Eighteen-year-old Alex woke up one morning in early May — in a panic.

He was struggling to breathe.

“It was like there was a plug — a plug in my throat — keeping air from getting in,” Alex says. “Every time I tried to take in a breath, there was something stopping it.”

Alex had already been worried that he might have COVID-19. He had been experiencing some of the symptoms, including a cough, fatigue and body aches. 

A few days prior, a doctor on a telemedicine call suggested he give it a day or two, to see if things might improve. Alex isolated himself and waited to feel better.

But he didn’t. He began vomiting. He spiked a high fever. And now, the breathing issue …

His mother rushed him to an emergency center in Lakewood Ranch, where he was promptly put on oxygen. That same afternoon, he was transported by ambulance to Johns Hopkins All Children’s Hospital.

“I had been healthy my whole life,” Alex says. “That was the first time I’d ever been to a hospital. I was pretty freaked out.”

Something else had been weighing on Alex’s mind … his history of vaping. It was something he had picked up earlier in his high school years, a practice that had started as a recreational pastime and eventually spiraled into a habit.

Was it COVID-19 that was making him so sick — or was it because of the vaping?

The answer is yes. Maybe. To both.

The mysteries of the novel coronavirus have forced a steep learning curve in recent months, as the health care community struggles to understand its riddles and combat its sometimes life-threatening manifestations.

One lesson that is becoming more and more clear to pediatric physicians and others … vaping and COVID-19 make a terrible twosome.

“We did believe there was a COVID connection with Alex,” says pediatric pulmonologist Deanna Green, M.D., “because he had much more severe vaping-induced lung injury than we would normally see.”

Because the symptoms of COVID-19 and vaping-induced lung injury can present in such a similar fashion, it can be difficult to try to separate out the two. Like the classic riddle, “Which came first — the chicken or the egg,” physicians often can’t determine whether the vaping started the lung injury first, or if the patient would never have experienced the lung injury had they not been exposed to COVID. 

Doctors do know the two together can make things much worse — but neither one may have presented without the other.

To confound matters, despite several tests for COVID-19, Alex, like some others with vaping-induced lung injury, repeatedly tested negative. 

“It was a significant conundrum for the pulmonary team — and why we were scouring the literature, which also seemed to support our theories,” Green says. “You did not have to actually test positive for COVID to have these severe complications.”

Alex did test positive on many of the inflammatory markers that are present in a condition called multisystem inflammatory syndrome in children (MIS-C), which impacts the lungs, the heart, the brain, the joints, the liver, the GI tract and other functions — something doctors in the New York area began reporting early on in the pandemic. One of the criteria was a positive COVID test at some point.

For Alex, the next 19 days in the hospital would unfold in a hazy, at times painful fog.

About one week into his hospitalization, after he was taken off a ventilator, but still on oxygen, Alex felt an excruciating pain in his right lung.

“It was like an elephant sat on me,” Alex says.

He pushed the call button for help. For good measure, he threw an ice pack at the door of his room — just to ensure he was heard. He knew something was very wrong.

Nurses rushed in and tended to his pain. Scans quickly revealed something called a pneumothorax. Essentially, Alex had a collapsed lung.

Clinical staff helped him with his anxiety as they adeptly inserted a tube in his chest to help him breathe.

“Everybody at Johns Hopkins All Children’s was so helpful and caring,” Alex says. “They always made me feel like, no matter what we faced, we were a team, and we were going to fight through this thing together.”

Eventually, the chest tube was removed. Each day after that, Alex got a little bit stronger. Slowly, he was weaned off the oxygen, and reclaimed his ability to breathe on his own. He was feeling more like himself. He was going to make it out of here.

Alex was motivated to get well by his faith, and by his caring mom, Samina, who stayed by his side through his ordeal. 

But something else moved him. It was the vision he held for a life change he was determined to make. A focus on a new future, which included a healthier, vape-free lifestyle. He would take some business courses and think about culinary school. There were dreams to pursue.

“Vaping may make you feel good in the moment, but you have no idea of the damage it can do,” Alex says. “This experience has really shown me what’s important in life.”

As for those teens who aren’t so sure about the dangers of vaping — just ask Alex. He will tell you about a choice that proved to take so much more from him than it ever offered.