The outbreak of vaping-associated lung injuries this summer and fall can officially be attributed to vitamin E acetate in THC-containing vaping products, the Centers for Disease Control said today. The new confirmation of the link between the chemical and the injuries came after a new study found it in nearly all of the lung fluid samples from a new set of patients.
As of December 17, 2,506 people have been hospitalized with e-cigarette, or vaping, product use-associated lung injury (EVALI), according to the CDC. There have been 54 deaths. The injuries started increasing in June before peaking in September, new CDC data indicates, and the number of visits to emergency departments for vaping-associated injuries have been declining since.
“It is clear that the outbreak represented a new phenomenon,” said Anne Schuchat, principal deputy director of the CDC, during a press conference. “It’s not a recognition of a common syndrome that had evaded our attention.”
Vitamin E acetate was first identified as a key focus of a statewide investigation in New York in September. It was later described as a chemical of concern by the CDC in November, after it was found in every one of a set of 29 lung fluid samples tested by the agency. Investigators also found that most patients with EVALI reported using THC-containing vaping products before their injury. Product testing by the Food and Drug Administration has found many of those products are contaminated with the chemical. It hasn’t been found in nicotine-only vaping products.
In the new study, published today in the New England Journal of Medicine, clinicians collected lung fluid samples from 51 patients with either confirmed or probable EVALI. Vitamin E acetate was found in 48 of the samples — 94 percent. The majority of the patients also had THC in their lung fluid samples. Of the 11 patients who said they had not used THC products in the 90 days before their injury, nine had detectable levels of THC.
This set of patient samples was also compared to those from a group of 99 healthy people without EVALI, who were either e-cigarette smokers (with nicotine only), traditional cigarette smokers, or non-smokers. None of the samples from healthy people had vitamin E acetate, including those from the e-cigarette smokers.
The combination of this new data, along with previous reports and product analysis, allowed the CDC to conclude that the chemical was responsible for the outbreak. “The very large increase in cases is attributable to what was happening in this past year in the supply, with vitamin E acetate diluting or tainting THC products,” Schuchat said. In Minnesota, for example, THC-containing products from 2018 did not contain vitamin E acetate, but products from 2019 did.
Vitamin E acetate is a safe dietary supplement and ingredient in topical lotions and creams, but when it’s inhaled, it may interfere with proper lung function. Heating the chemical in a vaporizer can also cause it to break down into a compound called ketene, which can irritate the lungs. More studies are underway to figure out how vitamin E acetate might cause the type of damage seen in EVALI patients. “We don’t have to hold our breath for those results, but they’ll be helpful for us to go a little deeper in understanding the problem,” Schuchat said.
She stressed, though, that there may be more than one chemical causing these injuries. Not every patient with EVALI reported using THC-containing products, and not every tested product associated with an injury contained vitamin E acetate. “This does not mean there are not other substances in e-cigarettes or vaping products that have or are capable of causing lung injury,” she said.
Pediatricians warn of 'devastating collision course' ahead of flu season – CTV News
A group of pediatricians is warning of a “potentially devastating collision course” ahead of the approaching flu season without a mass immunization strategy.
In a new petition launched online Saturday, the pediatrics section of the Ontario Medical Association identified three key factors that could produce challenges this fall: unprecedented interest in flu shots, the decreased capacity of physicians to deliver vaccinations, and the “co-circulating” coronavirus.
Every year, more than 1,000 Canadian children are hospitalized with influenza and hundreds die across North America, the petition says.
“COVID-19 stands to compound that risk and complicate the logistics of getting our communities adequately immunized against flu,” the physicians wrote.
While children appear to be at decreased risk of severe COVID-19 symptoms, much is still unknown, including how the virus interacts with flu.
“Unlike COVID-19, we already have effective flu vaccines, available now.”
