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COVID-19 ISO Insights

Frequency and Severity: What Impacts Does Smoking Have on COVID-19?

April 20, 2020

By: David Geller, CPCU

Frequency and severity are two popular terms in the insurance universe. Below are multiple examples of how smoking—through both traditional cigarettes and e-cigarettes—may increase the frequency and severity of COVID-19.


Back in June 2019, an illness resulting from vaping was identified in the U.S. and eventually termed EVALI (e-cigarette, or vaping, product-use associated lung injury). To date, EVALI has contributed to over 2,800 hospitalizations across the United States.

While the number of these illnesses has reportedly slowed down in recent months, doctors and experts, per Healthline, are now contemplating how EVALI patients—and individuals who vape and/or smoke in general—may respond when inflicted with COVID-19.

For example, an associate professor of medicine in the Division of Pulmonary Critical Care and Sleep at the University of California San Diego, per Healthline, mentioned that the base chemicals in vaping aerosols (e.g. propylene glycol and glycerin) exposes the user to greater vulnerabilities of lung infection during influenza.

While the World Health Organization (WHO) notes that COVID-19 is not influenza, it does explain that there are similarities among the symptoms, including those related to the respiratory system. Given this, perhaps the increased exposure to lung problems that occur for those who vape and are inflicted with the flu applies to COVID-19 as well. According to the New York Times, this theory is substantiated by a study in which vape-exposed mice proved to be more susceptible to both viral and bacterial infections.

Additionally, a cardiologist at Catholic Medical Center in Manchester, NH, expressed trepidation to CBS Boston that a history of vaping in a patient could potentially interfere with a COVID-19 diagnosis:

“It also muddies the waters in terms of diagnosis, which is a real problem because when someone comes in with e-cigarette- or vaping-associated lung injury, the chest X-ray and the CT scan can look exactly the same as a COVID-19 infection… One you might treat with steroids. The other one you don’t want to treat with steroids. There’s different ways you treat these problems.”

Research reportedly continues to be undertaken that contemplates if COVID-19 will contribute to long-term lung damage among its patients as well. Could this lead to an increased risk among those who vape—or smoke—sustaining more severe lung injuries in the aftermath of COVID-19?

Ultimately, like much of the health landscape right now, it appears that there are more questions than answers relating to how vaping can potentially expose COVID-19 patients to more severe health issues. The associate professor at the University of San Diego California told Healthline that it is difficult to further dive into this potential relationship due, in part, to a lack of data. As of this posting, the ICD-10 codes that would indicate which COVID-19 patients have a history of vaping are not available.


The Times reports of the possibility that, in addition to smokers being more susceptible to the worst effects of COVID-19, they also may be more exposed to being inflicted with the illness itself:

The virus seems to attack the body by attaching to a binding receptor called angiotensin-converting enzyme-2, or ACE-2. Tobacco use may increase the expression of ACE-2. That is why doctors and researchers speculate that smokers may become infected with more copies of the virus than other patients.

Public health experts also reportedly believe that behaviors associated with smoking products may exacerbate the spread as well, due, in part, to the following reasons:

  • “Wafting smoke and vapor may contain virus particles.
  • Tobacco chewers tend to spit on the street. People often share e-cigarettes and cigarettes.
  • [I]n using the products, consumers touch their faces frequently, increasing both their chances of becoming infected and then transmitting the virus.”

Additionally, state officials, per the Times, are also conveying their concerns on vaping potentially leading to the spread of COVID-19. The article reports on an advisory released by the Massachusetts attorney general that, in part, warns that “[s]ocial sharing of smoking and vaping products can also facilitate the spread of the virus.”

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