With his class of about 700 medical students, IU School of Medicine Professor W. Graham Carlos recently looked at a COVID-19 case. He emphasized the importance of documenting a good medical history. This means asking about the patient’s social life, which includes vaping history.
“I believe that taking a good medical history for anybody presenting with breathing problems should include asking about smoking as well as vaping,” Carlos said.
Carlos is also section chief for pulmonary and critical care at Eskenazi Health, a hospital in Indianapolis, leading the COVID-19 unit.
People are still learning more from medical research about the effect of vaping on the lungs. Carlos said because vaping is relatively new, it’s hard to tell what the long-term effects of vaping are, let alone what effects it can have on coronavirus.
Vaping-associated pulmonary illness is a lung injury that can look a lot like COVID-19. When people come in with VAPI, they have coughs, shortness of breath and abnormal X-rays, Carlos said. This can make it more difficult on the health care team to decide what treatments to employ.
“As a pulmonary specialist, working here at Eskenazi Health and teaching at the medical school, I believe it’s my responsibility to warn patients and my trainees about a potential danger because both COVID-19 and vaping cause inflammation of the lungs,” Carlos said.
Because of the uncertainty surrounding VAPI and coronavirus, he advises people to avoid cigarette and e-cigarette use. He also reminds people that testing positive for COVID-19 does not necessarily mean having lung trouble.
Carlos has actually seen a decrease in the usage of cigarettes and e-cigs recently. But, David Jewell, general manager at Stimline Variety Smoke Shop, said at the start of this pandemic business really went up as they were one of the few smoke shops in the area to stay open. While they don’t sell vape juices, they do sell CBD cartridges.
“Everybody wants to buy up whatever they can, whether it’s twinkies or bread or toilet paper or e-cigs,” Jewell said.
Stimline Variety Shop was able to stay open mainly because they sell medicinal marijuana and products that help people relax in this crazy time, Jewell said. However, Jewell said people should do their best not to risk anyone’s health, including their own.
While Jewell said they are following social distancing guidelines and sanitizing to stay open, if cases were to worsen as other places reopen, they would be willing to shut their doors.
“We’re not medical experts,” Jewell said. “We’re just wanting to follow the guidelines of the local government to be honest.”
According to the blogpost of Dr. Nora Volkow, director of the National Institute on Drug Abuse, “Because it attacks the lungs, the coronavirus that causes COVID-19 could be an especially serious threat to those who smoke tobacco or marijuana or who vape.”
Carlos said he has seen patients who have vaped, smoked and done neither but who have each contracted the virus. The bottom line is that VAPI could be a confounder or lead to diagnostic uncertainty if patients were to test positive for COVID-19 as well, he said.
“So, picture this: somebody comes in with vaping injury, they test positive for COVID and the health care providers, we all think, ‘Oh, this is all COVID,’” Carlos said. “We could be fooled because their lung injury, their disease may be related to their vaping instead.”
A major limitation to studying the vaping population and coronavirus is it’s difficult to track who’s vaping through electronic medical records.
This is why it’s so important to Carlos to teach his students how to record thorough medical histories for patients.
“We don’t have enough evidence yet to make an association with the virus and outcomes and vaping,” Carlos said.
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