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A pediatric team from UC Davis Health presented a powerful case series of three teenagers who had unexplained breathing problems during the COVID-19 pandemic. The series highlighted the similarities between e-cigarette or vaping, lung damage associated with the use of the product (EVALI), and the symptoms and manifestations of COVID-19.
“EVALI and COVID-19 share many symptoms but have very different treatment plans,” said Kiran Nandalike, associate professor of pediatrics and lead author of the study. “For this reason, providers caring for pediatric patients with unexplained respiratory failure should consider EVALI and ask for a relevant smoking / vaping history.”
Teens facing COVID-19 and EVALI
As of February 2020, more than 2,758 hospitalized EVALI cases and 64 deaths were reported in the U.S. More than half of those hospitalized were under the age of 25.
According to Nandalike, most teens who vape using recreational marijuana get the drug from friends, family, or unlicensed drug dealers. Unregulated access to these products is linked to continuous outbreaks in this underage population. E-cigarette products obtained through these informal channels may contain vitamin E acetate, an additive strongly linked to lung damage.
Recent studies indicate that COVID-19 related practices may increase vaping among teens. Isolation from the school environment, loneliness, the stress of the current pandemic and a lack of social support could increase the potential for substance use. This risk is especially true for young people with pre-existing mental health conditions.
Common symptoms of EVALI and COVID-19
There are many similarities between EVALI and COVID-19 symptoms, laboratory findings, and radiological findings. Common symptoms include fever, cough, nausea, abdominal pain, and diarrhea. Both conditions also show bilateral ground glass opacity in chest imaging.
With the COVID-19 pandemic, it’s easy to miss the diagnosis of EVALI. Patients in the case series presented with fever, nausea and cough. They had a fast heart rate, fast breathing and low blood oxygen levels. Their lab results indicated inflammation commonly seen in COVID-19, with higher white blood cell (WBC) counts and elevated inflammation. Their chest image revealed non-specific frosted glass opacities. While everything pointed to a COVID-19 infection, their SARS-CoV-2 test came back negative.
Vendors have been polling teens and their parents for any vaping history in the past 90 days. When patients shared information about the recent vaping, providers were able to diagnose EVALI and successfully treat them with corticosteroids.
Daphne Darmawan, a pediatric resident at UC Davis Health and first author of the study, is examining the clinical course and long-term health impacts of adolescents with EVALI. He is working on developing protocols to help with the early identification and treatment of these cases. Early onset of steroids for patients with EVALI can save lives and minimize the length of hospital stay.
“To help reduce the risk of EVALI recurrence, providers would recommend stop vaping counseling for patients and close outpatient monitoring,” Nandalike said.
The article was published on October 30 in SAGE Open Medical Case Reports.
Co-authors of this study are Daphne O Darmawan, Kriti Gwal, Brian D. Goudy, and Sanjay Jhawar of UC Davis Health.
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