As flu season approaches, doctors fear more young adults will die of vaping-related illnesses. 

With lungs already damaged by vaping, patients could face higher risks of complications from influenza. Even as doctors fear the flu will drive more patients to the emergency room, doctors don’t know the long-term consequences of the vaping-related illness. Nor can experts pinpoint the potential cost of the epidemic to taxpayers or employers. 

“We don’t know if people are going to be at higher risk for respiratory failure, or if they are going to die because life support won’t be enough for them,” said Dr. Peter Miller of Wake Forest Baptist Health. “We’re really concerned that if we get another flu season that targets this age group, there’s potential for a lot of young adults to be really sick and a lot to die.” 

Experts worry a difficult flu season compounded by vaping-related illnesses could wreak financial damage. Most of government spending on health care goes to those with long-term conditions and the elderly. 

“If these conditions end up being very hard to treat or untreatable, it would be like long-term care,” John Locke Foundation health policy analyst Jordan Roberts said. “Adding a new procedure that we know nothing about would potentially affect premiums if there was a huge spike in claims.”

Doctors say they don’t know enough to say how delays in care could affect patients with the vaping-related illness. Nor do doctors know how such delays would affect the cost of patients’ health care.

So far, at least 18 people have died, and more than 1,000 people have vaping-related illnesses. The vast majority have self-reported vaping bootlegged products with THC — the psychoactive substance in marijuana that gets users stoned — and almost all of them are less than 35 years old. 

“These are people who think they’re invincible, but clearly they’re not,” Miller said. “It definitely does impact you, when you see people who are healthy and younger than you lose their lives. We haven’t had a death that we’re aware of related to vaping, but realistically, it’s only a matter of time.”

Worse, the two illnesses mimic one another. 

Both present the same symptoms, but each requires different treatments. People with vaping-related illnesses struggle to breathe, with coughing and chest pain. Many also experience nausea, vomiting, diarrhea, and weight loss. 

“They can overlap significantly,” said Dr. Bradley Drummond, associate professor of pulmonary medicine at UNC School of Medicine. “It is going to be a challenge to disentangle these two entities as we go into flu season.”

The two illnesses appear so similar that the Center for Disease Control’s current definition of vaping-related illness requires the patient to test negative for influenza. 

“Most patients are often initially suspected of having a viral infection such as influenza. Vaping-related illness is only suspected after viral testing is negative,” Drummond said. “It complicates the diagnosis. If a patient has influenza, according to the current definition from the CDC, that is not vaping-related illness.”

Patients with the flu usually get sent home with antibiotics. But antibiotics won’t help patients with vape-related illnesses. Their lungs are inflamed, not infected. Doctors usually use steroids to treat vaping-related illnesses, and sometimes oxygen or life support.

At Cone Health, a patient recently came in with a combination of vaping-related illness and adenovirus, a flu-like illness.

“For all the world it looks like a vape-related lung injury,” said Dr. Murali Ramaswamy, director of the Interstitial Lung Disease Program for LeBauer Health, part of Cone Health’s medical group. “This patient was in the intensive care unit, but did not end up on life support. But it came close.”

Doctors’ ability to recognize vaping-related illness is only one of their concerns.

They also fear the flu could hit patients whose lungs are already compromised by the vaping-related illness. 

“Their airway and lung tissues are not as healthy, and viruses can easily make them sicker than a non-smoker,” Ramaswamy said. “Their susceptibility to a lung injury is exponentially higher.”

Doctors can treat the vaping-related illness with steroids, oxygen, and tiers of increasingly extreme life support. 

“It would basically be what we call supportive care, which can be all the way up through the highest form of life support possible, ECMO, which bypasses their lungs,” Miller said. “If their lungs are so sick that they can’t breathe at all on their own, we can do it for them with a machine.”

The N.C. Department of Health and Human Services advises people to get the flu shot and to stop vaping, especially bootlegged products. The state has focused on educating physicians and patients about vaping-related illnesses. 

“Pretty much all of those symptoms are similar to the flu. So, we are trying to cast a pretty wide net to make sure we get everyone,” said Dr. Elizabeth Tilson, state health director for DHHS. “The big message is that anyone who is experiencing vaping-related sickness — coughing, shortness of breath — or flu symptoms should be seeking medical attention.”

Doctors can send patients home by treating them with steroids, but they can’t yet guess at the long-term effects of the vaping-illness. 

The state hopes to block any potential health crises by marketing the flu shot.

“The main message to take home is to get the flu shot … and be sure to tell your health care provider if you have vaped or used e-cigarettes,” Tilson said. “That’s really important information for them to know.”