If there were trading cards for public health concerns, a pandemic (global outbreak) would beat an epidemic (more of a regional thing).

That, apparently, is why Troy Helland, a respiratory therapist with the Essentia Health Park Rapids Clinic, is so careful to describe vaping as an epidemic, not a pandemic.

Early this year, vaping – inhaling a vapor produced by an electronic cigarette or such device – topped the health-related headlines as a related lung illness spread quickly throughout the country.

According to the CDC, as of Feb. 18, more than 2,800 people were hospitalized and 68 had died as a result of e-cigarette or vaping-associated lung injury (EVALI), with confirmed cases in all 50 states, the District of Columbia, Puerto Rico and the U.S. Virgin Islands and deaths in 29 states and the District.

Compare that to (as of Thursday) nearly 634,000 positive tests for the coronavirus and 28,280 deaths attributed to COVID-19 in the U.S. and its territories alone. It’s not difficult to understand why the vaping issue has gone into the shade.

“It really gets swept under the rug when something like COVID-19 comes around,” said Helland.

Nevertheless, it seems a history of vaping, smoking or other tobacco use could increase the risk of severe symptoms for a person who contracts COVID-19.

Helland admitted that it’s still too early in the epidemic (vaping) – to say nothing of the pandemic (COVID-19) – to make a scientific connection between the two.

“Ask me again in a year or two years, and I’m going to have some really good data for you,” he said. “But at this point, it’s a little premature right now to be making those kinds of connections.”

Currently on furlough from his clinic job but still working part-time at Essentia St. Mary’s Detroit Lakes Hospital, he hasn’t seen a surge in COVID-19 cases yet and hopes it doesn’t come. But if and when it does, he said, “I’d like to look at each of the patients who end up getting that diagnosis, to see, ‘Are you a smoker or a vaper?’ That would be very valuable information to have.”

Risky history

Laura Oliven, tobacco control manager with the Minnesota Department of Health, said the MDH recently published a review of evidence-based research showing that “people who smoke are at higher risk of getting lung infections and having more serious illness.”

Oliven explained, “The chemicals in cigarette smoke cause inflammation in the lung tissue and change the cells in a way that allows the lung illnesses like COVID-19 to take hold more easily. So, you’re at risk of an increase in severity of the lung infection and more severe complications, and it will impede your body and lungs’ ability to recover.”

In his experience working with patients having severe lung issues, such as pneumonia, Helland said he has found a “very strong correlation” to a history of smoking or tobacco use.

“I mean, you come across patient X and it’s like, ‘Are you a smoker?’ ‘Oh, no, I quit 10 years ago,’” he said. “It seems to me that there’s a disproportionate number of folks who end up sick like this, and they’ve got that smoking history – whether they’re a current smoker, current vaper, or somebody who used to do it.”

Helland reasoned that the negative impact of smoking could be a risk factor for severe complications of COVID-19 because the coronavirus “is very specific to the lungs. It destroys specific cells in the lungs and causes them to fill up with fluid. There’s a huge inflammatory response.”

Meantime, he said, “If you’re smoking or vaping, you’re kind of micro-injuring your lungs every time you do that, and you’re weakening your immune system, and a host of other issues.”

“The lung is not a resilient organ, so that when people smoke, it erodes the health of the lungs,” Oliven agreed.

“You’re really setting yourself up for a serious problem, if you’re smoking or vaping and you end up with COVID-19,” said Helland. “So, absolutely, let’s not let the smoking-vaping-tobacco issue completely fall by the wayside here. It’s still a huge problem.”

Oliven said more study is needed about how vaping, in particular, affects the risk of suffering severe complications from COVID-19. “Because vaping is a relatively new phenomenon, we have much less research and evidence on that,” she said.

Help quitting

Noting that vaping may increase inflammation in the lungs, and that the vapor contains toxins, Oliven said, “This probably is not a good time to be inhaling chemicals into your lungs. We want to encourage people to take all steps that they’re ready to take to improve their lung health and improve their overall body’s immunity.”

To help people quit, the MDH recently launched a statewide tobacco cessation program called Quit Partner that provides free counseling, coaching and medication.

“We just launched it two weeks ago and we already have 1,000 registration,” said Oliven. “There’s just enormous interest by people who want to promote their lung health.”

Resources can be found at quickpartnermn.com or 1-800-quit-now.

“You can access everything you need from your home, talk to free counselors,” she said, “and we will send you mail-order medications in the form of patches, gum and lozenges, to your door, so you never have to leave home to get help.”

Before his clinic job went on furlough, Helland said, he “had a little bit of a rush of folks trying to quit using tobacco, trying to quit vaping. They kind of saw this coming.”

Once things get back to normal, he said his plan is to “work with folks who know the risks – and this has kind of put the fear of God into them, so to speak. They’re going to be looking for help in trying to quit, and quit for good.”