Smokers,Ex-smokers, Vaping, and the current novel Coronavirus pandemic [2019-nCov,now formally named “Corona Virus Disease 19” (COVID-19) by the World Health Organization]

Are you wondering about your own situation as to the health risks of COVID-19?

If you are a current tobacco smoker, you may well have increased susceptibility to COVID-19 illness.

If you are a former tobacco smoker and you now vape nicotine regularly, you may well have increased susceptibility to COVID-19 illness.

If you have never smoked tobacco and you now vape nicotine regularly, stay tuned.

There are new scientific studies being reported in the past month that cite increased ACE2 (angiotensin-converting enzyme II) receptors in current tobacco smokers. Why is this finding important? COVID-19 gains entrance to the human body by attaching to ACE2 receptors in the mouth and respiratory tract. It has been reported that ACE2 is the main human host cell receptor of COVID-19 and plays a crucial role in the entry of virus into human cells to cause the final infection. [Nature Research: Xu, H., Zhong,L., Deng, J. et al. High expression of ACE2 receptor of 2019-nCoV on the epithelial cells of oral mucosa. Int J Oral Sci 12, 8(2020). https://doi.org/10.1038/s41368-020-0074-x]

Now, it is still to be determined how long ACE2 receptors stay increased after a person quits smoking tobacco, and whether vaping nicotine and/or marijuana have the same influence on ACE2 receptors.

It is important to note, though, that from the epidemic analysis in China thus far, something that really jumps out is the gender mortality rates, which are 70% male, 30% female. This disparity needs to be explained by something other than gender as viruses do not normally target one gender over another. The answer could lie in the fact that 48% of Chinese males are smokers (which is a huge percentage), whereas only 5% of Chinese women smoke.

In a recent retrospective study of over a thousand COVID-19 cases in China, the epidemic was found to spread rapidly by human-to-human transmission. Notably, normal lung radiologic findings were present among some patients with confirmed COVID-19 infection.The disease severity factors (including oxygen saturation, respiratory rate, blood leukocyte/lymphocyte count, and chest X-ray/CT manifestations) predicted poor clinical outcomes.

According to this same study, it would appear that nicotine may be the key agent in up regulating ACE2 expression, i.e., increasing ACE2 receptors [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6295500/]. So, e-cigarettes, patches, and other nicotine replacement products may be just as problematic as smoking in this regard.

What about nicotine vaping in Chinese never-tobacco-smokers and their possible increased COVID-19 illness susceptibility? This question remains to be answered but more studies should be forthcoming in the next few months.

BOTTOM LINE: Tobacco smokers and ex-tobacco smokers who vape nicotine &/or use other nicotine replacement products should remain highly vigilant for avoiding exposure to COVID-19 and seek early evaluation if they develop the common symptoms of COVID-19 when illness gets started: fever, fatigue, dry cough, myalgia, and dyspnea.

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