Vaping Lung Injuries Continue, May Be Mistaken For COVID-19: CDC

Amid the continuing coronavirus pandemic, federal health experts warn that serious vaping-related lung injuries that began to surface last year continue to be a problem in 2020, but some of the cases may be mistaken for COVID-19.

The U.S. Centers for Disease Control and Prevention (CDC) published its Morbidity and Mortality Weekly Report late last month, which included a report that at least eight cases of e-cigarette, or vaping, product use-associated lung injury (EVALI) were reported in California during April 2020.

According to the report, officials from the California Department of Public Health (CDPH) received reports of EVALI from five counties. The victims were aged 14 to 50, with a median age of 17. Of the eight, seven were under the age of 21. All had to be hospitalized, with four patients admitted to the intensive care unit, and two requiring mechanical ventilation.

In 2019, the CDC received nearly 3,000 reports of severe lung injury linked to vaping, including at least 60 deaths.

As teens and adults began suffering from lung problems after vaping, officials struggled to find a source, but determined that a potential cause of the respiratory injury was vitamin E acetate, which was often used in vaping products containing tetrahydrocannabinol (THC).

However, little focus has been put on the issue since the outbreak of the coronavirus pandemic, which has sickened nearly three million Americans and has resulted in about 130,000 deaths in the U.S. In fact, all eight patients identified by the CDC as having EVALI were first tested for COVID-19, and when tests came back negative, seven of them were tested two or more times.

Combined, it took doctors a median of three days to suspect EVALI was behind their illnesses.

“Six patients reported vaping tetrahydrocannabinol (THC)-containing products, one reported vaping only nicotine-containing products, and one did not specify products vaped,” the CDC report states. “Seven patients had positive test results for THC on urine drug screen; one patient not tested by urine drug screen reported vaping THC.”

Vaping Lung Injury Concerns

The vaping lung injury problems were first reported by health officials in Illinois and Wisconsin in early August 2019, after several cases of severe lung injury were identified, where e-cigarettes were the only common factor. However, since then, health officials nationwide have either identified similar cases, or realized they had treated similar cases without knowing about the e-cigarette connection.

Part of the difficult process for diagnosing vaping lung illness is ruling out other infections, autoimmune disorders, and other conditions, experts say. In a case study by the Journal of the American College of Emergency Physicians (JACEP) Open, a doctor tested a 20 year old patient for strep, HIV, hepatitis and other diseases which came back negative. The treating doctor was forced to insert cameras into patient airways to examine the lungs to confirm the EVALI case.

The COVID-19 may have exacerbated that problem, according to the CDC. EVALI cases had trailed off since February 2020, and the CDC had discontinued collecting case reports. However, the CDC now wonders if the cases actually tapered off or were sometimes confused for COVID-19, which arose at the same time as the EVALI cases seemed to disappear.

“It is unclear whether EVALI cases have continued to occur and were underreported or missed or whether these cases might represent the background incidence of EVALI as previously identified by CDC review of syndromic data,” the CDC noted. “Because EVALI and COVID-19 signs and symptoms can be similar, health care providers should maintain clinical suspicion for EVALI during the COVID-19 pandemic.”