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As vaping lung injuries rise, state faces obstacles in data gathering

Oct 16, 2019

Many of the growing number of lung injuries caused by vaping in New York state are being treated in Rochester.

In the state health department’s regional breakdown of New York state, western New York is a 17-county region that stretches from the shore of Lake Erie in the west nearly to Syracuse and Binghamton in the east.

The New England Journal of Medicine says these are "computed tomographic scans of the chest obtained from patients with vaping-associated lung injury."
Credit New England Journal of Medicine

Thirty-one cases of vaping lung injuries have been reported in that region. More than half of them have been treated at one hospital: Strong Memorial in Rochester.

The University of Rochester Medical Center, which runs Strong, said the concentration does not mean that Rochester is the center of an epidemic. URMC said doctors across upstate New York routinely refer complex cases there because of its research centers and multidisciplinary approach.

The vaping injuries they see include damage to the lining of the lungs and blood vessels.  Sometimes blood starts to leak into the lungs. Patients end up on ventilators. One person, a 17-year-old from the Bronx, has died from these injuries in New York; the federal Centers for Disease Control says 26 people have died nationwide.

The CDC has not been able to identify exactly what is causing these deaths and injuries, but the agency is collecting reports from state health departments.

In New York, once doctors have identified a case of vaping-associated lung injury, the state has advised them to call both the health department and the regional poison control center.

But that’s not always happening. County and state health officials said there’s no legal obligation to report vaping injuries to the state.

Unlike communicable diseases like tuberculosis or measles, vaping injuries are not covered by the state’s reporting requirements.

In an email, a URMC spokesperson relayed a statement from Chief Medical Officer Michael Apostolakos, who said the center “encourages clinicians to report unusual cases without a clear diagnosis to government agencies, usually the health department.”

Still, because of the lack of a legal requirement, the Monroe County public health department has likely not been notified of all the cases identified locally, said department spokesperson Ryan Horey.

At Rochester Regional Health, doctors have seen at least three cases of lung injuries caused by vaping, according to spokesperson Derek DeSol.

DeSol said Rochester Regional staff received a memo from the state health department on Aug. 15 advising them to report “all cases of suspected severe lung disease potentially associated with vape products.”

But implementation of that advice has been spotty.

Pulmonologist Gary Dudek, who works at Rochester Regional’s Clifton Springs and Newark-Wayne hospitals took what he described as an “informal poll” of the other two pulmonologists he was working with Wednesday afternoon.

Dudek said he asked his colleagues what they would do if they had a patient in the intensive care unit who they thought fit the description of a vaping-associated lung injury.

“Neither of them thought they’d do anything other than treat the patient,” Dudek said. “Neither would have thought to report this to anybody.”

The state health department said its advice to clinicians is clear, but Dudek said its investigation is likely hamstrung by incomplete data.

“There are so many different products, and the patients that I’ve talked to get most of their products over the internet and have no idea where they’re coming from or what they contain,” Dudek said. “It’s impossible to really know what the risk is for any product unless it’s studied.”

Dudek said he used to recommend nicotine vaping to some patients who were unable to quit their cigarette habit. Now, he said, he’s reluctant to make that suggestion because of how little information is available about what’s causing vaping-related lung injuries.

“I’d like to know what’s in what they’re using, and so far, nobody knows,” Dudek said.