Opinion: COVID-19 and the Case for Putting Others Before Your Own Personal Liberties

Disclaimer: I am not an infectious disease expert. If any infectious disease experts have new information, especially if I’m hella wrong, LET ME KNOW so I can put it in here! Also, this post is labeled as an opinion piece, as a heads up.

I don’t know if you know this or not, but there is a BIG BAD outside right now, and sometimes inside, and maybe on our mail or produce. The details are still kinda fuzzy as researchers and health professionals patchwork together more and more information about what this BIG BAD does and how to protect ourselves and others from it.

The BIG BAD, of course, is COVID-19, also known as Coronavirus, SARS-CoV-2, and (what my friends and I jokingly call it to make it sound less bad so that we don’t have panic attacks) The ‘Rona. But Mari, you ask, What is all this about putting others before our own personal liberties? Good question, my good reader! Today I want to try to convince you that we should be social distancing and wearing masks. And we should be doing this not for ourselves (which is tied to personal liberties) but for other people.

Please don’t click out of this page just yet. I know it’s really controversial right now among different circles, but give me a chance, yeah? 

Thanks.

Why DON’T people want to social distance and wear masks?

Before we go any further, we should talk about why people are against participating in these public health measures. We gotta make connections and understand each other before we can have any real conversations, right? The big reasons I’m going to outline are just from personal experience (either my own feelings/thoughts or those of friends and acquaintances on the internets), so this is in no way a comprehensive list.

Social Distancing

Social distancing is the practice of physically distancing yourself from other people. The guidelines have changed quite a lot, from “no more than 10 people in a room” to “at least 6 feet apart” and now we are learning that it’s maybe more like 10 feet apart and also if you’re running or biking you should NOT be behind other people by 15-20 feet because you’ll run/bike through their germs.

This brings me to our first reason people aren’t super into it: because the rules keep changing, which means that not only are people unable to keep up, but constant change makes it feel, to many, that the experts don’t actually know what they’re talking about. As a scientist I feel that I should say that the reason it’s changing is because we are learning more and more, such that newer information is better information, but I totally get how the constantly changing guidelines would lead to uncertainty.

Another, more personal reason (in that I have personally felt this but also I know people who are feeling this even more) is the loneliness that comes with not seeing your family and friends for months on end and feeling trapped in your home. Y’all, it’s just really hard. I’m an extrovert and all my friends are moving away after finishing their dissertations (some have already left) and I don’t get to say goodbye and hug them before they leave. I have a few friends who have had the social isolation lead to worsening their depression/anxiety symptoms. Being alone is REALLY HARD and hanging out online is just not the same. This is even harder if you have kids. How do you tell them that they can’t play with friends or see grandma (not to mention being stuck with them all day every day if you’re not used to it).

So the rules are confusing and it’s bad for our mental health. Those reasons make a lot of sense, right?

Masks

The rules on masks are similarly confusing. Some places are requiring them, others are saying they’re not necessary. Which type of masks work? Who do they work for? Do they mean I can be closer than 6ft to people? Same as with social distancing, no one really knows whether they work or under which circumstances they work.

Also? Masks are hella uncomfortable. You can’t touch them and you can’t eat/drink in them and you just breath in your own breath and realize you should have taken a mint earlier (but now it’s too late) and suddenly your nose itches.

They’re also very difficult to get right now. The N-95 masks which are the best masks for this sort of thing are sold out to the point that hospitals can’t get them. So you keep hearing about not buying those. But those are the only ones that do anything to protect you. But you can’t get them anyway. So people are using other paper masks or sewn fabric masks. Which don’t protect the wearer much (but, as we will discuss a bit later, protects those around you more).

So, again, confusing rules, plus physical discomfort and difficulty in obtaining good-enough protection. Checks out.

Personal Liberties

Let’s go into the personal liberties aspect of all of this. The gist of it is that people are saying they do not need to wear masks or socially distance because it is their body and therefore their choice whether they put themselves at risk to get this virus. The idea is that if they don’t wear a mask or socially distance themselves, they are taking their own risk and if others want to wear a mask or stay home then they totally can.

There is also a lot of discomfort in the “forced” aspect of social distancing and wearing masks, where people worry that the government will take away more and more liberties until we live in an Orwellian dystopia. That one is…outside the scope of this blog post.

Why should you still do these things?

So here’s where I try to convince you (if you’re not sure about these things) that it’s still worth it to take these precautions. Again, not for yourself, but for those around you. And in turn those around you should be doing these things for you.

Before that, though, I want to remind you that I am not personally an infectious disease expert. I study public health policy on tobacco, which is very different. I have been reading things written by infectious disease experts and have a few friends in this field who I am constantly asking questions of, but if they tell you something else here, do that. And I’ll also edit this for that purpose because I believe in updating information based on new knowledge.

Okay. Here we go.

Let’s start with the underlying assumption that through going out and not wearing masks, you are only putting yourself at risk. This would make sense, if the disease were less contagious and if only people showing symptoms were contagious.

