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Vaping may leave users with underlying health conditions at higher risk of serious complications if they contract the respiratory disease caused by the novel coronavirus, the U.S. Food and Drug Administration said.

“People with underlying health issues, such as heart or lung problems, may have increased risk for serious complications from COVID-19,” Michael Felberbaum, an FDA spokesman, said in an email Friday in response to questions from Bloomberg. “This includes people who smoke and/or vape tobacco or nicotine-containing products.”

“E-cigarettes can damage lung cells,” Felberbaum said.

Some health experts have speculated that vaping is causing younger patients in the U.S. to be hospitalized with COVID-19 at a higher rate than anticipated. Felberbaum declined to comment on whether the FDA was investigating a possible connection.

Earlier this week, Nora Volkow, director of the National Institute on Drug Abuse, wrote a blog post warning that the coronavirus “could be an especially serious threat to those who smoke tobacco or marijuana or who vape.”

E-cigarettes have been touted by some as less risky than smoking. But any increased harm associated with COVID-19, and the FDA’s direct language linking the products to lung damage, could boost detractors who have raised questions about the potential that vaping can lead to health problems.

Last year, some vapers began coming down with a mysterious and sometimes deadly lung illness. Those cases have been linked to products containing THC, the active ingredient in marijuana.

The FDA under President Donald Trump originally took a largely hands-off approach to regulating e-cigarettes, but began to change course in 2018 to stem an epidemic of youth use. After multiple delays, e-cigarette makers have until May to apply to the FDA for clearance to continue marketing their products. None have received FDA approval to market themselves as less risky than smoking.

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