Rashelle Bernal never expected to end up in the hospital because she vaped. But she could be part of a nationwide outbreak of a severe lung illness that’s sickened more than 1,000 people. Researchers suspect those illnesses, and some deaths, are linked to vaping. Now, they're trying to find the precise cause.
Bernal moved from California to Louisville this summer. There, she sometimes smoked cigarettes and marijuana. But Bernal is pretty health-conscious, and she heard that vaping was a better alternative.
“I got really started trying to do it in the last year to try something different, I guess a safer alternative is what we were told,” she recalls. “But it doesn’t seem like that wasn’t the case in my situation.”
In Louisville, she started vaping more frequently. She was living away from family and friends for the first time and it was stressful. Vaping helped her cope.
“It became like, something I would do on the hour, just like instinctively,” she says.
Soon after the habit took hold, Bernal started getting winded, nauseous and felt like there was an elephant on her chest.
“I got to the point where I thought I had the flu,” she says. “And then to the point where I couldn’t eat anymore, I started vomiting after I had anything, couldn’t keep down water.”
So she went to the emergency room. One of her doctors, Ehab Haj Ali, says that at first, he thought she might have pneumonia. But that was ruled out through tests.
“All the workups were negative, and the only links we could find was vaping,” Ali says.
At that point, Bernal was having a really hard time breathing. Ali said Bernal was put into a coma and put on a ventilator.
Bernal doesn’t remember that. All she remembers is waking up, and being very confused about what happened. Her family in California flew to Louisville to care for her. But as she recovered, she had to use a walker, and couldn't braid her daughters hair, let alone her own.
“My big thing is that I wouldn’t want another family or another parent, you know, just to see their kid on a ventilator,” Bernal says.
The Long Game
Sts. Mary and Elizabeth Hospital didn’t respond to inquiries about whether Bernal has been reported to the state as a possible vaping-related case. But Ali says her symptoms line up with what the Centers for Disease Control and Prevention is pointing to: a rapid onset of coughing, significant breathing difficulties, nausea, vomiting and diarrhea.
The CDC says there are still a lot of unknowns about connections among these cases. Some people report vaping a product that contained THC, the main active ingredient in marijuana, or using black market products. Others say they bought regular nicotine vapes sold in retail stores.
Health experts say this outbreak might have gone on for awhile, but doctors only recently started connecting the dots.
But the outbreak of lung illnesses is only part of a larger question about vaping: What will the long-term health effects be?
Deborah Buckles, program director at Indiana University’s Simon Cancer Center Tobacco Treatment Program, says though there are claims that vapes are safer than cigarettes, that’s not proven.
“It’s going to be 2027 at the earliest before we really know what the long-term effects are,” she says. “So for us to say that these are safer at this point is not accurate. We don’t know that yet.”
Greg Conley, president of the American Vaping Association, points to a paper from the Royal College of Physicians in England that says vaping is safer than smoking cigarettes, and can be used to stop smoking.
“And that smokers who make that switch get back similar benefits that they do if they quit nicotine smoking altogether,” Conley says.
He and others in the vaping industry are frustrated federal officials have warned people to stop vaping because of the outbreak. Conley calls that irresponsible.
“Vaping remains a far less hazardous option for smokers,” Conley says.
There is some evidence that e-cigarettes are effective at helping people quit smoking cigarettes. But one study in the New England Journal of Medicine found vapes were effective when combined with behavioral support from a professional in person.
That study also found that a high percentage of people who quit smoking cigarettes by vaping, kept vaping. Study authors say that could be problematic because there are unknown long-term health risks.
Youth Vaping And Safety
Conley did say that people who’ve never smoked a cigarette should not start vaping. And research shows that vaping use is rising among youth. According to a recent nationwide study, more than one in four high school seniors vapes, a rate that doubled from 2017.
Vape flavors — bubble gum, strawberry and others that appeal to young people — are heping to drive that trend. The vaping industry has come under fire from federal officials who found these companies were marketing to teens and other young people.
President Donald Trump has said the government may put a ban on flavored vapes, and the Food and Drug Administration has proposed tougher regulation.
But Buckles of IU says vaping companies intentionally targeted young consumers in marketing campaigns.
“The FDA can regulate the marketing, the flavoring, the how these products are sold, where they’re sold, what flavors can or cannot be used. However, they’ve been very slow to do that,” Buckles says. “And, unfortunately, the industry did in fact, know what they were doing, and knew that if they could get kids addicted quickly enough, before there was too much FDA regulation, that they’d have users for life. And that’s exactly what’s happened.”
The FDA plans to ask vaping companies to submit what are basically risk-benefit applications. Companies will have to show evidence that the products are safe, if they do help people quit smoking and if those benefits outweigh the risk of teens starting to vape.
Meanwhile, Bernal is still recovering from her hospital stay. An FDA representative recently visited her at home, and she provided information about the kinds of vapes she was using.
Her doctor says she would have died had she not gone to the hospital.
“Now I’m part of a statistic,” Bernal says, adding that she hopes her story serves as a cautionary tale.
This story was produced by Side Effects Public Media, a news collaborative covering public health.