CDC urges clinicians to keep EVALI on their radar as it could be mistaken for Covid-19

Cough, fever, diarrhea — all raise diagnostic hackles for suspicion of SARS-CoV-2, the virus that causes Covid-19 —but don’t forget the differential. To that end, the CDC is reminding physicians that those are also symptoms of e-cigarette, or vaping, product use-associated lung injury (EVALI).

Writing in the Morbidity and Mortality Weekly Report, Chirstina Armatas, MD, from the center for Health Communities, California Department of Public Health, Richmond, California, and colleagues noted that in April 2020, there were eight patients hospitalized with EVALI that were reported to the department of health. Their median age was 17 years (range 14-50) and seven were over age 21. They were hospitalized within a median of 4 days after symptom onset — four were in an ICU and two required mechanical ventilation. All of them were tested for SARS-CoV-2 and all were negative.

“Patients met California and CDC EVALI case definitions, including negative respiratory pathogen testing and chest imaging findings consistent with EVALI,” Armatas and colleagues reported.” They noted that, due to the negative tests for SARS-CoV-2, the clinicians documented their “suspicion for EVALI in their notes on hospital days 1–8 (median = day 3).”

And, the story of the EVALI cases is a familiar one, with six patients reporting that they vaped tetrahydrocannabinol (THC)-containing products. One patient reported only vaping nicotine-containing products, and one did not specify the type of product used.

“Two patients reported obtaining their vaping products from friends; six patients were not asked or did not disclose vaping product source. Recreational cannabis use is legal in California for adults aged ≥21 years,” Armatas and colleagues reported. “Products might have been acquired from informal or unlicensed sources by patients aged <21 years who reported THC product use.”

After EVALI cases across the U.S. peaked in September 2019 and gained public awareness, they began to wane and, in February 2020, the CDC said it would no longer collect data on the cases, instead asking local jurisdictions to continue to do so. The cases reported by Armatas and colleagues are the first reported to the California Department of Public Health (CDPH) since February.

Ruling out Covid-19 is now part of the case definition for EVALI to ensure that a case of Covid-19 is not mistaken for EVALI and vice versa, according to the report.

“It is important that health care providers ask patients with symptoms consistent with EVALI, especially teenagers and young adults, about e-cigarette use, or vaping, during Covid-19 evaluations,” Armatas and colleagues wrote.

Candace Hoffmann, Managing Editor, BreakingMED™

Cat ID: 190

Topic ID: 79,190,254,930,791,932,570,730,933,190,926,192,927,151,928,925,934