Although it may have eclipsed our memories, COVID-19 is not the first disease outbreak that the Centers for Disease Control and Prevention has faced in the last three months.

It was as late as Feb. 25 — well after the first novel coronavirus case in the United States was reported — that CDC updated its numbers on what it called the EVALI (e-cigarette, or vaping-associated lung illness) outbreak. On that day, while COVID-19 was silently spreading throughout the country, CDC announced that this “e-cigarette”-related disease had caused 2,807 hospitalizations and claimed 68 lives. Little did we know at the time that these two events were profoundly connected.

Throughout its investigation of the first outbreak, CDC created public hysteria over the dangers of electronic cigarettes by attributing the outbreak to all vaping products, whether they contained nicotine or THC and whether they were purchased at a highly regulated vape shop or from a drug dealer on the street. The very name that CDC attached to the outbreak directly implicated electronic cigarettes, which are nicotine-delivery devices that are effective in helping adult smokers to quit smoking.

Following CDC’s lead, state health departments spread the word that using an e-cigarette to quit smoking could be life-threatening — so much so that seven states issued emergency bans on the sale of most or all electronic cigarettes.

What the CDC failed to tell the public until nearly the end of the outbreak, and what many state health departments have still not publicly revealed, is that the lung illness outbreak was not caused by electronic cigarettes at all. Instead, it was caused by THC-containing vaping cartridges that were laden with a viscous oil — vitamin E acetate oil — that had begun to be used as a thickening agent in many black market THC vaping products shortly before the outbreak started.

Experts in the cannabis industry had the cause of the outbreak pretty much figured out by Aug. 30 and had definitively figured out the cause by Sept. 11. David Downs — the California bureau chief of — was almost single-handedly responsible for getting wholesale THC vape cartridge manufacturers (both licit and illicit) to stop using vitamin E acetate oil as a thickening agent. This not only led to the “eradication” of EVALI, but it has proven that e-cigarettes were never involved since the outbreak has ended but e-cigarettes continue to be sold in high volume and without any changes in their ingredients or manufacturing process.

Nevertheless, as late as Dec. 11, the Massachusetts Department of Public Health was still warning the public that: “We don’t understand what is causing these illnesses. From a public health point of view, we cannot recommend that anybody use vaping or e-cigarette products at this time.”

The result of this scare-mongering about electronic cigarettes was predictable: e-cigarette sales plummeted and sales of tobacco cigarettes increased.

Sales data reported by PiperJaffray for the four weeks that ended Oct. 20 (when the Massachusetts emergency ban was in effect for 25 of the 28 days) and the four previous weeks (mostly before the ban went into effect) revealed that there was a substantial shift from vaping to smoking in the state. Nationally, there was very little difference in the rate of decline in cigarette sales between these two time periods from 2018 to 2019. The rate of decline decelerated by just 0.3 percentage points (from -7.8% to -7.5%). However, in Massachusetts, the rate of decline decelerated by a massive 5.7 percentage points (from -9.8 percent to -4.1 percent). This suggests that that many ex-smokers in Massachusetts who were reliant on e-cigarettes to stay smoke-free returned to smoking.

National data reported by Bloomberg News revealed the same pattern: the rate of decline in cigarette consumption slowed significantly because of the e-cigarette scare.

And the nation’s largest cigarette manufacturer — Altria — acknowledged in its 2019 annual report that: “Growth of the e-vapor product category and other innovative tobacco products has further contributed to reductions in cigarette consumption levels and cigarette industry sales volume and has adversely affected the growth rates of other tobacco products. Continued growth in these categories could have a material adverse impact on the business, results of operations, cash flows or financial position of Altria and its tobacco subsidiaries.”

What does this have to do with COVID-19?

It means that due to the zeal of CDC and other health agencies to condemn electronic cigarettes, cigarette smoking in the United States got a significant boost just before one of the most devastating respiratory disease outbreaks in our nation’s history. And there is strong evidence that smoking makes COVID-19 significantly worse.

Thus, the e-cigarette scare significantly worsened the health consequences of COVID-19, potentially resulting in more deaths than would have occurred if the CDC and state health agencies had simply told us the truth.

Dr. Michael Siegel –

is a professor in the Department of Community Health Sciences, Boston University School of Public Health,

where he has conducted research on tobacco for 25 years. He wrote this for

This op-ed appears today at:


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