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How doctors discovered the vaping illness: ‘This is not infectious’

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Chris Ratcliffe | Bloomberg | Getty Images

Dr. Lynn D’Andrea thought she was dealing with an infection when two teenage boys struggling to breathe arrived in intensive care at the Children’s Hospital of Wisconsin over the Fourth of July week.

The teens had fevers and coughs and were fatigued, D’Andrea recalled. When she looked at the CT chest scans, their airways looked very sore, red and irritated. Some of the airways were even bleeding. The symptoms would have indicated an infection like pneumonia, but there should have been a lot of pus and there wasn’t.

“It really looks like some sort of inhalation injury,” said D’Andrea, a pediatric pulmonologist at the Wisconsin hospital.

Two other teens with similar symptoms arrived at the hospital the previous month. With four teens in the hospital — three of them in the ICU and all sick from a mysterious lung illness with no apparent cause — D’Andrea and her colleagues started to think it was something none of them had seen before.

Common theme

“It was like teenager, teenager, teenager and going. ‘There’s got to be a common theme here,'” said Dr. Mike Meyer, medical director of the pediatric intensive care unit, told colleagues at the time.

The only thing they all had in common was a history of vaping.

D’Andrea, Meyer and their colleagues at Children’s would be among the first doctors in the nation to uncover and sound the alarm on the vaping lung illness, tentatively being called EVALI, short for e-cigarette, or vaping, product use associated lung injury. To date, the illness has taken the lives of 39 people and sickened at least 2,051 across 49 states, Washington, D.C., and the Virgin Islands. Alaska is the only state that has been spared.

Health officials still don’t know exactly what’s making people sick. The Centers for Disease Control and Prevention has dispatched more than 100 physicians and investigators to pinpoint the cause of the deadly outbreak, which it initially said resembled a rare form of pneumonia.

This August 2019 image provided by Intermountain Healthcare, shows an x-ray image of one of the first patients in Utah treated for vaping-related respiratory illness by Dr. Dixie Harris, an Intermountain Healthcare pulmonologist.

Intermountain Healthcare | AP

Early symptoms include coughing, shortness of breath, fatigue, chest pains, nausea, vomiting and diarrhea. State and federal health officials are painstakingly interviewing patients and their parents, gathering data on what the victims were vaping. They have covered about half the cases so far, according to CDC officials. FDA scientists are running tests on the actual vaping pens patients are using.

“Connecting the products and how they were used to specific patients is critically important to our investigation to determine to the extent possible the cause or the causes of these injuries,” Mitch Zeller, the Food and Drug Administration’s director of the Center for Tobacco Products, told reporters on an Oct. 25 conference call.

Public health officials are urging consumers to stop vaping, especially THC, the psychoactive ingredient in marijuana. A spike in teen use of e-cigarettes has prompted the Trump administration to draft new rules that would temporarily remove all flavored e-cigarettes from the market until the FDA can review their safety. Although doctors suspect THC as a possible problem, a portion of patients say they’ve only vaped nicotine.

The ‘index’ patient

It’s unclear what role e-cigarettes have played in the illnesses, and research on vaping’s impact on the lungs is scant.

The first case of EVALI appeared in April and rapidly increased beginning in July, even though consumers had been vaping for years. CDC officials have theorized that the rise of nicotine-filled e-cigarettes may have laid the groundwork for teens to start experimenting with riskier products, like THC, that led to the illness.

Some individuals who vape “are more frequently starting to experiment with other products,” Dr. Anne Schuchat, the CDC’s principal deputy director, told reporters last month. “That may be laying a fertile ground for the expanded use of risky products.”

The Wisconsin doctors said their first patient, a male BMX biker labeled the “index” patient, was admitted on June 11. The teen had lost weight, had a fever and was having difficulty breathing, the doctors recalled.

“He was vaping and he was biking,” D’Andrea said. “We really thought he had just probably inhaled some dust or dirt.”

They conducted a standard chest x-ray and chest CT before taking him to the operating room for a bronchoscopy to rule out infection.

“Very quickly, it became evident that we didn’t think that this was a typical community-acquired infection and that we needed more evaluation,” Meyer said.

‘This is not infectious’

It wasn’t until the next three patients arrived that the doctors started putting it all together. Meyer said he can distinctly recall the exact moment D’Andrea said they may be dealing with an outbreak of some kind.

“She’s like, ‘This is not infectious,'” Meyer said. ‘”This does not look like a lung that has an infection. There clearly has to be something else. I just don’t know what this is.'”

Prior to the lung illness outbreak, the doctors had already identified vaping as a common issue among teens. They had taken an extensive social history of the patients, including what the teens had been inhaling.

Among the 867 cases where the CDC has data on which substance patients were vaping, 86% said they used THC and 64% reported using nicotine. More than a third, 34%, said they exclusively used THC while 11% said they only vaped nicotine.

Sometime in mid-July, Dr. Michael Gutzeit, the hospital’s chief medical officer, reached out to the Wisconsin Department of Health Services. On July 25, the doctors held their first press conference on EVALI, announcing that eight adolescents in the state had been hospitalized with severe pulmonary disease after vaping.

“We weren’t sure what we were dealing with,” Gutzeit said. “But we felt it was imperative to raise a warning to the public because of the significance of what we were finding and concern that this was a public health issue.”

No one cause

Since then, Wisconsin officials have confirmed 82 probable cases in the state, with 14 other patients under investigation.

