The Centers for Disease Control and Prevention (CDC) warned the nation against electronic cigarettes after a cluster of vaping-related lung illnesses.
On Aug. 21, CDC released a media statement alerting people to a string of potential cases of severe lung illness associated with the use of electronic cigarette products, like e-cigarettes, vapes, and Juuls.
As of Sept. 26, the number of confirmed and probable reported cases rose to 805 across 46 states and the U.S. Virgin Islands. There are 12 confirmed deaths in 10 states.
The spiraling healthcare emergency appeared across the country.
In North Carolina, there was a cluster of five cases, according to the CDC’s Sept. 6 press briefing.
All five patients were between the ages of 18 and 35, who were short of breath and suffering from nausea, vomiting, and fevers. Every patient had a history of vaping.
After testing the patients, doctors determined they did not have infections, but showed abnormal chest x-rays. A couple patients eventually needed intensive care. They were diagnosed with lipoid pneumonia — which is when the lungs become inflamed due to the presence of fat particles inside .
On July 10, the Children’s Hospital of Wisconsin recognized another cluster of five patients who reported similar symptoms over a month. They also tested negative for infectious and auto-immune disease, but showed evidence of lung illness. They alerted the Wisconsin Department of Health Services.
From there, the Wisconsin Department of Health Services alerted clinicians on July 20, and notified the Illinois Department of Public Health. They launched a joint investigation on Aug. 1. The CDC began assisting on Aug. 20.
Health officials expanded symptoms of possible severe vaping-related lung illness to include shortness of breath, chest pains, nausea, vomiting, diarrhea, fatigue, fever, and abdominal pain. These symptoms develop over days or weeks.
Out of the patients seen, 98% were hospitalized. Over half of them required intensive care, and 32% needed mechanical ventilation to help breathe.
However, that is where the similarities end.
As of the Sept. 19 conference call between Washington College Health Services and the CDC, 61% of 53 cases from Illinois and Wisconsin reported using e-cigarette products containing nicotine; 80% reported using tetrahydrocannabinol (THC), the chemical in cannabis with psychoactive properties; 7% reported using cannabidiol (CBD), another chemical in cannabis with antipsychotic effects; 37% used only THC; 17% used only nicotine; and 44% used both nicotine and THC, according to Director of Health Services Lisa Marx.
All the products used were of various brands and flavors. However, the CDC notes that exposure data is self-reported, meaning it is limited by patients’ recollections, abilities, and willingness to share information.
In early media speculations, Vitamin E acetate — which Marx said is a substance used in many skin care products and dietary supplements that is not meant to be inhaled — was considered a possible cause of the illnesses.
However, out of 120 samples of products and substances used by patients, there is no single substance identified between all tests, according to Marx.
This rush of illness comes 18 years after the patenting of electronic cigarettes by Chinese pharmacist Hon Lik. While they are still in their technological and scientific infancy, e-cigarettes have become a cultural staple across the globe.
Lik’s e-cigarette was introduced to the Chinese market as a way to stop smoking in 2004, and came to the United States by 2007.
During the early years of e-cigarettes, they were mostly found in mall kiosks and on the Internet, according to the 2009 New York Times article, “Cigarettes without smoke, or regulations.” However, today, they are available in specialized vape shops and even gas stations.
Concerns about e-cigarette safety rose as they became more popular.
E-cigarettes caught the attention of the World Health Organization (WHO) which, in a Sept. 19, 2008 news release, said it did not consider e-cigarettes to be a legitimate therapy for smokers trying to quit. This proclamation was due to lacking scientific evidence to confirm the product’s safety and efficacy.
The Food and Drug Administration (FDA) followed with a similar reaction. They halted importations of e-cigarettes in the summer of 2008, according to the 2009 CNN article “FDA hazy on e-cigarettes’ safety.”
Later, in July 2009, the FDA produced a press release that issued concerns that e-cigarettes would increase nicotine addiction among young people and may contain ingredients that are toxic to humans.
To mitigate their affects, the FDA claimed that e-cigarette products were combination drug device products under the Federal Food, Drug, and Cosmetic Act in 2009.
By 2010, countries began responding to e-cigarettes. Australia became the first country to ban them completely, while other countries, including the U.S., introduced laws to protect consumers.
As their commonality increased, so did health officials’ worries.
There was concern about both the ingredients in vape products and the mechanisms’ safety.
In 2016, there was a rise in reported e-cigarette battery explosions. In the Consumer Report article entitled “E-Cigarette Explosions Are More Common Than Previously Thought, Report Says,” they cite Dr. Elisha G. Brownson — then burn and trauma physician at an emergency room in Seattle — as a first-hand witness to battery explosion-related injuries.
Dr. Brownson and her colleagues cared for 15 patients with vape explosion-related injuries between October 2015 and June 2016. They were caused by the loose battery in the mechanism heating up and blowing out of the cigarette.
Recently, attention has again turned to e-cigarettes because their addictive properties. While they are advertised as alternatives to smoking, the CDC found that in 2015, 40% of 18 to 24-year-old people that vaped were never regular cigarette smokers, prior to e-cigarette use.
Additionally, in 2018, the CDC found that 3.6 million U.S. middle and high school students had used an e-cigarette in the past 30 days. That means the relative percentage of middle schoolers who vaped in 2018 — 4.9% — almost doubled the percentage of adults who vaped in 2017 — 2.8%.
The rates of children using e-cigarette products and the recent rise in possible vaping-related lung illness lead to states passing legislation regulating vaping products.
Some states and Washington, D.C. began raising their tobacco age to 21, according to the Consumer Reports. Michigan banned flavored e-cigarettes in September, and Washington, D.C. proposed a ban on flavored e-cigarettes on Sept. 17.
President Donald Trump held a meeting on Sept. 11 to discuss banning most flavored vape products nationally.
The CDC is still studying e-cigarettes to determine exactly what is making people sick.
For now, the CDC recommends that people using vapes should stop smoking. People using e-cigarettes as an alternative to regular cigarettes should not return to regular cigarettes.
Additionally, if someone that vapes suffers any aforementioned symptom, they ought to contact their primary physician or call poison control at 800-222-1222.
Health Services at WC agrees with the CDC’s recommendations.
“Best advice is not to use any inhaled substances and if you develop symptoms, to see a healthcare provider and provide detailed accurate information about tobacco or vaping product use,” Marx said.
CDC continues to update this case every Thursday.