By Dr. Anthony Policastro

We know that vaping is not benign. We also know that some individuals use it to move their nicotine addiction away from cigarettes. What is less clear is the exact relationship between the two issues.

On Sept. 24, 2019 Massachusetts issued a full ban on nicotine vapes. The ban lasted until Dec. 11, 2019, At that point a new law went into effect allowing sales of vaping products with low nicotine content.

Rhode Island and Washington issued four-month bans on vaping products in Oct. 2019. However, those bans only affected flavored vaping products. Non-flavored ones continued to be sold. 

A number of other states also passed bans. However, they were only temporary until halted by court orders. These states were Michigan, Oregon and New York.

The result was that the period the study covered included three states from Sept. 2019 until Jan. 2020.

In Massachusetts vaping was not available for the entire period. Over that period of time sales of cigarettes increased by 7.5 percent. This suggested that the individuals who had been vaping just substituted cigarettes as their source of nicotine.

In Rhode Island and Washington, the ban was only for flavored vaping products. Sales of cigarettes in those two states rose by 4.5 percent. This suggests that some individuals were already using the non-flavored vaping products and continued to do so. Others switched from flavored to non-flavored. Still others switched to cigarettes as the source for their nicotine addiction.

Much of this was not surprising. Previous studies had shown that increased taxes on vaping products increased cigarette sales. Minimum age laws for purchase of vaping products increased cigarette sales. Advertising regulations on vaping products increased cigarette sales.

We know that nicotine addiction is very strong. Alcoholics who go to rehab continue smoking. Those rehabilitated from drug addiction continue smoking.

Therefore, it should not really be a surprise that those addicted to nicotine will continue to find a source for it. It is one reason that the approach to nicotine addiction needs to be approached as an addiction and not a dirty habit.

Vaping is one source. Cigarettes are another. There appears to be a great deal of interchange between those two sources.

COVID update- Sussex County remained at the low risk level for hospitalizations last week.

Nationally the number of new cases went from 211,000 last week to 230,000 this week. So there was not much of a change. 

Delaware did a data adjustment last week. They removed 1,452 cases of COVID-19 from the totals because they determined that those cases represented non-Delaware residents. That resulted in the total number of new cases in Sussex County actually dropping by 271 over a 24-hour period. The result is that the statistics for new cases in Sussex County this week are meaningless.

On April 5, the New England Journal of Medicine published follow up data on fourth vaccine doses from Israel. The initial data had shown decreased infection rates after a fourth dose. However, the numbers were small.

Further data showed that protection against infection continued at a maximum for four weeks after the fourth dose of vaccine. However, protection against infection appeared to disappear at about the eight-week point. Thus infection rates only decreased for about two months with the second booster.

The good news is that the decrease in severe infections appeared to continue out to at least the eight-week point. That decrease was from four cases per thousand to one case per thousand.

The bottom line is that the fourth dose of vaccine essentially protects three people out of every thousand from severe infection for at least eight weeks.

An alternative approach is to get tested early for any COVID symptoms. Then if you test positive, you can take one of the antiviral medications within five days.

Both Pfizer and Moderna are currently testing Omicron specific vaccines. If the tests prove successful (and they probably will), we can expect the new version of the vaccine to be approved. That will likely occur by the fall time frame. 

Those who have had the first booster can get that dose as their second booster. Those who choose to get a second booster now should still consider that as a third booster.