The Children’s doctors said they worry the flu season could make it even worse, making it harder to detect and catch. And public health officials are still no closer to figuring out what exactly is making people sick.

“No one compound or ingredient has emerged as the cause of these illnesses to date; and it may be that there is more than one cause of this outbreak,” the CDC says. “Many different substances and product sources are still under investigation.”

Doctors initially said the illness resembled a rare form of pneumonia, caused by oil in the lungs, but a Mayo Clinic study cast doubt on that theory. Researchers who examined lung biopsies from 17 patients suspected of having the illness published a study last month that said a mix of “toxic chemical fumes,” not oils, may be to blame.

Officials aren’t just looking at what’s being vaped but also whether the heating process in e-cigarettes could be playing a role. They’re analyzing what people vaped as well as the devices they used.

“I think that there will be multiple causes and potentially more than one root cause. I do think that the phenomenon we’re seeing is going to have an explanation,” Schuchat told reporters last month. “But it may not be tomorrow. It may take a few months to really understand the portion of illness that’s due to some new risky practice in the preparation of these materials or other causes.”



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Commentaries, Analysis, And Editorials — November 11, 2019

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Yascha Mounk, The Atlantic: Evo Morales Finally Went Too Far for Bolivia

The socialist president claimed authoritarian powers in the name of the popular will. But average citizens were fed up with arbitrary rule.

Evo Morales has been attacking Bolivia’s democracy for many years. Since coming to office in 2006, the socialist president has concentrated ever more authority in his own hands, denounced the opposition in aggressive terms, and placed loyalists in key institutions, from the country’s public broadcaster to its highest court.

Read more ….

Commentaries, Analysis, And Editorials — November 11, 2019

Maduro’s military stands in the way of a Bolivia repeat in Venezuela — Brian Ellsworth and Vivian Sequera, Reuters

Released Lula in for greatest fight of his life — Pepe Escobar, Asia Times

Back to jail, or run for president: the legal maze facing Brazil’s Lula — Ricardo Brito, Reuters

Should China Police the Strait of Hormuz? — Lyle J. Goldstein, National Interest

Saudi Arabia’s Newest Tactic To Hush Dissidents — Michael Kern, Oil Price

Saudi Arabia’s Terrible War in Yemen Isn’t Going as Planned — Matthew Petti, National Interest

Iraq protests should be moment of truth for US State Department — Michael Rubin, Washington Examiner

‘Too late’ for Hong Kong government to gain citizens’ trust — William Yang, DW

Despite big bangs, Thai Muslim rebels fading away — Anthony Davis, Asia Times

How the Wagner Group Expands and Inflates Russia’s Influence — C. Rondeaux, WPR

Russia has joined the ‘scramble’ for Africa — Patrick Gathara, Al Jazeera

Russia Positioning Itself in Libya to Unleash Migrant Crisis Into Europe — Paul D. Shinkman, US News and World Report

Poll brings Spain no respite from political uncertainty — Barry Hatton and Ciaran Giles, AP

Socialists win repeat Spanish election, Vox becomes third-biggest force in Congress — El Pais

Why Britain’s Election Is So Unpredictable — Matthew Goodwin, Chatham House

What Should Donald Trump Really Be Impeached For? — Amitai Etzioni, National Interest



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Deval Patrick, Ex-Governor of Massachusetts, Is Considering White House Bid

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Former Gov. Deval Patrick of Massachusetts has told Democratic officials that he is considering making a last-minute entry into the 2020 presidential race, according to two Democrats with knowledge of the conversations, the latest evidence of how unsettled the party’s presidential primary is less than three months before the Iowa caucuses.

Mr. Patrick has told party leaders that he doesn’t think any of the candidates running have established political momentum and that he thinks there is an opening for somebody who can unite both liberals and moderate Democrats, according to Democrats who have spoken to him.

At the same time, Massachusetts Democrats close to Mr. Patrick have started to reach out to prominent party leaders in early nominating states to alert them that he may run, according to one Democrat who has received an inquiry.

His candidacy could complicate the strategic assumptions for a number of candidates, including the two who have led most national and early-state surveys: Mr. Biden and Ms. Warren. Mr. Patrick could threaten Mr. Biden’s support from black voters and also make inroads in New Hampshire, where Ms. Warren is counting on a strong performance in the southern part of the state that borders Massachusetts.

He and Ms. Warren have had an amicable, if not personally close relationship, and when she was asked at an event last week to name African-Americans she’d have in her cabinet she included Mr. Patrick.

Were he to run, the former governor may find it difficult to create a full-fledged campaign organization so late in the process. Two of his longtime Massachusetts aides are already committed in 2020: Doug Rubin is working for businessman Tom Steyer’s presidential campaign and John Walsh is overseeing the re-election of Senator Ed Markey, who is being challenged by Representative Joseph P. Kennedy III.

According to Massachusetts Democrats, though, Mr. Patrick has lined up at least one former adviser: Jennifer Liu, who worked for his political arm when he was governor and was recently laid off from Senator Kamala Harris’ campaign, where she had been finance director.

Mr. Patrick traveled to some early nominating states last year but decided against a presidential bid last November, saying at the time that he did not want the “cruelty of our elections process” to adversely impact his family.

The governor did not immediately reply to a text message seeking comment on Monday. Last month, when he was asked to fully rule out the prospect of a last-minute entry, Mr. Patrick said: “Don’t ask me that question.”

Thomas Kaplan contributed reporting.



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