratory illness like COVID-19 only makes me stress that message even more since it can potentially make it harder for the lungs to combat the infection."

"This was important prior to COVID-19," adds Dr. Goldberg. "But this becomes more critical during this global pandemic," he explains, recommending that people stop vaping "immediately."

Dr. Leone recognizes that quitting is not as easy as it sounds, though. "These stressful times put a person in a bind: They often feel a greater urgency to stop at the same time as they feel a continued need to use in order to control stress," he says. "It's possible to achieve both goals safely."

If you vape, Dr. Leone recommends checking in with your doctor to discuss possible strategies to quit. "Keep it simple and get it done," he says.

The information in this story is accurate as of press time. As updates about coronavirus COVID-19 continue to evolve, it’s possible that some information and recommendations in this story have changed since initial publication. We encourage you to check in regularly with resources such as the CDC, the WHO, and your local public health department for the most up-to-date data and recommendations.

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