Excerpted from CNN by John Maa

A college friend who is now a physician first introduced me to an electronic cigarette in 2008. He purchased his online from China with the hope of transitioning from smoking to vaping but found himself using both instead. A few years later, he shared a pleasant surprise — he had succeeded in quitting both vaping and smoking.

The breakthrough came one winter while he was recovering from a cold. As he reached for the e-cigarette, he realized the hazard of exposing his recovering lungs to a cloud of smoke. He gave his e-cigarette away, and never vaped or smoked again. His success story highlights the power of a second event to break the nicotine addiction. The current Covid-19 pandemic may serve as a similar warning call to smokers and vapers to stop promptly.

Over the past 10 months, three serial waves of severe acute respiratory illnesses have strained the American emergency care delivery system from 1) e-cigarette, or vaping product use associated lung injury (EVALI), 2) the influenza season, and 3) Covid-19. Around June 2019, US hospitals first noted a rise in respiratory illnesses linked to e-cigarettes. The US Centers for Disease Control and Prevention tracked this EVALI outbreak into early 2020, ultimately counting 2,807 hospitalized patients in all 50 US states, with 68 deaths as of February. Overlapping with the EVALI crisis has been the influenza season, which runs from October through May. So far, the CDC estimated there have been at least 39 million US cases of the flu, leading to 400,000 hospitalizations, and 24,000 deaths. The third stress has been the worldwide pandemic of Covid-19, totaling, at the time of writing, 337,933 cases in the US and 9,653 deaths.

Smoking has many negative effects on respiratory health, and the possibility of a relationship between smoking (both traditional cigarettes and marijuana) or vaping with Covid-19 were raised by early observations in China. One report, looking at 1,099 laboratory confirmed cases in China, revealed that 12.4% of smokers either died, required ICU admission or needed intubation, compared to 4.7% among never smokers. Another study found that among Chinese patients diagnosed with Covid-19 pneumonia, the odds of disease progression (including death) were an order of magnitude higher among smokers compared to non-smokers. The World Health Organization has noted that cigarette smokers are likely to have more serious illness if infected with Covid-19.
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