Dr. Hassan Nemeh, surgical director of thoracic organ transplant at Henry Ford Hospital, found himself in a surprising position last fall. A specialist in lung transplants related to chronic illnesses, Nemeh frequently sees patients with cystic fibrosis and chronic obstructive pulmonary disease (COPD), a condition developed in regular cigarette smokers. But this patient’s need for a double lung transplant wasn’t the result of a lifetime of smoking. In fact, he was only 17.
The young Grosse Pointe resident didn’t present just any case of chronic illness. Nemeh was about to perform the nation’s first double lung transplant on a patient with irreversible lung damage related to vaping, or the use of e-cigarettes, an epidemic that has rendered once-healthy young teenagers chronically, and sometimes fatally, ill addicts.
Vaping might just rival impeachment in terms of dominating the cultural conversation at the moment. Though vaping has been around for over a decade, its use has seen a remarkable surge in recent years, particularly among young people. Nemeh estimates that one in five high schoolers vape regularly, and that e-cigarette use is common even among eighth graders (one in eight) and sixth graders (one in 11). Still, in the offices of specialists like Nemeh, “vaping was simply not on the radar screen at all” until the spring of 2019, when the first cluster of reports linking acute lung failure to use of vaping devices in Illinois and Wisconsin began attracting the attention of hospitals and public health departments around the country.
“All of a sudden, a bunch of young people who were previously healthy were coming into the hospital ending up on ventilators and some of them were dying,” Nemeh says. “The common denominator seemed to be vaping or e-cigarettes.”
The 17-year-old who eventually ended up on Nemeh’s operating table had first come to his doctor at St. John Hospital with complaints of a fever and signs of a common, if severe, upper respiratory infection. But the diagnosis days later was far more grim: the high schooler was suffering from a shocking case of inflammation, what Nemeh describes as “total destruction of the lungs” brought on by habitual vaping. Few other medical centers would treat the patient. Seeing a patient so young with such horrific lung damage was like nothing Nemeh and the other medical professionals on his team had dealt with before. Without the transplant, though, Nemeh says, “the kid was gonna die!”
The procedure was performed successfully in mid-October, less than two weeks after the teenager arrived at Henry Ford and was placed on a transplant waiting list. “Within a very short period of time, our lives have been forever changed,” said the patient’s family in a statement following the transplant. “He has gone from the typical life of a perfectly healthy 16-year old athlete – attending high school, hanging out with friends, sailing and playing video games – to waking up intubated and with two new lungs, facing a long and painful recovery process as he struggles to regain his strength and mobility, which has been severely impacted.”
As of early January, more than 2,600 such cases of vaping-linked lung disease and over 60 deaths tied to vaping had been reported to the Centers for Disease Control and Prevention (CDC). Last fall, these cases made their way to the World Health Organization (WHO)’s International Code of Diseases as: U07.0, e-cigarette or vaping associated lung injury (ICD-10), known as EVALI. The title given to the outbreak is itself telling; the mechanisms behind it are still somewhat hazy. For many of those with symptoms, vaping hasn’t even been a habit for a full year. Nemeh says there has been “no clear association with dose or length of use,” a fact which makes this problem all the more intractable.
Researchers do have one lead: About 85 percent of these cases involved illegal vaping products containing THC, the active ingredient in marijuana. Specifically, a THC additive called vitamin E acetate was identified by the CDC as a “very strong culprit of concern.” But Nemeh recommends caution regardless. “Not 100 percent of these cases resulted from black market stuff,” he says. “About 15 percent of the cases were not associated with THC, but were regular nicotine vapes.”
Beyond lung disease, the ubiquity of vaping may present a “catastrophe for our society,” Nemeh says. Among youth, e-cigarettes are now more popular than traditional tobacco products. Nemeh worries that slick marketing campaigns have convinced young people that vaping is benign, when in fact, it is still addictive and not demonstrably safer than conventional smoking. What we know now may only be the tip of the iceberg, he adds. It took us some 60 years to collectively understand that cigarettes were harmful, and vaping has been around for just over a decade.
“Everyone should know that it’s harmful,” Nemeh says. “Everyone should know that its long-term effect is not known. It is addictive like cigarettes, so the easiest thing in the world is to not start. Because once you start it becomes difficult to stop.”
While legislative bodies are taking steps to regulate and limit the sale of vaping products and vape fluids, and schools are beginning to educate students on the risks associated with vaping, the vaping industry — and its hold on young people — won’t go down without a fight.
Old habits die hard. By human nature, we are quite resistant to changing those things we are accustomed to, and we cling to those things we enjoy. (That may be doubly true for the American teenager.) It takes a lot for us to stop doing what we are doing; at the very least, it takes a solid reason. So long as EVALI is just that, merely vaping associated, today’s youth may all too easily discount this real and severe danger to their health. A generation — and its lungs — are hanging in the balance.