School of Public Health

HSC researcher explains why vapers may be at higher risk for COVID-19

By Sally Crocker

Vaping

Vapers beware, as if the health threats of COVID-19 aren’t enough, there is new evidence linking vaping to a higher risk of getting coronavirus.

The risk has been shown to be 5-7 times higher, according to new scientific research, prompting lawmakers around the country to urge the FDA to temporarily clear the market of all e-cigarettes during the COVID pandemic.

This increased health threat is especially troubling for teens and young adults, considering that the CDC reports nearly one-third of all American high school students used e-cigarettes in 2019.

Why is COVID more dangerous for those who vape?

“There are a number of reasons why vaping leaves users more susceptible,” said HSC faculty researcher Dr. Tracey Barnett, Associate Dean for Academic Affairs at the HSC School of Public Health. Dr. Barnett focuses her work and community outreach on this important public health concern.

“Vaping has been shown to irritate the lungs, leaving users more vulnerable to illness, including flu, asthma and pneumonia. Inhaling e-cigarette products also requires deeper breathing and taking in more air,” Dr. Barnett said. “This is not the scenario you want during the COVID pandemic.”

“Young people are more apt to share e-cigarettes in close social settings, while hanging out, which doesn’t lend itself well to social distancing. Vaping also involves a lot of touching to the face and mouth, which could increase the possibility for infection. Overall, it’s a dangerous situation for spread of the virus.”

Vaping has been associated with lung inflammation, as has COVID-19. Both lead to irritation of the lungs’ protective lining.

“Both of those conditions together do a real number on the lungs, producing a double whammy effect,” Dr. Barnett said.

A recently published study in the Journal of Adolescent Health looked at more than 4,300 survey participants of ages 13-24 from all 50 states, who either had or had not used e-cigarettes in the previous month. The study took into account respondents’ self-reported compliance with shelter-in-place orders and the rates of COVID-19 in their states, as well as age, sex, race/ethnicity, body mass index and socioeconomic status. The researchers noted that sheltering in place may mean different things to different people, and that young adults responding to the survey may have considered sharing a smoke with friends in the backyard to be safe.

Overall, the research found that e-cigarette users were almost 5 times more likely to have had COVID-19 symptoms, testing and a positive diagnosis.

Dual users of both traditional and e-cigarettes were 6.8 times more likely to be diagnosed with COVID. Both smoking and vaping are known to damage the lungs and impact the immune system.

“This is a significant finding, in that adolescents and young adults are more apt to be dual users of both types of cigarettes,” Dr. Barnett said, “putting them at an even higher risk for COVID-19. It’s not a small risk, it’s an important one.”

“Young people who see vaping as the cool thing to do may not fully comprehend the health risks,” Dr. Barnett said. “They also might feel invincible because of their age, or ignore the public health warnings about COVID. Put these two factors together, and the combination presents a real recipe for concern.”

According to the Partnership to End Addiction, teens and young adults say they vape for a variety of reasons, including curiosity, peer pressure, appealing flavors and because they have seen others do it. Some also say they do it because they feel it is less harmful than other tobacco products and it’s also discreet.

It is now widely recognized that vaping is unhealthy and dangerous, with adverse health effects including coughing, wheezing, inflammation and potential severe lung injury. The lungs have to work harder, placing more stress on the body’s other organs.

Nearly all vapes contain nicotine, one of the most addictive substances, and in many cases as much as or more than in traditional cigarettes. Nicotine negatively impacts the cardiovascular system and respiratory/lung functioning.

Vape flavoring ingredients can also be harmful – many have been determined to contain cancer-causing and other toxic chemicals, heavy metals and tiny particles that go deep into the lungs, damaging lungs and cells and reducing the ability to fight off infections.

“A weakened immune system or damage to the lungs from vaping could produce a more serious case of COVID-19, with the body unable to keep up,” Dr. Barnett said.

This new research presents a wakeup call and a warning to young people, Dr. Barnett said, as well as parents and health providers, who can be instrumental in talking to kids about their health, especially during the pandemic.

“Far too many young people have suffered the effects of vaping, and now with the added threat of COVID-19 in communities across the country, it’s important to protect ourselves and stay as healthy as we can,” she said. “I hope this message resonates with young people and their families.”

Vaping
School of Public Health

COVID-19 adds double threat to U.S. drug crisis

By Sally Crocker

Emergency

 

The last two years had brought small but significant victories to the nation’s opioid crisis, with slow, steady declines in opioid use and deaths marking a positive change to this major public health problem.

That was until the COVID-19 pandemic hit, bringing months of an uncertain and unsettling new normal to people around the world.

