News outlets across the nation and locally have reported on the recent statement released by the Centers for Disease Control and Prevention as they investigate a multi-state outbreak of severe pulmonary disease. The believed culprit is the use of e-cigarette products, commonly known as “vaping”, which is the only link in the sudden epidemic that has already resulted in one death.
By Melissa Anderson
“We are saddened to hear of the first death related to the outbreak of severe lung disease in those who use e-cigarette or “vaping” devices. CDC’s investigation is ongoing. We are working with state and local health departments and FDA to learn the cause or causes of this ongoing outbreak,” Robert R. Redfield, MD, and Director of Centers for Disease Control and Prevention said in a statement. “This tragic death in Illinois reinforces the serious risks associated with e-cigarette products. Vaping exposes users to many different substances for which we have little information about related harms – including flavorings, nicotine, cannabinoids, and solvents. CDC has been warning about the identified and potential dangers of e-cigarettes and vaping since these devices first appeared. E-cigarettes are not safe for youth, young adults, pregnant women, or adults who do not currently use tobacco products.”
As of August 27, there have been 215 possible cases of severe pulmonary disease associated with the use of electronic cigarette, or e-cigarette, products reported by 25 states. The severity of the issue has expanded to include additional pulmonary illnesses in the investigation. North Dakota has joined the list of states as the Department of Health (NDDoH) has received the first report of severe respiratory illness of a patient with a history of vaping or electronic nicotine delivery systems (ENDS). The most concerning aspect of the epidemic is the potential for who will be affected as vaping and ENDS usage is highest among teenagers and young adults.
“Individuals are discouraged from using vaping and e-cigarette products of any kind as the long-term health impacts are unknown,” said Neil Charvat, director of the Tobacco Prevention and Control Program. “Patients with a history of vaping who are experiencing breathing problems should seek medical care and inform their health care providers of any ENDS use.”
The investigation has not identified any specific substance or e-cigarette product, such as the massively popular JUUL brand, that links to all cases. Based on reports from the states affected thus far, the respiratory symptoms associated with this are cough, shortness of breath, or chest pain. Some patients have also experienced gastrointestinal symptoms like nausea, vomiting, or diarrhea along with non-specific symptoms such as fatigue, fever, or weight loss. The reports have the symptoms varying in development, with some patients experiencing symptoms over a few days and others taking up to several weeks.
“As people call in with these reports, we will continue to gather data in an effort to find answers and linkages,” said Dr. Tracy Miller, state epidemiologist with the North Dakota Department of Health (NDDoH). “We’re working closely with the CDC on the national outbreak.”
The concern of vaping and ENDS use amongst Cavalier County youth has been on the radar of area public health officials, services and schools for some time. The urgency of addressing this issue has not been able to deter the admitted 21 percent of North Dakota youth who use this dangerous product.
“Many students do not even know that the products contain nicotine. Parents have no idea of the products that are out there. They look like any other product that a child would have,” Cavalier County Public Health nurse Terri Gustafson said.
The lack of information and misrepresentation of the products that appears to be a harmless, flavored water vapor has been a major challenge. The addictive liquids within a single cartridge can contain as much nicotine as a single pack of cigarettes along with known carcinogens like formaldehyde, diacetyl (linked to “popcorn lung” or bronchiolitis obliterans), heavy metals (including nickel, tin, chromium and lead), and volatile organic compounds.
All of these ingredients are heated creating ultra fine particles that are inhaled deeply in the lungs. This makes the nicotine even more potent as it is more readily absorbed into the bloodstream, making addiction not just likely but inevitable. A 2016 Surgeon General’s report concluded that youth use of nicotine in any form, including e-cigarettes, is unsafe, causes addiction and can harm the developing adolescent brain. A growing number of studies have found that young people who use e-cigarettes are more likely to become smokers, and many are low-risk youth who would not have otherwise smoked cigarettes.
At Cavalier County Memorial Hospital (CCMH), the Tobacco Cessation Council has been gaining knowledge and training on how to best combat the popular method of nicotine delivery. Council member Nancy Boe shared that recent training and seminars attended have stated that the best way to regulate JUUL and similar products is to do it at the local level, rather than state or federal.
“It’s dangerous because there is so much unknown related to it,” FNP and Tobacco Cessation Council member Liz Sillers said.
“We can’t connect vaping directly yet. As Liz was saying, we just don’t know yet. That’s why they want us to report,” David Kavish, CCMH Pharmacist, said.
Education has been the major tool used by public health and CCMH to make not only students aware of the risks of vaping but, also, parents. Boe stated that during every sports physicals the questions of vaping knowledge and use are asked of the youth. At Langdon Area School District, Superintendent Daren Christianson explained that vaping is considered drug use and covered under the LASD tobacco free campus policy.
“It is handled exactly as if it were tobacco,” Christianson stated.
As the popularity of vaping among youth has grown, LASD took note and has had guest speakers address the students directly about vaping and its dangers. The school has also invited Cavalier County Public Health to assist in educating staff about vaping, what the devices may look like, and the dangers of vaping. The teachers are also trained on what to look for and all of the common areas are under video surveillance.
“We are monitoring all areas as effectively as we can,” Christianson shared.
To say that the youth e-cigarette epidemic is a public health emergency that “demands the strongest possible action by the Food and Drug Administration and policy makers are all levels” is not an understatement and felt by many in the healthcare field. Gustafson explained that the FDA has taken some steps to address this crisis, including announcing plans to restrict where certain flavored e-cigarettes are sold.
“But these plans don’t go far enough,” Gustafson said.
The Campaign for Tobacco-Free Kids and other public health groups have called on the FDA to do more, starting with a ban on the flavored products that have made e-cigarettes so popular with kids.
“It is very important to have strong tobacco policies state-wide that include the use of e-cigarette products and that these products are considered tobacco products,” Gustafson stated.
In the meantime, public health and CCMH will continue to educate parents, adults and youth about all tobacco products. Promoting strong policy on products containing nicotine is also a focus for concerned groups nationwide as they push for the adoption and enforcement of policies that include restricting age, flavors, and implementing product taxes.
The NDDoH is asking individuals experiencing symptoms and that have a history of vaping or e-cigarette use to call the NDDoH at 866-207-2880 or visit ndhealth.gov to take the confidential survey.
For help in quitting any tobacco or nicotine products, including ENDS/vaping products, contact NDQuits by phone at 800-QUIT-NOW or online at ndhealth.gov/ndquits. To learn more about the national outbreak, visit www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html.