OUTDOOR TENTS, SCHOOL CLINICS
The new petition calls for a “better centralized, universal infrastructure” in Ontario for vaccinating the most vulnerable children, those six months to four years of age who typically visit their family doctors and pediatric clinics for the flu shot. Those clinics are not equipped to handle an influx of patients if interest in the flu shot is indeed spiking, says pediatric emergency physician Dr. Dina Kulik.
Kulik told CTVNews.ca that patients have been reaching out to her and her colleagues “in droves” asking for the flu shot, which is typically administered in October and November each year. The flu shot is not yet available in Ontario, where Kulik practices.
Recent surveys support the observation that interest is spiking among parents. In August, a global survey published in The Journal of Pediatrics identified a nearly 16 per cent increase in the number of caregivers that said they plan to get their child vaccinated against the flu. Researchers suggested that “[c]hanges in risk perception due to COVID-19” may be playing a role.
But family doctors and pediatrician clinics aren’t equipped to safely immunize hundreds of patients—as they typically would—during a pandemic, said Kulik. Some of those clinics have also yet to open, she added.
Instead, Kulik suggests there’s a need for “mass immunization programs” that allow for more efficient physical distancing and other health protocols necessary during the COVID-19 crisis. This could be “outdoor tents set up where kids can go through one at a time,” she said, citing research that shows there is less transmission of the virus outdoors.
Alternatively, immunization programs could be implemented in schools as they have been for Hepatitis B and Human papillomavirus (HPV) among older elementary school children.
“That posses other challenges since some kids are not in school, and other might be sick at the time,” she noted. Other options could be modelling a mass immunization strategy off drive-thru testing sites for COVID-19 where people wouldn’t even have to leave their vehicle.
Asked what support the province will provide concerned pediatricians, Ontario’s Minister of Health Christine Elliott didn’t specify any new initiatives to expand the existing influenza vaccine system outside individual clinics.
“Pharmacies are able to administer flu vaccines, although not to very young children—they will still need to be administered in their physicians’ offices,” said Elliott, adding that physical distancing, masking and hand-washing will help prevent the flu as well. “We are anticipating that if everyone continues to follow the same public health measures as they are to prevent the transmission of COVid, this should help the transmission of flu as well.”
THE AUSTRALIAN COMPARISON
As health experts sound alarm bells for the approaching flu season, one country’s experience has presented a possible upside to COVID-19 “co-circulating” at the same time as influenza: Australia. Every year, Canadian physicians model their flu vaccine predictions off of the Oceanic country, which this year saw record low influenza infection rates. Experts credited lockdowns and other pandemic protocols for stamping out the flu there.
While this initially may have seemed encouraging for the Canadian flu forecast, says Kulik, the country’s COVID-19 caseloads entering flu season are not similar. Australia, which has recorded nearly 27,000 COVID-19 cases, logged fewer than 100 new cases a day in June and less than 500 a day for much of July and August, the peak of its flu season. Over the last week alone, Canadian health officials have recorded more than 7,000 new cases.
Sept. 21 update: One probable COVID-19 case identified in Nova Scotia – Cape Breton Post
A Dalhousie University student has received an indeterminate COVID-19 test result.
Since the test result does not confirm the case is positive, it will not be included in the total COVID-19 case tally in Nova Scotia, the province said in its daily update.
The student, who lives off campus, was travelling outside the Atlantic bubble. They have been self-isolating since their return.
A COVID-19 test doesn’t differentiate between active virus and non-infectious virus fragments. So, an indeterminate test result could mean someone previously had COVID-19 and recovered, but non-infectious virus particles remain in their bodies. It could also mean that someone was tested before the virus is fully detectable.
Public health is treating the probable case as positive. In these situations, public health investigates whether the person had or is currently having COVID-19 symptoms. They also look into whether the person was recently exposed to COVID-19.
On Sunday, Nova Scotia Health Authority’s labs conducted 587 tests. To date, Nova Scotia has 1,086 positive COVID-19 cases, 87,928 negative test results, and 65 deaths. The last confirmed positive COVID-19 case was identified on Sept. 7.
