Is it the flu or vaping illness? Why it may be hard to tell the difference

"This year, it's not going to be that simple."

vaping, e-cigarettes

The “vaping-related illness” that first emerged this summer isn’t showing any signs of letting up. As the case count climbs to 1,299, going by the latest CDC numbers, doctors are becoming concerned as the season changes. Flu season is coming, and that could make it even harder to diagnose the elusive illness linked to vapes.

The vaping-related illness has been tied to THC vapes for the most part, particularly a vape cartridge “brand” called Dank Vapes — which are sold on the black market and filled with unknown, potentially dangerous additives. Patients who end up with the severest cases have shown damage in the lungs equivalent to the damage seen after industrial accidents, according to a recent analysis by the Mayo Clinic.

However, the early symptoms of the illness look and feel a lot like flu symptoms.

That similarity has led some doctors to worry that cases may be misattributed to flu as flu season nears. In fact that confusion has already happened: One patient, profiled by the Washington Post in August, experienced chest pains, difficulty breathing, and nausea. He actually thought he had the flu before he was eventually diagnosed with a severe case of the vaping-related illness that ultimately placed him on life support.

Sean Callahan, M.D. a pulmonologist at the University of Utah who has treated patients with vaping-related illness confirmed these concerns to Inverse.

“One big diagnostic challenge that’s going to come up is that in the winter when a young person comes in with that constellation of findings — fever, shortness of breath, cough and feeling crummy — a lot of emergency room physicians assume its the flu and move on,” he says. “This year, it’s not going to be that simple.”

dank vapes
Dank Vapes are a black market "brand" that have been tied to the vaping related illnesses. The cartridges are not filled by a single manufacturer, but are filled by unknown dealers across the country and sold under a single brand name. 

What are the symptoms of vaping-related illnesses?

The initial symptoms of vaping-related illness are a combination of breathing symptoms and stomach issues. Of the 53 patients analyzed in a report published September 6 in the New England Journal of Medicine, the most common respiratory symptoms were shortness of breath, cough, and chest pain. The stomach issues included nausea, vomiting, diarrhea and abdominal pain. Generally, the patients had these symptoms for six days before they went to the hospital.

These breathing symptoms, particularly the cough, feel familiar to anyone with the flu, which is also a respiratory illness. But some people with the flu also experience GI symptoms, alongside fevers —though again, not everyone with the flu has a fever. And to complicate matters, some vaping-related patients have reported that they felt like they had fevers too, though only 29 percent of those turned out to be confirmed by doctors.

Callahan notes that, in some cases, the stomach symptoms of the vaping-related illness could help distinguish it from the flu. But that not really sufficient enough, because sometimes those symptoms can appear in both conditions. He adds that, even when lung X-rays are taken, “it’s really hard to see on imaging the difference between the two.”

Essentially, there’s not a foolproof way to diagnose the vaping-related illness at the moment, so there is a chance that it may be misdiagnosed as flu this winter. However, on Friday the CDC released guidelines describing of how to diagnose the illness. Hopefully that can help them tease the two illnesses apart, but the guidelines also say that vaping related illness is a “diagnosis of exclusion.” That means that the only way to tell someone has it, is to confirm that they don’t have something else.

vaping related illnesses, map
States with the most cases of vaping related illnesses as of September 20 2019.

Why vaping-related illness can be deadly

While early symptoms are similar, the outcomes for both illnesses are different in the long run. The flu can be deadly in some cases, but it’s usually not as risky for young and healthy people. Illness linked to vaping, on the other hand, is primarily found among young adults, and the most severe cases progress to a condition called acute respiratory distress syndrome (ARDS). That’s when it becomes life-threatening.

ARDS isn’t a disease as much as it is a consequence of widespread lung illness, like the vaping-related illness. As Callahan explains, it happens when there’s widespread inflammation in the lungs, which can make patients so dangerously short on oxygen that they need immediate medical attention.

The New England Journal of Medicine’s September 6 report found that 15 of 53 patients from Wisconsin and Illinois met criteria for ARDS, and an independent analysis confirmed that at least 9 of those patients definitely had it.

“Part of what I think is happening, is that these patients have severe disease and it just kind of spirals into this syndrome,” Callahan says. “That’s my suspicion, but I can’t prove that for everybody.”

One idea is that some components within vape cartridges are causing widespread inflammation of the lungs that could, in severe cases, lead to this syndrome. That point was recently raised in an analysis co-authored Brandon Larson, Ph.D., a pathologist at the Mayo Clinic who suggested that “one or more toxic substance” lurking in certain vape cartridges could be to blame for that inflammation.

Before vaping-related illnesses reach critical status, it can be easy to mix it up with the flu, for both doctors and patients. What could help clear up the discrepancy is patients telling their doctors whether or not they’ve used a vape (in particular, black market vapes that look like this). The CDC now urges doctors to ask about vaping in regular checkups.

And while there may be a shot to inoculate against the flu, there’s no shot that provides immunity from black market vape cartridges which could be filled all sorts of dangerous additives. They’re still out there on the market, and as flu season nears it could be even more important to steer clear of them.

Read more about black market vaping, and vaping-related illness: