On Friday, U.S. public health officials announced that they are investigating 193 cases this summer of a mysterious, vaping-related respiratory illness which is now responsible for the death of a patient in Illinois. Investigators have not been able to find a common link more specific than vaping among patients, who are coming to emergency rooms in increasingly high numbers.
Officials are unsure if the burgeoning illness is caused by the type of product being vaped, the e-cigarettes themselves, or whether it is due to contaminated or defective black market substances. What they do know is that the symptoms exhibited by patients are consistent with chemical inhalation injuries. In Illinois, where the first death caused by this illness occurred, patients range in age from 17 to 38, according to the state’s health department, and cases have been reported in 22 states in total.
A leading issue in both the growing prevalence of the illness as well as finding solutions is the lack of regulation. There are hundreds of different kinds of vaping devices and ways to get and fill pods with any number of substances. Some experts speculate that users and counterfeiters are filling empty cartridges with homemade products, which makes it harder for the investigation to find commonalities. Because much of it is unregulated, sellers aren’t required to disclose all of the ingredients.
“We’re at a relatively early stage of understanding,” Mitchell Zeller, director of the Center for Tobacco Products at the FDA, told the New York Times. Early theories speculate that the illness might be caused by toxic products that vaporize the nicotine or other inhalants, though this has yet to be proven definitively. According to Brian King, the deputy director of research translation at the Office on Smoking and Health at the CDC, ultrafine particles containing heavy metals such as lead are a concern as well as which chemicals are used in flavor pods.
Vapes and e-cigarettes are already a complicated issue. The market for them is growing rapidly, but companies also face scrutiny for contributing to the rising popularity of such products among teenagers and creating a new generation of smokers. In 2015, the U.S. surgeon general reported that e-cigarette use among teenagers had increased by 900%, with 40% of those never having smoked previously.
Public health officials have not yet released a report on patterns they see among vaping patients. Right now, most investigations are happening on a state level by their respective health departments. The most ill patients have experienced severe lung damage requiring ventilators and oxygen treatments, and some are expected to have permanent lung damage.