Vaping: Public Health Heroes Track Down an Illness

Vaping: Public Health Heroes Track Down an Illness

Meet Wisconsin pulmonologist, Dr. Lynn D’Andrea. She knew something was wrong when three teenagers with mysterious, dangerous lung injuries came into the hospital gasping for air during a 4th of July weekend. Dr. D’Andrea noticed that those alarming cases followed those of another teen with matching symptoms. Her experience, along with those of her colleagues, led to the discovery of more than 530 probable vaping-related injury cases in 38 states, a U.S. territory and Canada.

A heroic tale of public health officials working overtime to identify a potential epidemic

While there is outrage that vaping has reached a dangerous level, there is a remarkable public-health success story. Doctors and regional officials in the Midwest took pieces of information and began to realize that a mysterious illness loomed much larger than it appeared. It’s a tale of teamwork, communication and dedication from public health officials working overtime despite cutbacks, lack of infrastructure and support.

Why was Wisconsin ground zero for uncovering the vaping link?

Wisconsin has ranked near the bottom nationwide for per-person spending on public health until a huge boost of $588 million more was greenlighted for the next two years. Wisconsin is also home to Juul vaping pod manufacturing sites. State officials discovered the outbreak, which showed no signs of stopping. No one could have anticipated the scale and seriousness of vaping.

Discovering the vaping link 

Isolated cases of respiratory problems were spotted as early as 2015 in West Virginia. Otherwise-healthy patients, including teenagers, complained of shortness of breath, weight loss, fatigue and gastrointestinal issues. They were often diagnosed with acute respiratory distress syndrome—a lung injury from an unknown cause. The cases baffled health providers nationwide. In North Carolina, clinicians puzzled over how healthy teenagers could suddenly be so ill that they needed ventilators for something that wasn’t infectious.

In Wisconsin, patient histories helped piece together the missing link among that initial cluster of vaping cases. This wasn’t an easy feat. Think teenagers concealing their vaping from their parents while vaping THC oil, the psychoactive chemical in marijuana. For Dr. D’Andrea, a 25-year veteran who specializes in children’s breathing issues, the patients’ openness is what solved the mystery. “They became part of the team trying to figure this out,” she said.

D’Andrea called the hospital’s chief medical officer on July 8. That call effectively elevated this from an isolated incident to a health crisis and put it on the nation’s radar. “It’s incredible that they saw this,” said Dr. Jeffrey Gotts, a pulmonologist at UCSF. “As front-line clinicians, there are very few things that we would report to public health authorities in the ICU. It’s not that unusual to have people show up with respiratory failure.”

The emergency quickly grew from a local to a national one

The Infection specialist from D’Andrea’s hospital gave the local health department a call. A chain of communications began. He reached out to the state’s respiratory disease epidemiologist whom he’d known for 15 years. He interrupted a meeting of the chief medical officer, “We need to talk about this.”

The epidemic exploded. It grew from four cases to eight. The original team notified public health officials across the Midwest to help manage the flu season. Communication is the biggest asset these team have when it comes to disease investigation. Most of the people on the front lines had worked together for years. They’d managed the Ebola crisis and others. A news conference was livestreamed on Facebook, and Wisconsin parents took their teenager with similar symptoms to the hospital.

Vaping spreads across the country

Not surprisingly, a clinician in Illinois saw the news and worried that her patient might be experiencing the same symptoms. She began calling health departments and hospitals to see if they were experiencing these cases. Within a couple of days, they had two patients. In San Francisco, a doctor saw a patient whose mother had seen the news out of Wisconsin and asked if it might be connected to her hospitalized teenager. By August, there were new reported cases in Wisconsin and Illinois. More cases were being reported across the country.

The Epi-X Tipping Point

The Wisconsin health department decided to send out an Epi-X alert on Aug. 8. That’s an alert to all state health departments on the Epidemic Information Exchange network run by the CDC. After the bulletin announcing Wisconsin had up to 25 suspected cases linked to vaping, calls poured in from New Jersey to North Carolina.

The CDC announced on Aug. 17 that 94 possible cases existed, kicking off a media frenzy that culminated in national awareness of the dangers of vaping and cries for the head of the FDA to resign.

The CDC dispatched a team to help comb through cases

The team worked together to define the condition and coordinate information from other states. While the caseload has grown, there’s much that we don’t know about this illness. Many experts don’t believe this outbreak will end anytime soon. “That’s the way public health is supposed to work—though it doesn’t always work this way.”

We look forward to assisting our clients with their uncontested legal matters

Many of our clients are retired or thinking about retirement, so it’s not unusual that health-related conversations pop up in our offices, though vaping is a first. But this is an amazing story about an understaffed public-health team who worked overtime to identify a disease and alert the country about this condition. Sometimes we have to take time out and celebrate our heroes.

Juul faces an uncertain future

Juul valued at as much as $38 billion, was credited at single-handedly resurrecting the slumping e-cigarette market. It now faces challenges that include a write-down of its valuation by Altria; countrywide bans; a warning from federal regulators; investigations by members of Congress; and renewed questions about the long-term health impacts of vaping.

As we embrace another year, we look forward to assisting our clients across a range of uncontested legal matters. Whether it’s a Divorce, Living Trust, Probate or Business Formation, we guide our clients through the process. We prepare the legal documents and file them with the courts. For most of our services, we charge one flat fee. We’re helpful, compassionate and affordable. Schedule an appointment today at one of our three Bay Area offices.