O1041: Inadequate Screening for Adolescents and Young Adults Leads to Unclear Association Between Vaping and Severity of COVID-19 Illness

Background: E-cigarette use (vaping) may cause significant lung injury including chemical pneumonitis and EVALI (e-cigarette vaping associated lung injury). Smoking is associated with more severe COVID-19 symptoms; the link between vaping and COVID-19 is less well-defined.

Methods: We conducted a retrospective chart review of patients, ages 12-30 years, seen outpatient in a designated “suspected COVID” clinic and hospitalized (acute pediatric service or pediatric intensive care unit) during two initial waves of COVID-19 at Stony Brook University Hospital, between February 10, 2020 and September 24, 2020. Outpatient setting: Initial encounters of patients with acute (respiratory or gastrointestinal) symptoms of suspected COVID-19 infection, sent from all Stony Brook outpatient offices. Inpatient: Patients were categorized according to admitting and associated diagnoses, likely (i.e.,with respiratory or gastrointestinal symptoms) or confirmed COVID-19 infection (if testing available). Additional variables included need for respiratory support, associated symptoms, length of stay, need for blood work or imaging. In both settings, positive vaping status (use within 90 days) was noted from a confidential psychosocial questionnaire or as documented elsewhere in the encounter.

Results: 742 patients were included in this preliminary analysis: 504 from outpatient and 238 from inpatient. Demographics were representative of Suffolk County, NY (Table 1). 24/504 (4.8%) of outpatients and 37/238 (15.5%) were diagnosed with COVID-19 infection. Documentation of vaping status was noted in 52.8% of outpatient charts and 23.1% of inpatient charts. Outpatients who were identified as vaping were 5.8% < 18 years, 3.8% 18-21 years and 0.4% > 21 years. Inpatients who were identified as vaping were 12.5% < 18 years, 19.4% 18-21 years, and 13.9% >21 years. Of those seen outpatient, 0.6% were sent to the hospital; 29.4% had follow-up outpatient visits. Four admitted patients were diagnosed with EVALI. In both outpatient and inpatient cohorts, vaping was not associated with COVID-19 positive status or associated symptoms, nor was vaping associated with repeated outpatient visits (Table 2). Inpatient length of stay was 5.7 days (SD 7) overall, 4.1 days (SD 4.5) for those who vaped, and 7.7 days (SD 4.9) for COVID-19 positive patients. No inpatients with suspected or confirmed COVID-19 were also diagnosed with EVALI.

Conclusion: We anticipated vaping status would be associated with increased severity of COVID-19 illness, but found no association in this preliminary analysis. While demographics of those diagnosed with COVID-19 infection were reflective of local and national data from that time period, the prevalence of vaping, particularly in the outpatient setting, was lower than expected, likely due to underreporting and lack of documentation. Further studies are needed to evaluate vaping’s impact on COVID-19 infection severity. Screening and documentation for vaping status must be improved.