COVID-19 & Mentor

There are several reasons to be concerned. We know that cigarette smoking suppresses the immune system; smoking is also a risk factor for contracting respiratory (e.g., pneumonia) and other infectious diseases and for more serious outcomes among people who become infected. Smoking also causes heart and lung diseases. These effects could potentially put people who smoke cigarettes at a greater risk of contracting COVID-19, and those infections could be more severe. Indeed, recent meta-analysis covering more than 11,000 patients found that smoking is a risk factor for the progression of COVID-19, with smokers having higher odds of COVID-19 progression than never smokers.

We should also be concerned about the potential impact of vaping. E-cigarette use can expose the lungs to toxic chemicals. Animal studies have shown that exposure to e-cigarette vapors can disrupt the ability of the lungs to fend off a viral infection and that, compared to control animals, those exposed die at higher rates, but it is not yet clear if vaping increases the risk of human contracting the virus that causes COVID-19 and if the symptoms could be more severe. However, many e-cigarette users are current or former smokers. Vaping devices or e-cigarettes should never be used by youth, young adults, and pregnant women, or adults who do not currently use tobacco products.

A recent meta-analysis suggests that smokers are indeed at higher risk of COVID-19 progression than never smokers. More specifically, in this analysis, a total of 218 patients with a history of smoking (29.8%) experienced disease progression, compared with 17.6% of non-smoking patients.

Much remains to be learned about COVID-19, including how it affects people who smoke or vape, or who have substance use disorders. However, we do know that these individuals are more likely to have suppressed immune systems, are at greater risk for respiratory infections, and may have lung and heart diseases. This could present a greater risk for COVID-19 infection, or more serious cases of the disease. But there are many other ways in which the COVID-19 epidemic can hamper outreach efforts or worsen clinical outcomes in the addiction field.

For example, access to health care may be limited in some locations, placing people with addiction at greater risk for many illnesses. Also, SUD patients who are already in treatment are uniquely challenged by physical distancing measures. Self-quarantine and other public health measures may disrupt access to medications and other support services.

A high percentage of individuals with SUDs experience homelessness, and vice versa. Among countless other difficulties and risks faced by those who have housing instability, increased risk for disease transmission in homeless shelters is particularly important now. The same is true of incarceration. More than half of U.S. prisoners have SUDs, and prison populations are at great risk for disease transmission during this pandemic.

COVID-19 is of special concern for people who have opioid use disorders (OUD). Opioids negatively impact lung and heart health, so people who use opioids at high doses may be more susceptible to COVID-19, and the illness may be more severe. People who have OUDs also face separate challenges to their respiratory health. Opioids act in the brainstem to slow breathing, which not only puts the user at risk of life-threatening or fatal overdose, it may also cause a harmful decrease in oxygen in the blood (hypoxemia). While brain cells can function for short periods of low oxygen, longer periods with low or no oxygen can be especially damaging to the brain. Chronic respiratory disease can increase deadly overdose risk among people taking opioids, and diminished lung capacity from COVID-19 could similarly endanger this group.

A more general challenge has to do with the fact that people with SUDs already tend to be marginalized by health care services, largely because of stigma. Much of this stigma is based on the mistaken but continuing belief that addiction is the result of weak character and poor choices. But science has clearly shown it to be a disorder that results from changes in brain circuitry. It is important that all people with SUDs be treated with compassion and dignity.

The American Academy of Child and Adolescent Psychiatry site collates valuable and timely resources for parents interested in learning critical skills like how to talk to their kids about Coronavirus or how to help them cope while sheltering in place.