Anyone who has is currently experiencing or has experienced within the last 48 hours one of the following symptoms should visit https://811.novascotia.ca to determine if they should call 811 for further assessment:
- new or worsening cough
- fever (i.e. chills or sweats)
Anyone experiencing two or more of the following symptoms (new or worsening) should also visit the website:
- sore throat
- runny nose or nasal congestion
- shortness of breath
Probable COVID-19 case involving Dalhousie student announced Monday – HalifaxToday.ca
As of today, Sept. 21, Nova Scotia has no active cases of COVID-19. No new cases were identified Sunday, Sept. 20.
The province is reporting one probable case of COVID-19 involving a Dalhousie University student who has received indeterminate test results. The student recently returned from travel outside the Atlantic Bubble, lives off-campus and has been self-isolating, as required.
Based on public health assessment, this case is being treated as though it is a lab-confirmed positive to ensure all precautions are taken.
Indeterminate test results do not provide a negative or positive. They may occur because someone previously had COVID-19 and the virus is still detectable in their system, or someone has been tested before the virus is fully detectable. In these situations, public health conducts further assessment, including whether someone had or has symptoms or was recently exposed to someone with COVID-19, to inform how the case is treated. Since probable cases are not confirmed to be positive, they are not included in the total number of positive cases of COVID-19 in Nova Scotia.
Nova Scotia Health Authority’s labs completed 587 Nova Scotia tests on Sept. 20.
To date, Nova Scotia has 87,928 negative test results, 1,086 positive COVID-19 cases and 65 deaths. No one is currently in hospital. Cases range in age from under 10 to over 90. One thousand and twenty-one cases are now resolved. Cases have been identified in all parts of the province. Cumulative cases by zone may change as data is updated in Panorama.
Visit https://811.novascotia.ca to determine if you should call 811 for further assessment if in the past 48 hours you have had, or you are currently experiencing:
— fever (i.e. chills/sweats) or cough (new or worsening)
Two or more of the following symptoms (new or worsening):
— sore throat
— runny nose/ nasal congestion
— shortness of breath
When a new case of COVID-19 is confirmed, public health works to identify and test people who may have come in close contact with that person. Those individuals who have been confirmed are being directed to self-isolate at home, away from the public, for 14 days.
Anyone who has travelled outside of Atlantic Canada must self-isolate for 14 days. As always, any Nova Scotian who develops symptoms of acute respiratory illness should limit their contact with others until they feel better.
It remains important for Nova Scotians to strictly adhere to the public health order and directives – practise good hand washing and other hygiene steps, maintain a physical distance when and where required. Wearing a non-medical mask is mandatory in most indoor public places.
As of July 3, interprovincial travel within Nova Scotia, New Brunswick, Prince Edward Island and Newfoundland and Labrador, without the requirement to self-isolate for permanent Atlantic Canadian residents, is permitted. All public health directives of each province must be followed. Under Nova Scotia’s Health Protection Act order, visitors from other Canadian provinces and territories must self-isolate for 14 days. Other visitors from outside the Atlantic provinces who have self-isolated for 14 days in another Atlantic province may travel to Nova Scotia without self-isolating again.
Nova Scotians can find accurate, up-to-date information, handwashing posters and fact sheets at https://novascotia.ca/coronavirus .
Businesses and other organizations can find information to help them safely reopen at https://novascotia.ca/reopening-nova-scotia .
— testing numbers are updated daily at https://novascotia.ca/coronavirus
— a state of emergency was declared under the Emergency Management Act on March 22 and extended to Oct. 4
Government of Canada: https://canada.ca/coronavirus
Government of Canada information line 1-833-784-4397 (toll-free)
The Mental Health Provincial Crisis Line is available 24/7 to anyone experiencing a mental health or addictions crisis, or someone concerned about them, by calling 1-888-429-8167 (toll-free)
Kids Help Phone is available 24/7 by calling 1-800-668-6868 (toll-free)
For help or information about domestic violence 24/7, call 1-855-225-0220 (toll-free)
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