In April 2020, during the early coronavirus disease 2019 (COVID-19) pandemic, eight patients hospitalized with e-cigarette, or vaping, product use–associated lung injury (EVALI) were reported to the California Department of Public Health (CDPH).
Patients resided in five counties and were aged 14–50 years (median = 17 years); seven were aged <21 years. All hospitalizations occurred in April 2020, a median of 4 days (range = 4–13 days) after symptom onset. Four patients were admitted to an intensive care unit; two required mechanical ventilation. Nucleic acid testing for SARS-CoV-2, the virus that causes COVID-19, was performed on all patients at the time of hospitalization; all tests yielded negative results. Seven patients were tested two or more times, and lower respiratory tract specimens were tested from the intubated and mechanically ventilated patients. Patients met California and CDC EVALI case definitions, including negative respiratory pathogen testing and chest imaging findings consistent with EVALI (Box).*
Health care providers first documented suspicion for EVALI in their notes on hospital days 1–8 (median = day 3), after testing for SARS-CoV-2 returned negative results. Six patients reported vaping tetrahydrocannabinol (THC)-containing products, one reported vaping only nicotine-containing products, and one did not specify products vaped. Seven patients had positive test results for THC on urine drug screen; one patient not tested by urine drug screen reported vaping THC. No epidemiologic links were identified among the patients. 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. Products might have been acquired from informal or unlicensed sources by patients aged <21 years who reported THC product use.
Christina Armatas, Amy Heinzerling, Jason A. Wilken – CDC – June 26, 2020.
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