As the pandemic continues to stretch on with no clear end in sight, the U.S. rates of anxiety, depression and drug use are all on the upswing.

“Tighter drug monitoring, recovery programs and medical treatments were all making a difference,” said HSC Regents Professor Scott Walters, PhD, who serves as Steering Committee Chair for the HEALing Communities Study, an aggressive, National Institutes of Health (NIH) trans-agency effort to speed scientific solutions to the national opioid public health crisis.

Other factors had also been helping.

Many states began to make naloxone, a rapid-acting overdose antidote, accessible to the public through pharmacies or by mail without the need for a prescription. Some states also began distributing this lifesaving medication to people at risk for overdose, such as those being discharged from jail or prison.

“These changes have greatly helped people who are trying to quit, or to stay clean, achieve more successful outcomes,” Dr. Walters said.

But now, there is worry that these gains are being lost due to the anxieties, stresses and negative mental health consequences of COVID-19.

In an August 2020 report, the CDC estimated that as many as 40% of U.S. adults have struggled with mental health or substance use during the pandemic. The study, which looked at a one-week sample period in June, found that 31% of participants had suffered with anxiety and symptoms of depression; 26% had trauma or stress-related symptoms; 11% had seriously considered suicide; and 13% had started or increased substance use.

“The pandemic has really complicated our efforts to address these problems,” Dr. Walters said.

In July, the New York Times reported that drug deaths for 2020 had risen an average of 13% over last year, with warnings that, “If this trend continues for the rest of the year, it will be the sharpest increase in annual drug deaths since 2016, when a class of synthetic opioids known as fentanyls first made significant inroads in the country’s illicit drug supply.”

“Supply and demand in the illicit drug industry was impacted early on by COVID-19,” Dr. Walters said. “Some states initially experienced decreases in drug use because supply chains were pinched – chemicals were harder to get, shipping was slowed, and people couldn’t produce or deliver the product – in this case, illegal drugs.”

“But then it came back with a vengeance. Homegrown, locally-manufactured drug supply took over.”

With drugs like fentanyl, where even the slightest changes in chemical compounds or dosing can mean the difference between intoxication and death, the results can be tragic.

Users who are unable to get illicit drugs because of supply chain slowdown, Dr. Walters noted, will also have lower tolerance when reintroduced to drugs, which could put them at serious risk for overdose, even if they are using their usual amount.

Treatment services and recovery groups have also suffered disruptions during pandemic closings and social distancing, leaving users in a perilous place for support.

“Most of these services are online now,” Dr. Walters said. “It’s more challenging to connect with a provider, especially for treatment programs requiring an initial in-person assessment or follow up, as with methadone programs. Many of the usual safety networks are operating differently now.”

“Other likely contributors to the increase are people having more time on their hands without much to do, social isolation, substances being used to cope with the anxieties of COVID life, employment concerns, loneliness, fear, personal or family issues,” he added.

With Texas overdose rates mirroring other states around the U.S., at about 18% higher for the first six months of 2020 compared to 2019, the big question is, where do we go from here?

“Federal guidance waiving in-person requirements for drug disorder visits will continue to be important, as will the programs that have already started to support at-risk populations,” Dr. Walters said.

“Most people who start using opiates get them from someone’s medicine cabinet, so securing prescription medicines at home, using socially-distanced drop off programs in your community to get rid of old medications, or even flushing medicines on the FDA’s approved list might make the difference in saving a life,” he said.

When community take-back options are not available or impacted by a crisis like COVID-19, the U.S. Food and Drug Administration offers a listing of specific drugs that may be flushed, including fentanyl and oxycodone.

Community programs like HSC’s new partnership with Deterra pouches by Verde are also helping to distribute tools that destroy drugs when warm water is added to bags containing deactivating pods.

“Responding to this public health threat is even more critical right now,” Dr. Walters emphasized, “as communities struggle with the realities of COVID-19’s impact on mental stress and substance use. The actions we take now will affect today’s outlook as well as tomorrow’s.”

Emergency
School of Public Health

Sally Crocker named PR Daily’s Nonprofit Communications Professional of the Year

Npawards 300x250 WinnerSally Crocker, Communications Manager for the HSC School of Public Health, has been recognized with the Grand Prize: Nonprofit Communications Professional of the Year Award in PR Daily’s 2020 Nonprofit PR Awards, for her work this year during the COVID-19 pandemic.

“Sally Crocker was among the many faculty and staff at the University of North Texas Health Science Center who began working from home on March 13, 2020, as the coronavirus began its devastating path across the U.S.,” Ragan Communications reported. “Sally set out to reinforce key messages (including the fact that science is important).”

To achieve those goals, Ragan said, she researched COVID-related topics and developed a list of articles and website content ideas that could provide helpful information to the public.

