In the last month, two adults with a history of vaping have been admitted to Stony Brook Southampton Hospital for acute respiratory failure, tying the East End into the national outbreak of vaping-related hospitalizations.
First reports of hospitalizations and deaths associated with vaping came about a month ago, immediately bringing the issue to the national spotlight and leading federal agencies to investigate the outbreak.
Matters have escalated quickly since then. The number of reported cases nationwide has been rising at an alarming rate. New York State has implemented a ban on flavored e-cigarette cartridges, and now local school districts are planning community forums to tackle rampant vaping in schools.
There have been 805 cases of vaping-related lung injuries nationally as of September 27, according to the Centers for Disease Control and Prevention. Twelve deaths have been reported in ten states.
Effects In New York
In New York, 101 cases have been reported as of October 1, and that number has grown every week. Eleven days prior, that number was at 81.
Of the 81 cases, 17 percent were teenagers — similar to the nationwide ratio of 16 percent — and 56 percent were under the age of 25.
The State Department of Health first received reports of those numbers in early August, and the state has taken swift action since then to address what Governor Andrew Cuomo called a “public health crisis.”
On September 17, New York became the second state to ban the sale of flavored e-cigarettes and nicotine e-liquids effectively immediately, in an effort to mitigate teen vaping.
“New York is not waiting for the federal government to act,” Mr. Cuomo said in a prepared statement, “and by banning flavored e-cigarettes we are safeguarding the public health and helping prevent countless young people from forming costly, unhealthy and potentially deadly lifelong habits.”
Almost 40 percent of 12th-grade students and 27 percent of high school students have vaped in New York in 2018, according to data from the DOH, which blames flavored e-liquids as the reason for the youth appeal to vaping. In four years, usage among high school students increased by 160 percent.
The most popular vaping device among teenagers, and within the country, is Juul, a sleek black e-cigarette shaped like a USB flash drive that uses disposable cartridges called “pods.” Each cartridge contains roughly the same amount of nicotine as one pack of cigarettes, according to the manufacturer. Flavors include mango, creme, cucumber and fruit.
The sale of tobacco- and menthol-flavored Juul products is still permitted in the state, but DOH Commissioner Dr. Howard Zucker recommended to Mr. Cuomo on September 26 to include menthol in the ban. The governor accepted the recommendation that day and directed Dr. Zucker to hold an emergency meeting of the Public Health and Health Planning Council to expand the regulations of the ban.
Local Schools Confront The Epidemic
The Southampton and East Hampton school districts are joining forces to host call-to-action forums in October to address youth vaping. Southampton’s forum will take place on October 3 and East Hampton’s on October 2, both at 7 p.m. in their respective high school gymnasiums.
District administrators, student activists and local health officials will speak at the events, as well as national medical experts Dr. Victor DeNoble and Dr. Bonnie Halpern-Felsher, who can offer expertise on the dangers of vaping and how young people make health-related decisions.
High school principals in both districts introduced the forum to their school boards on the evening of September 17.
“We are really excited about this opportunity,” Dr. Brian Zahn, the principal of Southampton High School, said at his district’s meeting. “It’s an amazing experience that we have to get our students involved in this very important national topic.”
Dr. Zahn said that school administrators are partnering with the district’s chapter of Students Against Destructive Decisions, or SADD, to engage the community and take action.
“We’re on the front lines of it every day,” Dr. Zahn said to the board. “But hearing from the mouths of our students, in terms of the impact that it’s having not only in our classrooms and our hallways, on our athletic fields, on our buses, but also on their social lives and everywhere else, in their own households, it’s just astonishing.”
The two districts are also collaborating with Peter Emerson, a former White House aide with deep ties in Washington, D.C. Dr. Zahn explained that this partnership could publicize the local school districts’ efforts on a national scale.
“Teenage vaping and the concerted efforts to market liquid-based nicotine to our children have created substantial health risks and financial strains on our school systems. We hope everyone can come out for what will be two very informative evenings,” said Adam Fine, the principal of East Hampton High School.
What The State Ban Is And Isn’t Addressing
The State DOH will begin enforcing the ban on Friday, October 4, two weeks after it was implemented, to ensure that retailers are no longer selling flavored vaping liquids. They can face fines of up to $2,000 per violation.
When the ban was announced, Mr. Cuomo also directed the DOH and State Police to crack down on retailers who sell the products to underage buyers. Most counties’ minimum legal age to purchase liquid nicotine is 18, but some counties raised the age to 21 this year, including Suffolk and Nassau counties.
In Suffolk County, 32 establishments were issued violations in September as a result of a sting operation that centered on underage vape sales. The Suffolk County Police Department and the state DOH conducted the sting, called “Operation Vape Out,” from September 4 to 18. County Executive Steve Bellone and Police Commissioner Geraldine Hart announced the results on September 24.
It is unclear how enforcement would occur for online sales. Additionally, the Shinnecock Indian Nation’s legal department is reviewing whether the tribe should adhere to the state ban, Tribal Council Chairman Bryan Polite said last Thursday, September 26.
The American Academy of Pediatrics, or AAP, wanted New York to take the ban a step further and prohibit the sale of menthol-flavored vaping products as well, according to Dr. Louis Goldblum, a part-time physician at Southampton Pediatrics in Hampton Bays and a current member and former president of AAP’s New York chapter covering Queens, Brooklyn and Nassau and Suffolk counties.
Dr. Goldblum said members of his chapter’s executive board recently met with communities within the chapter’s coverage area as well as various elected officials to warn them of the dangers associated with vaping.
“As a pediatrician, I’m amazed when I see kids — and I practice out on the East End — who vape. It is so common,” Dr. Goldblum said, noting that he is “so happy” the state implemented legislation to address the issue.
The ban could prevent young vape users from forming or maintaining a nicotine addiction, which may have led to some of the reported health problems. But most patients in the nationwide cases reported using other vape products containing THC, the psychoactive compound found in cannabis, according to the CDC.
Vape cartridges containing THC are either purchased from marijuana dispensaries or on the black market, the latter of which is not subject to oversight regarding the chemical makeup of such products.
The local cases are part of that majority statistic as well. Both of the patients at the Stony Brook Southampton Hospital admitted to vaping cannabis compounds, according to Dr. Howard Sklarek, a pulmonologist who has been practicing for more than 20 years.
So although the state ban does not address THC usage, Dr. Sklarek said, “as far as our community, [the ban] might be the most important thing to do right now,” referencing the prevalence of youth vaping.
Dr. Sklarek said he considers the two Southampton cases to be more like one and a half, as one was deemed a “probable” case and the other a “questionable” case. The probable patient developed acute lung injury and acute respiratory failure, and the questionable patient had acute respiratory failure and asthma-like symptoms without having asthma, the doctor explained.
Both patients were discharged after a short period of time and their symptoms improved quickly after taking appropriate medication.
“Right now, we don’t know what the actual cause is. A couple of different pathologies in the lungs and until we can tie a specific product — nicotine alone, nicotine with cannabis, or cannabis alone, or flavors, we haven’t targeted anything — we’re not sure,” Dr. Sklarek said. “My recommendation is not to use any of them.”