The problem is that this is a very contagious disease, that you can get by breathing in someone’s breath, or touching your face after touching a surface that someone else sneezed on (or they sneezed on their hand and put it on the surface, even). So it’s super easy to transmit. But the scariest part is that it is super easy to transmit even without the symptoms.

Hypothetical story time: If I do not have any symptoms or have very light symptoms but have COVID, and I go on a run and someone is running behind me and they breathe in enough of my COVID-y particles, then they might get COVID and they may not be as lucky as I am with my no-symptoms. If we had been farther apart, they may not have been exposed.

This is my new favorite way to think about masks.

Hypothetical story time 2: Electric Boogaloo: If I do not have symptoms or have very light symptoms but have COVID, and I go to the grocery store and I see a friend there and we chat in the aisle (let’s say I’m not wearing a mask but they are). Their mask doesn’t give them much protection against me because I don’t have a mask on (again, one of the reasons people aren’t super into the idea of wearing masks), meaning they might catch my COVID and who knows if they’ll have worse symptoms. If we both wore masks, then the chances of contagion decrease.

So I talk about chances a lot. That’s because there is not going to be a PERFECT way to not get this unless you hide away until it’s eradicated and have a year’s worth of groceries already stockpiled or something. But any way to lower to chances that someone gets sick should be worth it, right? This means that using these measures is less about us and more about the people around us. This is a test in empathy, and in taking responsibility for the health of others.

In conclusion

Please do the things that infectious disease experts are telling us to do because they protect us and the people around us to some degree, and some degree is better than no degree if it means saving lives.

I know this one wasn’t nearly as science-y as usual. I’m honestly also being affected by this whole thing (my motivation/focus has plummeted) and I’m in the middle of my dissertation writing. I promise more science will come.

 

Here’s my dog, who is very happy that I am working from home.

What the heck is in e-cigarette liquid?

Electronic cigarettes. E-cigarettes. E-cigs. Vapes. Vape-pens. Tank systems. Even though they only officially entered into the United States economy in 2006, they have become pervasive as both smoking cessation methods as well as smoking alternatives. Because of their rising popularity (and because I just started my PhD dissertation on the abuse liability of e-cigarettes), I thought we could go over the basics of what an e-cigarette is, what is in e-liquids, and what we do and do not know about the impact of these ingredients on health.

What is an e-cigarette?

E-cigarettes (also known as vapes) are a group of electronic devices designed to heat e-liquid (or e-juice) into a vapor/aerosol for inhalation. There is a lot of variability in the design, type of liquid, and wattage of e-cigarettes. First generation e-cigarettes looked similar to cigarettes, and are sometimes called “cig-alikes.” Second generation generally include larger, refillable tank systems. Newer e-cigarettes, such as Juul, use a nicotine salt cartridge so everything in this blog post may not pertain to them but if I figure out how they work and their more specific components, I’ll let you all know.

 

What is in e-cigarette liquid?

E-cigarette liquid generally contains nicotine, propylene glycol/glycerin, and flavoring chemicals. There is a lot of variability in the amount of each of these components, but I’ve tried to include the basics of them below.

Nicotine

Nicotine metabolism pathway. Scientists can measure nicotine metabolites such as cotinine to gain knowledge about how much nicotine a person has consumed.

Nicotine is the highly addictive substance found in cigarettes, e-cigarettes, hookah, etc. It works by increasing dopamine in the reward centers of the brain to incentivize further use and is the reason why quitting smoking is so difficult [1]. One of the primary uses of e-cigarettes is to stop using combustible cigarettes which bombard the system with toxic chemicals such as volatile organic compounds. E-cigarettes still provide nicotine, and thus do not treat nicotine addiction itself, but because they expose individuals to fewer toxic chemicals they are thought to have a modified risk (aka they’re still not good for you but they’re less bad than cigarettes. The more I learn about cigarettes the more I realize that it is not difficult to be less bad than they are).

Nicotine, other than being addictive, can increase the risk of or exacerbate several chronic disorders such as cardiovascular, respiratory, and gastrointestinal disorders. It can also decrease general immune function and reproductive health [2]. This means that while e-cigarettes are generally deemed less dangerous than traditional combustible cigarettes, they are still addictive and come with the same nicotine-associated risks.

There are nicotine-free e-liquids available, which only contain flavoring chemicals suspended in a propylene glycol/glycerin mixture. These are generally used by individuals who have quit smoking but who still enjoy the action of smoking without the nicotine. They are also gaining popularity among adolescents who use nicotine-free e-liquids to try out different flavors in social settings or to learn how to do vape tricks (e.g. blowing vapor rings).

For more info on nicotine in electronic cigarettes, you can check out this more-specific blog post I wrote about it.

Propylene Glycol/Glycerin

Nicotine and flavoring chemicals are suspended in propylene glycol (PG), glycerin (VG), or a  mixture of the two. Aerosolized propylene glycol/glycerin mixtures can produce mouth and throat irritation and a dry cough, and are thought to contribute to respiratory function impairment [3]. Propylene glycol in other contexts such as when applied to the skin topically causes skin irritation and redness [4]. Glycerin has a variety of uses other than in e-liquids, including as a sugar substitute, a lubricant, or a laxative. While these chemicals have been approved for all these other uses, they have not been approved by the FDA as safe for inhalation.

