The death of the unidentified individual escalates to a new level the sudden emergence of unexplained, serious lung conditions among vapers, most of them young, in 22 different US states.
There were 193 potential cases as of Thursday, according to Ileana Arias, senior scientific advisor and acting deputy director for non-infectious diseases at the Centers for Disease Control and Prevention (CDC). The CDC and Food and Drug Administration (FDA), both federal agencies, are working with authorities in the affected states to track the outbreak and attempt to determine a cause.
“Investigators haven’t identified any product or compound linked to all of the cases,” said Arias. “In many cases patients report a gradual start of symptoms, including breathing difficulty, shortness of breath and/or hospitalisation before the cases. Some have reported gastrointestinal illnesses as well.
“In many cases patients have reported use of THC-containing products while speaking to healthcare professionals in follow-up interviews by health department staff. However, no specific product has been identified in all cases nor has any product been conclusively linked to the illnesses.”
An infectious disease appeared unlikely to be the cause, Arias added.
While vaping seems to be a common factor among most if not all patients, widespread speculation has focused on the possibility that vaping of cannabis products – specifically tetrahydrocannabinol (THC), the psychoactive ingredient that produces a marijuana high – is to blame, rather than commercially available nicotine e-liquids.
However, while acknowledging that THC is under investigation, CDC and FDA officials at a press conference would not be drawn further on what kind of vaping they considered likely to be involved, or on the vaping habits of the affected individuals.
One CDC staffer did mention substances long reputed to pose a risk in mainstream e-liquids; “ultrafine particulates”, “heavy metals like lead”, “cancer-causing chemicals” and diacetyl were all referred to by Brian King, deputy director for research translation in the CDC’s Office on Smoking and Health, although there was no suggestion that they were under particularly intense scrutiny.
Establishing a cause for individual cases remains the responsibility of states. But at a national level, the investigation will include both epidemiological elements, with the CDC helping to identify and track incidents nationwide, and examination by the FDA of products used by (or similar to those used by) affected patients.
“We have received some product samples, and we’re analysing those samples to see whether they contain nicotine, substances such as THC, or other chemicals or ingredients,” said Mitch Zeller, director of the FDA’s Center for Tobacco Products (CTP).
“The results of the testing will be shared with states to aid in their ongoing investigation. FDA is also working to investigate the brand and type of vaping products and devices and whether any of them are products that would fall within FDA’s regulatory authority, as well as where they were obtained.”
Illinois health authorities provided no further details of the death in their state, such as vaping habits or pre-existing conditions, but the department’s health information officer Melaney Arnold confirmed that this is the first fatality. “The severity of illness people are experiencing is alarming and we must get the word out that using e-cigarettes and vaping can be dangerous,” said state public health director Ngozi Ezike.
Illinois reported that 22 people from 17 to 38 years old have been hospitalised with respiratory problems after vaping in the past week and a further 12 are under investigation.
Several states such as Wisconsin, New York and Texas have made announcements in recent days on the issue, and in some cases the lung disease was detected in people using vaping products containing cannabis.
Meanwhile, early signs are also appearing of the outbreak becoming a political issue as well as a public-health one.
“We are paying the price for allowing the public, especially kids, to be guinea pigs in a giant experiment by a predatory industry. These vaping-related illnesses are occurring at the same time that e-cigarette manufacturers are continuing their irresponsible legal battle to delay FDA public health review,” said Matthew Myers, president of the lobbying group Campaign for Tobacco-Free Kids.
What This Means: Authorities in Illinois, at the CDC and elsewhere are now making a clear linkage between vaping and an unknown condition that has killed a person as well as affecting many more. This has all the potential to be a major crisis in the making for the vaping industry and community, but while the causes of the condition remain so uncertain, it is equally unknowable how far that potential will develop into actuality.
– David Palacios and Barnaby Page ECigIntelligence staff