The Washington State Board of Health’s emergency 120-day ban on the sale of flavored vape products in October was aimed at stemming the tide of the nation-wide rash of vaping-related lung illnesses and injuries, with more than 2,100 people diagnosed and 42 who have died because of it so far.

Some local officials, however, are hoping that it has another impact: reducing the usage of vape products in schools.

“Statewide, (vaping) is an epidemic,” Sequim Middle School principal Mark Harris said.

“This is not just a big city problem. We’re not immune out here, no matter how isolated we think we are.”

While Harris said vaping at SMS isn’t as ”rampant” as at other schools (according to other principals across the state), he noted it is a “much bigger issue” this school year, based on last school year’s data. That increase, he said, is down to “learned behaviors” that students picked up over the summer.

In fact, the problem grew to an extent that the middle school had to start closing the eighth grade bathroom during lunches, as students were going there to do “things they shouldn’t be doing,” as Harris put it.

That bathroom is the furthest from the cafeteria and thus the hardest to monitor, so Harris and his staff decided that closing it during that problematic time was the best course of action, forcing students to use the sixth- and seventh-grade bathrooms located closer to the cafeteria.

Harris is hoping that the ban on flavored vape products helps the situation at schools, but believes that the companies involved with the marketing of flavored vape products knew what they were doing.

“No doubt in my mind,” Harris responded when asked if he felt that flavored vape products were made and marketed to target youth.

“People using vaping to stop smoking don’t need bubble gum flavors.”

The health view

Dr. Steve Kirtland, a pulmonologist and the chief of medical staff at Virginia Mason Medical Center in Seattle, seemed to agree with that assessment.

“Flavored vaping products aren’t aimed at people using these products for cigarette cessation,” Kirtland said. “They’re for attracting new smokers.”

Kirtland said that recent medical data indicates that there is no benefit for using e-cigarettes or other vape products as smoking cessation aids, and added that the need right now is to keep young people safe and healthy.

The state board of health echoed that sentiment, as said by Secretary of Health John Wiesman in the board’s press release about the ban.

“This is a critical part of our response to the youth vaping epidemic and the outbreak of associated lung injury in Washington and throughout the country,” Wiesman said.

“We know that these products are not safe and we must act quickly to protect young people.”

According to information made public by the Centers for Disease Control, 2,172 people had been diagnosed with e-cigarette, vaping or product use associated lung injury, which they refer to as EVALI, over the last several months, with the latest update coming on Nov. 13.

Those totals include every state except Alaska, plus this District of Columbia and the U.S. Virgin Islands. Forty-two people had died of causes connected to EVALI, the youngest of whom was 17 years old.

Despite the age range of patients to age 75, the median age is just 24 years old, meaning the age of vape users succumbing to these issues appears to skew very young, with 40 percent of the patients being between 18-24. The youngest identified EVALI patient is just 13 years old, and 14 percent of the total patients being under the age of 18 — an age range at which it is not currently legal to purchase vape paraphernalia.

“Maybe the most concerning thing right now is that we don’t know the long-term impact of what this will do to patients, especially with all these young people being impacted,” Kirtland said.

“I hope the ban is effective at stopping young people from getting started with (vaping).”

Getting to the cause

On Nov. 8, the CDC released a statement indicating that in testing done on lung tissue on 29 patients suffering from EVALI, all 29 had traces of vitamin E acetate present, suggesting a potential link between that compound and the source of the damage being done to patients’ lungs.

While vitamin E acetate is a common additive and supplement in food and health products and is safe to ingest or put on your skin, the CDC reported that previous studies indicate that inhaling it can interfere with normal lung function.

The CDC is stopping short of calling it the cause, as more research still needs to be done, but that was still enough information for the state board of health to call for vape fluid production companies to stop using vitamin E acetate in their products.

Dr. Kirtland cautioned that there might not be just one specific cause of EVALI, as there’s still several factors involved in e-cigarettes and vapes that could be factors, including the devices themselves.

“The heat elements have to get incredibly hot to create the vapor,” Kirtland noted, “and not all of the materials they’re made of are meant to be exposed to that much heat. Who knows what chemicals are getting added because of that?”

One of the issues that has made tracking down the cause, according to Kirtland, is that the symptom chain in cases of EVALI have tended to be somewhat non-specific.

“Most of the symptoms are respiratory,” Kirtland said. “But some patients have had fevers while others haven’t, and some have presented with high white blood cell counts that look like a bacterial infection where none can be found.

“There’s also gastrointestinal symptoms in about 80 percent of patients, many of whom reported those symptoms as predating their respiratory problems.”

Kirtland also added that many of the cases look similar to pneumonia when examined with a chest x-ray, which is one of the reasons why he thinks that cases of EVALI may actually date back much further than when vape-related lung injuries began making headlines over the summer.

“I think it took awhile for anyone to realize what was going on and connect the dots,” Kirtland said. “No one was thinking to ask about vaping. Now that we have a better idea of what to look for and what to ask about, it’s easier to find.”

Local impact

While there have been no reported cases of EVALI in Clallam County, Washington state has not been exempt from the situation. As of Nov. 15, there had been 15 reported cases of vape-related lung injury across the state, including seven cases in King County, and one case each in nearby Kitsap and Mason counties.

Of those 15 cases across the state, four of them were reported to be between the ages of 10-19. Four more were between the ages of 20-29, statistics fairly in line with the national numbers, but still concerning given their youth and the lack of knowledge of the long-term impacts of EVALI, as Kirtland points out.

The Sequim School District has been assessing how to best proceed to keep students healthy and safe, with the school board considering policy and procedure changes to reflect the changing times that e-cigarettes and vapes represent.

Sequim Middle School has already been proactive in making changes for themselves. Harris said staff have been proactive in getting information about vapes and EVALI to families, and that they’re already seeing a reduction in vape-related incidents in the school compared to earlier in the year.

“The legislation around eliminating ‘kid flavors’ from the shelves and raised adult awareness has helped across the board,” Harris said.

Representatives from Sequim High School declined to talk about the vape situation in the school.

Harris and Kirtland both suggested that this situation can be a turning point in understanding how to properly handle vape products when it comes to their marketing and sales, and that hopefully that increased knowledge can also help keep children safe.