Taking chances

Vaping, smoking covid risk for kids

The week leading up to Halloween was a rough one for kids: 61,000 American children and teens were diagnosed with covid-19, at that point the most in any week since the pandemic began. And this was in the days before anyone did trick-ortreating.

In April, approximately 2% of covid-19 cases were children. That number is now slightly more than 11%. And the cases are probably undercounted since kids are more likely than adults to have mild or asymptomatic cases, which makes it less likely to be diagnosed and counted.

My wife and I don’t smoke, we have no tobacco products in the house, and I know very little about vaping, so recently my adolescent son had to educate me as to what the piece of vaping equipment was that he found in our yard. We also have three younger sons, and I have no doubt that from now until they all leave home, the temptations of cigarettes and vaping will be in front of them.

The medical literature is clear that there is great benefit in a health-care provider having conversations with even young children regarding the hazards of tobacco products and the many health risks that come from using them. A recent study in the Journal of Adolescent Health documented another one. The use of old-fashioned cigarettes alone or cigarettes and electronic cigarettes (e-cigarettes), socalled “dual use,” are significant risks for children to become infected with covid-19.

The association was striking. If a kid had ever used e-cigarettes, he or she was five times more likely to have a covid-19 diagnosis. If he or she had ever used both cigarettes and e-cigarettes, the likelihood of a covid-19 diagnosis was seven times greater. And if a child/teen was diagnosed with covid-19 and had been a dual user in the past 30 days, that child was almost five times more likely to be symptomatic. African American and Hispanic kids were more likely to experience these covid-19 symptoms.

There are several explanations for this association. Nicotine and the other chemicals in cigarette smoke are damaging to lungs, even young ones, and make it more likely those lungs can be infected with and impacted by covid-19.

Another explanation is straightforward: If you are putting something in your mouth repeatedly, you are more likely to transmit whatever germs are on your hands into your mouth. And third, teens are more likely to share cigarettes and e-cigarettes than adults. They pass them around, and whatever germs ride along get transferred also.

What do we do about it? This is not a doctor-only responsibility. While healthcare providers need to screen kids for cigarette and e-cigarette use, all adults, parents, teachers, youth leaders, coaches, and policymakers can help get the word out to children that smoking cigarettes and e-cigarettes increases the risk of catching covid-19.

Most kids have the physical resilience to get through a bout of covid-19. But some don’t, and some can have long-term residual symptoms. And I think every child will be sensitive to the risks to the adults they love of bringing a potentially deadly disease home.

Any discussion about the perils of tobacco and nicotine should include the significant risks of heart and lung disease and cancers. Incidentally, the journal Pediatrics recently published research showing that strict household rules, agreed on by all family members, stating that no one uses any kind of tobacco or nicotine product at the home, even Uncle Bob who just has to have a cigarette after Thanksgiving dinner, is more effective than parents telling kids that tobacco is bad and they shouldn’t use it.

Every parent is aware of the distorting influence of this pandemic on kids growing up. But we all do the best we can and look forward to the day when life for children seems more normal. Between now and normal, educating kids about the association between cigarettes, e-cigarettes, and covid-19 diagnosis and symptoms should be part of a kid’s education, whether from a parent, teacher, or doctor.