Sometime between Wednesday and Friday, an Illinois resident died of an unknown respiratory illness that may have been the result of vaping. The death was the result of one of nearly 200 cases of mysterious respiratory problems across 22 states whose only known link is the recent use of electronic cigarettes, or vapes, according to the Centers for Disease Control and Prevention.
The CDC is now working with state health agencies and the Food and Drug Administration to try and find the cause, part of an investigation launched in mid-August after dozens of people, mostly teenagers and young adults, started showing up in hospitals reporting symptoms including difficulty breathing, fatigue, weight loss, and chest pain. That population has increased to 193 cases, all of whom had vaped in the month prior to their illness. Some were smoking nicotine, others THC or cannabinoids. The victims used different products, and no one ingredient stands out as a potential culprit.
“We do know that e-cigarettes do not emit a harmless aerosol,” says Brian King of the CDC’s Office on Smoking and Health. Scientists have already identified a variety of ingredients in e-cigarettes as dangerous, including particulates that contain lead, chemicals that cause cancer, and toxic flavorings. The CDC is now working to identify whether one of these potentially “problematic” agents is to blame for the current outbreak.
The investigation is still in the early stages. Mitch Zeller, director of the FDA’s Center for Tobacco Products, says the FDA is trying to identify the compounds in each product. “That won’t necessarily determine causality, but it’s an important piece of the puzzle,” he says.
When e-cigarettes first came on the market in 2007, the FDA didn’t move to regulate them, even though the Tobacco Control Act gives the administration the authority. Some e-cigarette makers advertised their products as being low-risk or less harmful than regular cigarettes, which are the kinds of claims the FDA is supposed to assess during “pre-market reviews” before something goes on sale.
But that didn’t happen here. Today, any new e-cig products have to be approved before they go on sale. But for products already out there, the deadline for submitting applications for FDA review has been pushed back to 2022.
In the meantime, vaping has become a hugely popular habit, particularly among teenagers. Between 2011 and 2015, vaping among middle- and high schoolers shot up 900 percent. The growth has slowed but continues to trend upward. From 2017 to 2018, rates of high school vaping increased by more than 75 percent. According to the CDC’s most recent studies nearly one in five high schoolers vapes. The US surgeon general has called the ubiquity of teenage vaping an epidemic.
One of the challenges facing anti-vaping advocates is that science progresses slowly, and e-cigarettes can be difficult to study. Nicotine is bad for you, and it’s especially bad for young people whose bodies and brains are still developing. But less clear is how these new vaporizing mechanisms—all of which use different nicotine doses, different solvents, different heating mechanisms, and sometimes different flavoring ingredients—affect humans. Untangling the effects of each component takes time, just as it did when scientists first studied the effects of regular cigarettes.
Public Health England, a UK government agency, has said e-cigarettes 95 percent safer than regular, combustible cigarettes, and one study did show that e-cigarettes are more effective than nicotine-replacement patches or gums at getting people to quit. But a growing body of scientific evidence paints a darker picture.
One study found that smoking e-cigarette vapor, even without nicotine, had an acute and significant negative impact on blood vessels. Other research has associated smoking e-cigarettes with wheezing, emphysema, and increased risk of stroke. The chemicals in the cartridges are also unstable. A flavoring that gives the aerosol a buttery flavor reacts with other ingredients, creating toxins while the cartridges sit on the shelves.
Still, scientists have many outstanding questions. Because the products are relatively new, the long-term effects of extended vaping remain unknown, as do the specifics of how they might affect growing teenage bodies.
Vaping may have been causing respiratory illnesses for years, but the CDC’s investigation is the first attempt to collect, aggregate, and analyze national data. The FDA encourages anyone who has had a health problem related to e-cigarettes to file a detailed report at www.safetyreporting.hhs.gov.