“She conducted countless interviews and assembled visuals to accompany articles and help promote them on social channels, resulting in ongoing press pitch opportunities and news coverage for the University,” the judges noted.

Crocker HeadshotBetween March 18 and April 24, Crocker produced and published 10 School of Public Health articles on the pandemic, two Dean’s e-newsletters, and shared content with HSC News Team colleagues and community partners for extended communications outreach.

Article topics were intended to help the public understand the pandemic, offer expert advice from faculty researchers on staying safe and emotionally well in a challenging time, reflect on history and science, address important public health concerns and perspectives, separate COVID facts from fiction and share real stories involving HSC’s commitment to the community.

“We congratulate Sally on her remarkable achievements,” wrote Brendan Gannon, Marketing Manager of Awards Programs for Ragan Communications and PR Daily. “Well-deserved recognition!”

Npawards 300x250 Winner
School of Public Health

COVID contact tracing uncovers the stories behind the numbers

By Sally Crocker

Sujita AdhikariBehind the numbers of COVID-19 are real people. Real stories. Real experiences.

In her final term as an HSC School of Public Health student, Sujita Adhikari joined Tarrant County Public Health’s (TCPH) contact tracing team, calling quarantined, COVID-positive patients to track their connections to other community members who may also have been exposed to the virus.

This major community health effort was quickly set up in March as the pandemic spread across U.S. cities and states.

Adhikari was one of the HSC students involved in the COVID response collaboration between the University and the public health department.

“Our HSC students were ready to step up and respond to the call when needed,” said Dr. Dennis Thombs, SPH Dean. “They were able to put their public health training to work in a very real way, serving the community at a time of crisis. For many of these students who joined the effort, the work still continues.”

Adhikari said that even with a full schedule finishing up for graduation – toward her MPH in Maternal and Child Health, leading to a Program Manager position with HSC’s INCEDO office of continuing education – it was “really important to get involved” in the community’s COVID contract tracing efforts.

During April and May, she called approximately 60 COVID-positive patients, both asking and answering questions, listening to their experiences, sometimes working with a translator to gather needed details.

She rejoiced with those who were recovering and feeling very thankful.

She offered support and resources to those who felt concerned and afraid.

And she was there for patients who were lonely, sad, not doing so well – and for those who were missing their families, those who had no families, individuals out of work, and the people who were unsure if they would have a home to go to when they left the hospital.

“Some days were emotionally exhausting,” Adhikari said. “Our supervisors encouraged us to take breaks in between calls to clear our minds and just breathe, maybe go outside for a few minutes to process it all and put our work into perspective.”

“I talked to people who trusted me so much. I couldn’t stop thinking about those conversations at the end of the day.”

Others didn’t want to talk or disclose their personal health information. Some couldn’t recall their experiences, how they might have contracted the virus, or others they may have come in contact with.

“It was very challenging to create a connection within a few short minutes. You have to develop a rapport right away. Some people were open to that, while others were more guarded, or even angry about the overall circumstances of the pandemic,” Adhikari said.

Contact tracers also risked calling people who were resting and didn’t want to be disturbed, or those who were having a really bad day.

Contact tracing isn’t an easy process. It takes time, and investigators like Adhikari are only the first step that leads to other team efforts like reporting and monitoring, infection control and those who follow up with close contacts of infected patients.

Investigators like Adhikari asked questions about where people worked, if they had traveled recently, large gatherings they might have attended, people they may have come in contact with, their signs and symptoms, risk factors and underlying conditions, and if they suspected where they might have been exposed to COVID.

They gave advice on protocols, whether retesting would be required, when quarantine could end and when patients could feel safe being around others. If someone needed a thermometer, it was arranged.

“People had so many questions and weren’t sure where to reach out,” Adhikari said. “We were all learning and navigating the situation as we lived through it.”

Working as a contact tracer has its own personal challenges too. The nature of the job calls for employees to be at the public health department. Social distancing was well enforced, with computers stationed six feet apart and masks required.  Temperatures were taken daily, and student shifts were designed to accommodate classes, job interviews for positions after graduation, and other obligations.

For Adhikari, the opportunity to serve the community at such an important time was “a privilege.”

She moved to the U.S. from Nepal after completing her pharmacy degree and working in the field. She was led to HSC because of her interest in maternal and child health and her desire to work closely with the community and impact public health on a broad scale.

“Being able to help North Texas during the COVID-19 pandemic was an important experience for me. I feel as though I was really able to help others and be a part of finding solutions,” she said.

“It felt really good to feel trusted by so many patients who are relying on us during this very challenging time.”

Sujita Adhikari