Despite fearmongering by anti-tobacco and vaping organizations, smokers and vapers are largely underrepresented among COVID-19 cases with data available on underlying conditions. Although scientists work fervently to determine why it is that smokers are less impacted by the coronavirus, it is important for policymakers pay close attention to the data, especially as local, state, and federal governments continue to regulate and eliminate adult access tobacco harm reduction products.

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In an April 3, 2020 Morbidity and Mortality Weekly Report, the Centers for Disease Control and Prevention (CDC) published data on 5,143 COVID-19 patients. Of these, only 96, or 1.3 percent, were classified as current smokers. Only 165 patients, or 2.3 percent, were classified as former smokers. Further, only 9.2 percent of patients were diagnosed with chronic lung disease, including “asthma, chronic obstructive pulmonary disease (COPD), and emphysema.”

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Unfortunately, the CDC is now omitting smoking status in recent reports, but chronic lung illnesses remain underrepresented. As of April 25, 2020, CDC reported 2,028 COVID-19 hospitalizations with data on underlying conditions. Of these, only 12.7 percent of adults had asthma, and only 20.9 percent of adults had been diagnosed with chronic lung disease. Conversely, over 57 percent of the hospitalized patients had been diagnosed with hypertension, and 50 percent of patients were classified as obese.

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The findings by the CDC are similar to state health departments.

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As of April 28, Georgia Health has identified underlying conditions in 182 of the state’s 241 deaths. Of the 182 patients with data, only 23 percent of patients were diagnosed with chronic lung disease.

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As of April 27, the Louisiana Department of Health has reported 1,950 COVID-19 deaths. Of these, only 3.62 percent of patients were diagnosed with asthma. Further, only 11.65 percent of patients had underlying pulmonary issues. Further, 55.28 percent and 34.35 percent of Louisiana’s deceased COVID-19 patients had been diagnosed with hypertension and diabetes, respectively.

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In Mississippi, smoking-related lung illnesses are largely underrepresented as well. In a racial breakdown of deceased COVID-19 patients in the state, as of May 1, 2020, 43 percent of African Americans and 42 percent of white patients were diagnosed with lung disease as an underlying condition. Hypertension, diabetes, and cardiovascular disease was noted in 87 percent, 88 percent, and 94 percent, respectively, of African American COVID-19 deaths. Among whites, hypertension, diabetes, and cardiovascular disease was reported in 66 percent, 37 percent, and 66 percent of deaths, respectively.

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Further, in states with smoking status listed, smokers are largely underrepresented.

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In the Oregon Health Authority’s (OHA) April 28, 2020 COVID-19 Weekly Report, as of “April 26, there have been 2,345 cases of COVID-19 reported to” OHA. There have been 94 COVID-19 deaths in Oregon and OHA was able to obtain comorbidity data for 73 of the deceased patients. Of the 73 deaths, only one was a current smoker, representing 1.4 percent of Oregon’s COVID-19 deaths with data available. 18 of the deceased patients were former smokers, or 24.7 percent of deceased patients.

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As of April 20, 2020, the West Virginia Department of Health and Human Resources (WVHHS) was providing information on smoking status in COVID-19 cases. In its April 20 report, WVHHS noted that only 8 percent and 14 percent of COVID-19 cases were current and former smokers, respectively. Further, only 7 percent of patients had been diagnosed with COPD. It should be noted that similar to the CDC, WVHHS is now omitting smoking status from their COVID-19 updates.

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Perhaps most intriguing is that researchers in other countries are looking into the effects of nicotine on COVID-19. On April 21, French researchers published a study examining the nicotine acetylcholine receptor and its “key role in the pathophysiology of Covid-19 infection.” The researchers hypothesize that “a substance in tobacco – possible nicotine – may be stopping patients from catching Covid-10.” In light of these findings, the French government limited sales of nicotine replacement therapy in pharmacies and halted online sales.

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Should nicotine provide some benefits in protecting against COVID-19, the findings will be significant and should be welcomed by proponents of tobacco harm reduction products. Since 2007, electronic cigarettes and vapor products have emerged as an effective smoking cessation tool that have helped millions of American adults quit smoking combustible cigarettes.

Despite alarmist campaigns, e-cigarettes are significantly less harmful than combustible cigarettes, as noted by numerous public health groups, including the Royal College of Physicians, Public Health England, the National Academies of Sciences, Engineering and Medicine. Indeed, the American Cancer Society noted in 2019 that the use of e-cigarettes “is likely to be significantly less harmful for adults than smoking cigarettes … because e-cigarettes do not contain or burn tobacco.”

Unfortunately, despite their reduced harm, numerous localities and states have attempted to eliminate adult access to e-cigarettes. In November, Massachusetts banned the sale of flavored e-cigarette products, which took effect immediately. A ban on sales of menthol cigarettes will go into effect June 1, 2020. In January, New Jersey banned the sale of flavored e-cigarettes which took effect on April 20, 2020. The ban includes menthol flavors in vapor products.

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In March, Rhode Island permanently banned the sale of flavored vapor products. This followed a temporary ban that had went in to effect in October of 2019. Finally, in April, New York banned the sale of flavors in vapor products except tobacco flavor. The ban goes into effect on May 18, 2020. Similar legislation has been introduced in other states.

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It is imperative that lawmakers refrain from restricting adult access to tobacco harm reduction products. Their use is significantly less harmful than combustible cigarettes and they have been effective in helping smokers quit combustible cigarettes.

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Further, it is overwhelmingly apparent that smokers, and by default, vapers, are largely underrepresented in COVID-19 cases. Although more data is need to fully understand the effects of smoking and nicotine on susceptibility to COVID-19 infections, preliminary data is promising and lawmakers should wait for a clearer picture prior to enacting draconian policies on tobacco and vapor products.

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Nothing in this analysis is intended to is intended to influence the passage of legislation, and it does not necessarily represent the views of Tobacco Harm Reduction 101. For more information on tobacco harm reduction products, please visit www.thr101.org.