The heating of propylene glycol, glycerin, or a mixture of the two into an aerosol (aka how e-cigs do) produces higher-than-we-want levels of toxic aldehydes, including formaldehyde and acetaldehyde [5], suggesting a need to examine its safety following heated aerosolization. Essentially, these chemicals have a lot of uses but maybe inhalation shouldn’t be one of them.

Flavoring Chemicals

Honestly, I could have written an entire blog post just on the flavoring chemicals because there are so many of them and the research on them has exploded in the past ten years as everyone has scrambled to figure out what they do when turned into an aerosol and are inhaled. The variety of flavors is the main appeal for both adults interested in quitting smoking as well as youth interested in the novelty and variety [6]. Thousands of flavor compounds are currently available on the market from simple flavors like vanilla to complex flavors with Gatorade-esque names like “BOOM,” “Dragon Juice,” “Diamond Ice,” and “Space Jam Meteor Milk” (I wish I were joking but these are all real flavors).

I told you it was real.

Flavoring chemicals used to create these flavors have all been deemed “generally recognized as safe” for consumption as food additives. But, and THIS IS IMPORTANT, they have not been recognized as safe for inhalation. In fact, recent research examining the potential toxicity of different flavoring chemicals has found that many of these chemicals (for example, diacetyl aka buttery popcorn flavoring associated with respiratory diseases like the famed “popcorn lung”*) when heated in to an aerosol can produce cytotoxicity and cell death [7] and are detected in aerosol exceeding safety exposure limits [8]. This suggests that many of the flavor chemicals used should either be decreased to below-exposure limits or cut out all together. There are some flavors that did not exceed safety limits or that do not currently have prescribed inhalation safety limits.

CT scan of popcorn lung (or as doctors call it, “bronchiolitis obliterans”

*For those who may not know, popcorn lung was named such because it was a common respiratory issue for workers in a popcorn plant in Missouri (also because it looks..well…kind of popcorn-like in a way I’m not comfortable with). They found out it was due to the workers breathing in an absurd amount of diacetyl. This lead to (some) better respiratory protection for factory workers in 2000. Here’s the CDC page for it:  https://www.cdc.gov/niosh/topics/flavorings/default.html

 

So what do we know about e-liquid and health?

Sorry, everyone, but we really don’t know very much about e-cigarette liquid. We know what goes into it (if the often-unregulated companies tell us) but we don’t know how those chemicals all interact when heated, and we aren’t sure what the long-term consequences of exposure are since most people didn’t start using e-cigarettes until the last five or so years. Researchers are slowly characterizing the chemicals and their decomposition in the face of heat (such as that needed to aerosolize an e-liquid) but there are SO MANY chemicals that are used, not to mention the combinations of chemicals and the device characteristics (for example, increased device voltage also increases the heat and therefore the combustion of your e-liquid).

We need more information on the other parts of the e-cigarette as well, such as the coils used (do the metals emit anything harmful?) and the other aspects of the heating and wadding elements.

I realize this is not a satisfying answer to “what are the effects of e-liquids on health?” This is how science is a lot, especially in newer fields. So…Have this bonus picture of my dog:

References: 

[1] Benowitz, N. L. (2009). Pharmacology of Nicotine: Addiction, Smoking-Induced Disease, and Therapeutics. Annual Review of Pharmacology and Toxicology, 49, 57–71.

[2] Mishra, A., Chaturvedi, P., Datta, S., Sinukumar, S., Joshi, P., & Garg, A. (2015). Harmful effects of nicotine. Indian Journal of Medical and Paediatric Oncology : Official Journal of Indian Society of Medical & Paediatric Oncology, 36(1), 24–31.

[3] Callahan-Lyon P. (2014). Electronic cigarettes: human health effects. Tobacco Control, 23:ii36-ii40.

[4] Jacob, S.E, Scheman, A., & McGowan, M.A. (2018). Propylene Glycol. Dermatitis, 29(1).

[5] Leon Kosmider, Andrzej Sobczak, Maciej Fik, Jakub Knysak, Marzena Zaciera, Jolanta Kurek, Maciej Lukasz Goniewicz; Carbonyl Compounds in Electronic Cigarette Vapors: Effects of Nicotine Solvent and Battery Output Voltage, Nicotine & Tobacco Research, Volume 16, Issue 10, 1 October 2014, Pages 1319–1326.

[6] Harrell, M. B., Weaver, S. R., Loukas, A., Creamer, M., Marti, C. N., Jackson, C. D., … Eriksen, M. P. (2017). Flavored e-cigarette use: Characterizing youth, young adult, and adult users. Preventive Medicine Reports, 5, 33–40.

[7] Behar, R. Z., Davis, B., Wang, Y., Bahl, V., Lin, S., & Talbot, P. (2014). Identification of toxicants in cinnamon-flavored electronic cigarette refill fluids. Toxicology in Vitro, 28(2), 198–208.

[8] Barrington-Trimis, J. L., Samet, J. M., & McConnell, R. (2014). Flavorings in Electronic Cigarettes. JAMA, 312(23), 2493.